Is there a 'universal' core? Using semantic primes to select vocabulary across languages in AAC.

Core vocabulary lists and vocabulary inventories vary according to language. Lists from one language cannot and should not be assumed to be translatable, as words represent language-specific concepts and grammar. In this manuscript, we (a) present the results of a vocabulary overlap analysis between different published core vocabulary lists in English, Korean, Spanish, and Sepedi; (b) discuss the concept of universal semantic primes as a set of universal concepts that are posited to be language-independent; and (c) provide a list of common words shared across all four languages as exemplars of their semantic primes. The resulting common core words and their corresponding semantic primes can assist families and professionals in thinking about the initial steps in the development of AAC systems for their bilingual/multilingual clients.

Teaching South African center-based caregivers to implement augmentative and alternative communication strategies.

In South Africa, many children with extensive support needs-including children who require AAC-are accommodated in care centers rather than the public schooling system. Caregivers employed at these centers need training in order to support children's communication using augmentative and alternative methods. A total of 29 center-based caregivers took part in this study. A single group pretest-posttest design was used to evaluate the effect of a 5-day training workshop on caregivers' ability to demonstrate and implement five AAC strategies. The effect of the workshop on caregivers' perceptions of their own skills as well as the social validity of the training were also evaluated. Results suggest that the workshop effectively taught caregivers to demonstrate the skills in a simulated roleplay situation. A proportion of caregivers also supplied video footage after the workshop that suggests the ability to implement the strategies in the care center contexts. Caregivers also perceived their own skills to have improved post workshop, and evaluated the training positively.

Stakeholder validation of a Sepedi core vocabulary list as a resource for augmentative and alternative communication.

PURPOSE: The development of culturally and linguistically appropriate resources to support communication interventions for underserved communities is an urgent necessity. The purpose of the study was to obtain stakeholder feedback on vocabulary items from a Sepedi core vocabulary list developed as a resource for vocabulary selection for augmentative and alternative communication (AAC) systems, and to expand the list based on stakeholders' vocabulary recommendations. METHOD: A questionnaire was used to obtain the ratings of 57 stakeholders regarding the importance of including 155 Sepedi words from the Sepedi core vocabulary list on an AAC system for a child with receptive language skills at the level of a 4-year-old or higher. Stakeholders also suggested additional words to include on the system. RESULT: All words were rated as important or very important. However, there was a statistically significant inverse relationship between the average frequency of occurrence of words belonging to a specific category and the average importance rating that stakeholders assigned to words in that category. A total of 48 words were additionally suggested by three or more stakeholders. CONCLUSION: Stakeholder ratings validated the list as relevant to consult in vocabulary selection for Sepedi AAC systems for children. Stakeholder-suggested words may be a useful supplement to this list.

Communication strategies to support decision-making by persons with aphasia: A scoping review.

BACKGROUND: An individual's ability to make autonomous decisions is fundamental to self-determination. The presence of neurological pathology, for example, aphasia, and its associated difficulties with language and/or cognition, may affect an individual's capacity to make decisions, or their ability to reveal their capacity to make decisions. Decision-making by persons with aphasia (PWA) can be enhanced when communication partners are trained and if communication supports are provided, for example, supports that reduce the linguistic and cognitive demands of the task, and/or that facilitate expression. AIMS: The main aim of this review is to identify the types of decisions for which persons with post-stroke aphasia receive support, the communication partners involved in supporting decision-making by PWA and the communication strategies implemented to support decision-making by PWA. METHODS & PROCEDURES: A multifaceted search strategy was used. Specific keywords were used to search seven electronic databases. Hand-searches of two journals, as well as ancestral searches of the reference lists of selected articles was also performed. Through the application of predefined selection criteria, 16 journal articles, spanning from 1998 to 2021, were selected from the initial yield of 955 articles for inclusion in this review. Data pertaining to the aims of the study were extracted using a data-extraction form. OUTCOMES & RESULTS: This review shows that most of the research to date has focused on supporting persons with post-stroke aphasia in decisions pertaining to discharge planning or accommodation, and decisions pertaining to informed consent for participation in research. The communication partners cited most frequently as supporting decision-making by PWA are speech-language pathologists and family members. A range of communication strategies, most of which are components of Supported Conversation Techniques for Adults with Aphasia (SCA™), support decision-making by PWA. The most frequently listed strategies include augmenting information with different modalities, acknowledging the competence of the PWA, thereby inviting initiation and collaboration by the PWA, and the allocation of sufficient time for the decision-making process. CONCLUSIONS & IMPLICATIONS: This review presents research trends regarding the support of PWA in decision-making. Future research should focus on the effectiveness of the different strategies identified, and on the support of PWA in the making of a greater variety of complex decisions. WHAT THIS PAPER ADDS: What is already known on the subject PWA have the right to be given the opportunity to participate in personally relevant decision-making through all stages of life. Research has shown that decision-making can be enhanced with trained communication partners and if supports are provided that reduce the linguistic and cognitive demands of the task, and that support the expressive abilities of PWA. What this study adds to existing knowledge This scoping review is the first to synthesize the findings of research regarding the types of decisions for which persons with post-stroke aphasia receive support, the communication partners supporting PWA in making these decisions and the communication strategies implemented to support decision-making by PWA. What are the potential or actual clinical implications of this work? Clinicians working with PWA may be sensitized to the role they can play in supporting decision-making by PWA, the current state of the literature regarding types of decisions that may need to be supported, communication partners who can provide such support and communication strategies that may be helpful in this regard.

Learning graphic symbols in two languages: Effects of monolingual teaching.

PURPOSE: Limited research exists to guide augmentative and alternative communication (AAC) intervention for children from multilingual backgrounds. When a graphic symbol-based AAC system is provided to children, they need to learn the meaning of the graphic symbols. This study determined the effect of teaching the association between a graphic symbol and a spoken word in one language on the ability of bilingual children without disabilities to transfer this learning to their second language. METHOD: A one-group pre-test-post-test design was used. The ability of 30 English-Afrikaans bilingual children aged 4-5 years to provide the spoken words associated with nine graphic symbols in English and Afrikaans was evaluated before and after teaching them the symbol-word associations in English. RESULT: Correct symbol-word associations in English increased from a median of 0-9 post-teaching, while correct symbol-word associations in Afrikaans increased from a median of 0-6. A moderate positive relationship was identified between children's performance on symbol-word associations in Afrikaans during the post-test and their use of Afrikaans in the home. CONCLUSION: Results suggest the presence of positive transference of graphic symbol-word associations learnt in one language to another known language. The implications of this finding on the provision of multilingual AAC intervention are discussed.

The Sustainable Development Goals: A framework for addressing participation of persons with complex communication needs in South Africa.

BACKGROUND: Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa. PURPOSE: This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa. RESULT: Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs. CONCLUSION: The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society.

Health information and education needs for youth with complex communication needs during the Covid-19 pandemic: rehabilitation professionals' perspectives.

PURPOSE: The worldwide Covid-19 pandemic has highlighted inequities faced by persons with complex communication needs (CCN) in accessing health information and education. This study reports on the perspectives of South African rehabilitation professionals regarding access to health information and education for youth with CCN. MATERIALS AND METHODS: Two asynchronous online written focus groups were conducted with 15 rehabilitation professionals. Participants' contributions were thematically analysed. RESULTS: Participants reported that youth with CCN faced a variety of challenges when accessing health information, related, amongst others, to the format and quality of the information. Participants reported on strategies they had successfully used to support comprehension of health information and the youth's communication during healthcare encounters. Participants suggested various Covid-19-related and general health topics of value to youth, as well as a variety of multimodal and multilingual presentation formats to make health information accessible. This information was used in the development of accessible health information resources that are now freely available on the authors' institutional website. CONCLUSIONS: The results confirmed that there is an urgent need to make accessible health information available in order to include South Africans with CCN in health services during the pandemic and beyond. Implications for rehabilitationHealth information and education (including information and education provided with respect to the Covid-19 pandemic) has often not been accessible to youth with complex communication needs (CCN).South African rehabilitation professionals reported on a variety of challenges that youth with CCN face when attempting to access health information and education, but also reported on strategies that had helped to support them in this.They also highlighted Covid-19-related and general health topics that would be of value to youth, and suggested a variety of information formats and strategies to make health information more accessible.This information can assist in the design of appropriate and accessible health information resources for youth with CCN and other individuals who experience communication challenges.

Perspectives of rehabilitation professionals on assistive technology provision to young children in South Africa: a national survey.

PURPOSE: Various factors influence the selection of assistive technology for young children within a context with limited resources, such as South Africa. Rehabilitation professionals are required to weigh up different factors as part of their professional reasoning process when making assistive technology (AT) selections. Insight into the perceived influence of different factors may assist in understanding how professionals make decisions about AT in this context. MATERIALS AND METHODS: An online survey with questions designed using best-worst scaling was distributed to rehabilitation professionals throughout South Africa. Factors influencing assistive technology selection included in the best-worst survey were identified in previous phases of a larger project. A total of n = 451 rehabilitation professionals completed the survey by selecting the factors that were most and least influential on their assistive technology provision. RESULTS: Results of the survey were obtained by calculating the number of times each factor was selected as most influential across the entire sample, and across all questions, enabling the researchers to sort the items in terms of the frequency of selection. CONCLUSIONS: Even though the rehabilitation professionals that participated in the study provide services in a context with limited resources, assessment and factors pertaining to the assistive technology itself were generally perceived to be of greater influence than environmental factors. It is recommended that these factors be reflected in frameworks and models of AT selection.IMPLICATIONS FOR REHABILITATIONThe family's ability to support the implementation of AT is an important resource that is perceived to influence the selection of AT by an RP.Insight into the mind-set of professionals that are used to selecting AT within settings with limited resources may provide RPs in well-resourced contexts with guidance on how to do more, with less.RPs should aim to determine child preference and attitude towards AT during the AT selection process.RPs should be aware of their own influence on AT selection. Existing AT Selection models should be adapted to clearly reflect the influence of the recommending professional.

Designing electronic graphic symbol-based AAC systems: a scoping review. Part 1: system description.

PURPOSE: This is the first of two papers summarizing studies reporting on the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems, to determine the state of the field. The aim of this paper was to provide an overview of the general characteristics of the studies and to describe the features of the systems designed. METHODS: A scoping review was conducted. A multifaceted search resulted in the identification of 28 studies meeting the selection criteria. Data were extracted relating to four areas of interest, namely (1) the general characteristics of the studies, (2) features of the systems designed, (3) availability of the systems to the public, and (4) the design processes followed. In this paper, findings relating to the first three areas are presented. RESULTS: Most study authors were affiliated to fields of engineering and/or computer science and came from high-income countries. Most studies reported the design of AAC applications loaded onto mobile technology devices. Common system features included customizable vocabulary items, the inclusion of graphic symbols from both established AAC libraries and other sources, a dynamic grid display, and the inclusion of digital and/or synthetic speech output. Few systems were available to the public. CONCLUSIONS: Limited justifications for many of the complex design decisions were provided in the studies, possibly due to limited involvement of rehabilitation professionals during the design process. Furthermore, few studies reported on the design of graphic symbol-based AAC systems specifically for middle- and low-income contexts and also for multilingual populations.Implications for rehabilitationComplex design decisions about electronic graphic symbol-based augmentative and alternative communication (AAC) systems should be made purposefully and with sufficient justification.Increased collaboration between designers and rehabilitation professionals during the design of electronic graphic symbol-based systems could improve the products.Design of AAC systems for populations residing in low and middle-income contexts and also for multilingual populations are urgently needed.

Designing electronic graphic symbol-based AAC systems: a scoping review. Part 2: application of human-centred design.

PURPOSE: This is the second of two papers summarizing studies reporting on the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems. The aim of this paper was to describe the design approaches used and to determine to what extent the principles of human-centred design (HCD) were reflected in the design approaches and processes used. METHODS: A scoping review was conducted. A multifaceted search resulted in the identification of 28 studies meeting the selection criteria. Data were extracted relating to four areas of interest, namely, (1) the general characteristics of the studies, (2) features of the systems designed, (3) availability of the systems to the public and (4) the design processes followed. In this paper, findings related to the last area are presented. RESULTS: Design approaches were often inconsistently described. User-centred design was mentioned more often than HCD. Even so, various HCD principles were considered in most studies. Notably, stakeholders were involved in the design process in all studies. However, users were not involved in all studies and stakeholder roles were predominantly informative rather than collaborative. Prototype and product evaluations focussed mostly on usability rather than user experience. Although many design teams were multidisciplinary, engineers and computer scientists predominated. CONCLUSIONS: There is a need for designers to be more transparent about the type of design approach used to guide the system design and also to clearly report on design approaches and processes used. The application of HCD to the design of graphic symbol-based AAC systems is still limited.Implications for rehabilitationHuman-centred design approaches can productively guide the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems.Creative methods are needed to involve stakeholders with complex communication needs in all phases of the design process.Evaluation of electronic graphic symbol-based AAC systems should consider both usability and user experience.

The involvement matrix as a framework for involving youth with severe communication disabilities in developing health education materials.

INTRODUCTION: Involving youth with severe communication disabilities in health research is foregrounded in a perspective of rights and participation. Researchers aligned with a participatory and inclusive research agenda recommend that involving youth in health research should be a deliberate and well-planned process. However, limited examples exist of how researchers can facilitate the involvement of youth with severe communication disabilities in research projects. METHOD: The aim of this paper was to describe the application of the Involvement Matrix as a conceptual framework to guide the three phases of a research project with youth with severe communication disabilities. RESULTS: Six youth aged 19-34 years consented to be involved in the project. All youth had a severe communication disability and used augmentative and alternative communication (AAC) to support their involvement in the research project. The Involvement Matrix provided a structure to delineate four involvement roles in three research phases: In Phase 1, youth were listeners to research information and advisors in the needs analysis. In Phase 2, as advisors and decision-makers, youth provided their opinions on selecting picture communication symbols for health materials. In Phase 3, as partners, they were copresenters at an online youth forum. CONCLUSION: The Involvement Matrix was used to plan and implement the involvement of youth with severe communication disabilities in codeveloping health materials for use during the COVID-19 pandemic. The Involvement Matrix can be applied together with AAC to enable meaningful involvement of youth in a health research project as listeners, advisors, decision-makers and partners. PATIENT OR PUBLIC CONTRIBUTION: This study project was codeveloped with youth with severe communication disabilities who use AAC in South Africa. A person with lived experience was involved as an advisor to the health material development process and in the drafting of the manuscript.

Determining the core vocabulary used by Sepedi-speaking children during regular preschool activities.

PURPOSE: In order to provide equitable communication intervention and support services to clients from diverse cultural and linguistic backgrounds, the development of language-specific resources for assessment and intervention is needed. The purpose of the study was to develop a core vocabulary list based on language samples from Sepedi-speaking children, in order to make it available as a resource to inform vocabulary selection for augmentative and alternative communication (AAC) systems for children in need of AAC from a Sepedi language background. METHOD: The speech of six typically developing Sepedi-speaking children aged 5-6 years was recorded using small body-worn audio recording devices. Children were recorded during their regular pre-school day. The recordings were transcribed, coded and analysed. RESULT: The composite transcript consisted of 17 579 words, of which 1023 were different words. The core vocabulary was determined by identifying all words that were used with a minimal frequency of 0.05%, and were used by at least half of the participants. The Sepedi core vocabulary consisted of 226 words that accounted for 88.1% of the composite sample. CONCLUSION: The core vocabulary determined in this study represents a small pool of reusable linguistic elements that form the grammatical framework of the Sepedi language. As such, is a valuable resource that can be used to assist with vocabulary selection for children who require AAC and who come from a Sepedi language background.

Multilingualism and augmentative and alternative communication: examining language ideology and resulting practices.

Although the literature suggests that multilingual augmentative and alternative communication (AAC) interventions hold benefits for children from multilingual backgrounds, there is little guidance on how such interventions can be implemented. While various barriers to this process have been noted, language ideology has not received much attention in the AAC literature. This paper aims to highlight multilingualism as both a linguistic and a sociopolitical phenomenon. An awareness of the influence of language ideology on AAC practice may lead to more considered and reflective approaches when supporting multilingual clients and their families. A description of the multilingual experience is followed by a discussion of language ideologies and views of multilingualism and how these may translate into AAC practices. Through a series of questions, AAC practitioners are encouraged to reflect on the influence of language ideology on their practices. The influence of language ideology on the legal and policy context, service models, and family language practices and choices is then explored. By situating AAC interventions for children from multilingual backgrounds within a macrosystemic and ideological framework, researchers and practitioners may be able to identify not just constraints on but also opportunities for providing person- and family-centered intervention.

The core vocabulary of South African Afrikaans-speaking Grade R learners without disabilities.

BACKGROUND: Augmentative and alternative communication (AAC) can enable individuals with little or no functional speech to communicate functionally in a variety of communication contexts. AAC systems for individuals who are not (yet) fully literate often require that the vocabulary for the system be preselected. By including the most commonly- and most frequently-used words (core vocabulary) in an AAC system, access to novel utterance generation can arguably be facilitated. At present, no Afrikaans core vocabulary list based on children's speech samples exists. OBJECTIVES: This study aimed to identify the most frequently- and commonly-used words of South African Afrikaans-speaking Grade R learners without disabilities. METHOD: Spontaneous speech samples were collected from 12 Afrikaans-speaking Grade R learners during regular preschool activities. Samples were transcribed and analysed to determine the number of different words used, the frequency with which each word was used, as well as the commonality of word use across the 12 participants. RESULTS: A total of 239 words met the criteria for inclusion in the core vocabulary (words used with a frequency of more than 0.05% in the sample, and used by at least half of the participants). These words accounted for 79.4% of words used in the entire speech sample. CONCLUSION: The established core vocabulary consists of a relatively small set of words that was found to represent a large proportion of speech. AAC team members may consider including these words on Afrikaans AAC systems that are intended to give access to a measure of novel utterance generation.

Determining a Zulu core vocabulary for children who use augmentative and alternative communication.

Vocabulary selection is an important aspect to consider when designing augmentative and alternative communication (AAC) systems for children who have not yet developed conventional literacy skills. AAC team members have used core vocabulary lists (representing words most commonly and frequently used by speakers of a natural language) as a resource to assist in this process. To date, there are no core vocabulary lists for Zulu. Therefore, the aim of this study was to identify the vocabulary most frequently and commonly used by Zulu-speaking preschool children, in order to inform vocabulary selection for peers who use AAC. Communication samples from 6 Zulu-speaking participants without disabilities were collected during regular preschool activities. Analyses were conducted both by orthographic words and by morphological analysis of formatives. Due to the linguistic and orthographic structure of Zulu, an analysis by formatives was found to be more useful to determine a core vocabulary. The number of different formatives used, frequency of use, and commonality of use among the participants were identified. A total of 213 core formatives were identified; core formatives related to language structure were used more frequently than those that related to lexical content. The characteristics of this Zulu core vocabulary were consistent with those of core vocabularies established in other languages. Implications for the design of Zulu AAC systems are discussed.

Multilingualism and augmentative and alternative communication in South Africa - Exploring the views of persons with complex communication needs.

BACKGROUND: Augmentative and alternative communication (AAC) can assist persons with complex communication needs to communicate competently with a variety of communication partners in a variety of contexts. However, AAC systems and intervention often do not take multilingual aspects into consideration. OBJECTIVE: This small-scale exploratory study had three aims, namely: (1) to describe the self-reported language skills of multilingual South African adults using AAC, (2) to describe the languages and communication modalities they used in interaction and (3) to obtain their views regarding access to various languages. METHODS: Twenty-seven adults using AAC were recruited via an empowerment programme, as well as an email list for persons interested in AAC, and provided responses to a questionnaire. To compensate for access and written language challenges, the questionnaire was administered with help and/or as a face-to-face interview where needed. Responses were analysed using mostly descriptive statistics. RESULTS: Participants generally could not express themselves in all the languages they understood and were regularly exposed to. Speech-generating devices specifically gave access almost exclusively to English. Participants expressed a desire to increase their expressive language repertoire, and mentioned both limitations of communication technology as well as their own literacy skills as barriers to overcome in this regard. CONCLUSION: In order for multilingual South African adults using AAC to express themselves in multiple languages, appropriate AAC systems and interventions as well as literacy learning opportunities need to be developed and provided. KEYWORDS: adult, augmentative and alternative communication; multilingualism; complex communication needs, language and communication skills; self-report, views.

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals.

Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group. METHOD: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context. DATA ANALYSIS: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes. DISCUSSION: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa. Implications for rehabilitation Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process. Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources. Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals. Home and school visits during assessment ensure a good match between assistive technology and users within the particular context. Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

Adapting and translating the Mullen Scales of Early Learning for the South African context.

BACKGROUND:  South African speech-language therapists have identified the need for culturally valid and sensitive assessment tools that can accommodate multiple languages and cover a reasonable age range. The Mullen Scales of Early Learning (MSEL) extend from birth to 68 months, contain five separate subscales including receptive language, expressive language, gross motor, fine motor and visual reception scale, are straightforward to administer and have been successfully used in other African countries, such as Uganda. It also identifies a child's strengths and weaknesses and provides a solid foundation for intervention planning. OBJECTIVES:  This research aimed to demonstrate the appropriateness and usefulness of the translated and culturally and linguistically adapted MSEL across four South African languages (Afrikaans, isiZulu, Setswana and South African English) through two sub-aims: (1) to describe differences, if any, in MSEL performance across language groups and (2) to describe differences, if any, in MSEL performance between age groups. METHOD:  A total of 198 typically developing children between the ages of 21 and 68 months spread across the four language groups were individually assessed with the culturally and linguistically adapted and translated MSEL. RESULTS:  A one-way analysis of variance (ANOVA) showed no statistically significant differences between the four language groups for total MSEL scores. A Welch's one-way ANOVA showed that the total MSEL scores were significantly different between age groups. CONCLUSION:  The translation and adaptation of the MSEL was successful and did not advantage or disadvantage children based on their home language, implying that linguistic equivalence was achieved. The MSEL results differed between age groups, suggesting that the measure was also successful in differentiating the performance of children at different developmental levels.

AAC services for multilingual populations: South African service provider perspectives.

BACKGROUND: In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. AIMS: The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. METHODS & PROCEDURES: Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. OUTCOMES & RESULTS: Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. CONCLUSIONS & IMPLICATIONS: Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics.

Language Assessment for Children With a Range of Neurodevelopmental Disorders Across Four Languages in South Africa.

Purpose: The purpose of this study is (a) to examine the applicability of a culturally and linguistically adapted measure to assess the receptive and expressive language skills of children with neurodevelopmental disorders (NDDs) in South Africa and then (b) to explore the contributions of 2 additional language measures. Method: In Part 1, 100 children with NDD who spoke Afrikaans, isiZulu, Setswana, or South African English were assessed on the culturally and linguistically adapted Mullen Scales of Early Learning (MSEL). Clinicians independently rated the children's language skills on a 3-point scale. In Part 2, the final 20 children to be recruited participated in a caregiver-led interaction, after which the caregiver completed a rating scale about their perceptions of their children's language. Results: Performance on the MSEL was consistent with clinician-rated child language skills. The 2 additional measures confirmed and enriched the description of the child's performance on the MSEL. Conclusions: The translated MSEL and the supplemental measures successfully characterize the language profiles and related skills in children with NDD in multilingual South Africa. Together, these assessment tools can serve a valuable function in guiding the choice of intervention and also may serve as a way to monitor progress.