CLINICAL REPORT Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication

This clinical report defines common terms of use and provides information on current practice, research, and limitations of assistive technology that can be used in systems for communication. The assessment process to determine the best devices for use with a particular child (ie, the best fit of a device) is also reviewed. The primary care pediatrician, as part of the medical home, plays an important role in the interdisciplinary effort to provide appropriate assistive technology and may be asked to make a referral for assessment or prescribe a particular device. This report provides resources to assist pediatricians in this role and reviews the interdisciplinary team functional evaluation using standardized assessments; the multiple funding opportunities available for obtaining devices and ways in which pediatricians can assist families with obtaining them; the training necessary to use these systems once the devices are procured; the follow-up evaluation to ensure that the systems are meeting their goals; and the leadership skills needed to advocate for this technology. The American Academy of Pediatrics acknowledges the need for key resources to be identified in the community and recognizes that these resources are a shared medical, educational, therapeutic, and family responsibility. Although this report primarily deals with assistive technology specific for communication impairments, many of the details in this report also can aid in the acquisition and use of other types of assistive technology. Pediatrics 2008;121:1271–1280 BACKGROUND Communication skills are ranked as the concern of highest priority for adults with physical disabilities and, therefore, should be of paramount importance for children with impaired communication and their families.1 Nearly 5 million children in the United States (approximately 15%) have some type of disabling condition.2 Among children with disabilities who are attending school, 20% have significant communication impairments that are not attributable to impaired hearing.3 Conditions that can cause communication impairment include cerebral palsy, autism spectrum disorders, traumatic brain injury, and several genetic syndromes (eg, DiGeorge syndrome). Many children and youth with special health care needs can improve day-to-day functioning with the aid of assistive technology, including alternative or augmentative technology. “Assistive technology,” the more general term, describes systems and devices that help alleviate the effects of a disability and, thus, improve function. An example is the use of orthotics (braces) for a child who has L4 paraplegia attributable to spina bifida. “Alternative technology” substitutes for functional impairments related to a disability (eg, adapted power wheelchairs for children who have quadriplegia). Lastly, “augmentative devices” are those that augment a deficient area of functioning but for which residual abilities remain. An example of this would be an electronic voice-output communication aid (VOCA), sometimes called a speech-generating device (SGD), to be used for a child who has dysarthria attributable to cerebral palsy. In this situation, although natural speech may be somewhat understood by family members, it is augmented when communicating with people who are less familiar with the child. The most common context for alternative and augmentative systems is in the field of speech-language pathology (eg, augmentative/alternative communication [AAC] systems). According to an analysis of data from the National Survey of Children With Special Health Care Needs, approximately 2.1% of children and youth with disabilities have a need for “communication aids or devices”—AAC systems.4 The data also revealed that the needs for communication aids and devices were unmet for approximately 25% of these children. www.pediatrics.org/cgi/doi/10.1542/ peds.2008-0695 doi:10.1542/peds.2008-0695 All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.