# Why Parents Abandon AAC Devices (and What Makes Them Stick) **Deep Research Report — March 30, 2026** **Domain: AAC Adoption, Abandonment, and Sustained Use** **Purpose: Inform QuickChat AAC design decisions to beat the ~60% first-year abandonment rate** --- ## Executive Summary AAC device abandonment is the single largest failure mode in the field. Approximately 60% of AAC systems are abandoned within the first year of implementation (Johnson et al., 2006). Broader assistive technology research places the overall non-use rate at approximately 30% sustained over the past three decades (Scherer, 2014), but AAC-specific rates are consistently higher due to the compound complexity of communication technology. This report synthesizes research across 11 dimensions of AAC abandonment and adoption, with design implications for QuickChat AAC at the end of each section. The goal is not just to understand why families abandon AAC, but to identify the specific, addressable failure points where an app can intervene. --- ## Table of Contents 1. [AAC Abandonment Statistics](#1-aac-abandonment-statistics) 2. [Parent/Caregiver Barriers](#2-parentcaregiver-barriers) 3. [The "It Won't Work for My Child" Belief](#3-the-it-wont-work-for-my-child-belief) 4. [SLP Role in Adoption](#4-slp-role-in-adoption) 5. [Device Complexity and Abandonment](#5-device-complexity-and-abandonment) 6. [Technology Adoption Models Applied to AAC](#6-technology-adoption-models-applied-to-aac) 7. [Success Stories and What They Share](#7-success-stories-and-what-they-share) 8. [The First Week](#8-the-first-week) 9. [Cultural and Socioeconomic Factors](#9-cultural-and-socioeconomic-factors) 10. [App-Specific vs. Device-Specific Abandonment](#10-app-specific-vs-device-specific-abandonment) 11. [What Parents Actually Want](#11-what-parents-actually-want) --- ## 1. AAC Abandonment Statistics ### The Numbers The most-cited abandonment statistic comes from Johnson, Inglebret, Jones, and Ray (2006): **fewer than 40% of participants continued to use their AAC device 12 months after implementation.** This translates to a 60%+ abandonment rate within the first year. Other key data points: - **30-50%** of AAC users abandon or under-use their devices across populations (Frontiers in Psychiatry, 2024 multi-stakeholder study) - **One-third** of all assistive technology is abandoned even when well-designed and functional (Scherer, 2014 — a figure that has remained stable for 30 years) - **Three out of five** AAC apps and devices are "abandoned and left on a shelf within a year" (Medbridge, citing cumulative research) ### Abandonment by AAC Type | AAC Type | Approximate Abandonment Rate | Key Factors | |----------|------------------------------|-------------| | High-tech SGDs (dedicated) | 40-50% | Weight, complexity, repair delays, stigma of "medical" appearance | | High-tech apps (iPad-based) | 50-60% | Distraction (iPad as toy), setup overwhelm, lack of structured support | | Low-tech (PECS, boards) | 30-40% | Physical degradation, limited expressiveness, effort to maintain/update | Note: These are approximate ranges synthesized from multiple sources. No single study has done a clean head-to-head comparison across all three types with controlled populations. ### Populations Most at Risk - **Families of autistic children** report the highest abandonment rates, with user engagement rated as a top-3 barrier by 100% of parent-carers surveyed (vs. 30% of educators, 27% of clinicians) (PMC, 2024) - **Families without regular SLP support** abandon at higher rates than those with ongoing professional guidance - **Children introduced to AAC late** (after establishing alternative communication strategies like pointing, pulling, tantruming) resist device adoption because they already have "established pretty effective means of communicating" - **Low-income families and families of color** experience compounding barriers (see Section 9) ### When Abandonment Happens The research does not identify a single abandonment cliff, but the pattern is: 1. **Week 1-2**: Initial novelty wears off. If no "quick win" (child uses device to get something they want), motivation drops sharply. 2. **Month 1-3**: The "effort valley." Parents are past the excitement of a new device but haven't seen enough progress to justify the daily work of modeling and integration. This is the primary kill zone. 3. **Month 6-12**: Slow attrition. Device use becomes inconsistent, then stops. Often coincides with a life change (new school year, new therapist, device breaks). ### Reported Reasons for Abandonment (Ranked by Frequency) Based on synthesis across multiple studies (Johnson et al., 2006; Frontiers in Psychiatry, 2024; PMC meta-synthesis, 2022): 1. **Poor usability / high learning demands** — the device is too hard to learn or use effectively 2. **Lack of family involvement** — caregivers were not part of the selection or training process 3. **Insufficient professional support** — SLP turnover, inadequate training, no follow-up after initial setup 4. **Child disengagement** — the child won't use it, prefers other communication methods, or treats it as a toy 5. **Device doesn't fit the child** — wrong vocabulary, wrong access method, sensory overwhelm, too many icons 6. **Parent emotional readiness** — grief, denial, or feeling overwhelmed by the implications of AAC 7. **Cost and maintenance burden** — expensive equipment, fear of damage, slow repairs 8. **Social stigma** — device marks the child as "disabled" in public settings 9. **Communication partners can "understand" without it** — family members interpret gestures/behavior, removing incentive 10. **Lack of coordination across settings** — home, school, therapy using different systems or none at all ### Design Implications for QuickChat AAC - **The first 2 weeks are make-or-break.** The app must deliver a visible, emotionally meaningful "first communication" moment within the first few sessions. This is not optional. - **Month 1-3 is the effort valley.** The app needs built-in mechanisms to sustain parent motivation through this period: progress tracking, celebration of milestones, gentle nudges, and low-effort daily integration suggestions. - **Simplicity at first launch is critical.** The #1 abandonment reason is "too hard." QuickChat's scene-based navigation and limited initial vocabulary are directly addressing this. - **The app must be designed for the FAMILY, not just the child.** Family involvement is the #2 predictor of success. Every design decision should ask: "Does this make it easier or harder for the family to use this together?" --- ## 2. Parent/Caregiver Barriers ### The Barrier Landscape A 2022 systematic review and qualitative meta-synthesis (PMC, 19 studies, 297 parents) and a 2024 multi-stakeholder study (Frontiers in Psychiatry, 30 participants) identify consistent barriers: #### Tier 1: Most Common (Reported by >70% of parents) **Fear that AAC will prevent speech development** - This is the single most pervasive parent concern, despite unequivocal research refuting it - Millar, Light, and Schlosser (2006) meta-analysis: 27 studies, vast majority showed speech INCREASE after AAC. Zero showed decrease - A 2024 review found 89% of cases demonstrated gains in speech production alongside AAC use - Parents report professionals (including some doctors and older-school SLPs) reinforcing this fear: "If you only use this they will not verbalize" - This fear is particularly strong in families where the child has some speech, creating a "why risk it" mentality **Feeling overwhelmed** - "Introducing an AAC device amidst daily stressors like managing household responsibilities or financial worries can feel overwhelming" - Parents describe AAC as "one more thing" on top of multiple therapies, medical appointments, and daily caregiving demands - The systematic review found most parents "experienced difficulties finding time to support their child's use of AAC and felt that the use of AAC increases demands on their time" - Coordinating services for evaluation, procurement, training, and monitoring is described as "confusing and overwhelming" **Lack of training and confidence** - Parents consistently report feeling unprepared to use devices - Parents who abandoned devices despite initial commitment "likely did not feel they had the necessary training to encourage communication opportunities and implement their child's device" - Training is often one-time, at the point of device delivery, and insufficient - Parents need verbal, written, AND hands-on training methods — a single modality is not enough #### Tier 2: Common (Reported by 40-70% of parents) **Device complexity** - Over 80% of Proloquo2Go users do not follow the recommended setup process - 40% of Proloquo2Go users choose fewer than 20 buttons per page, limiting communication potential because the full layout is too overwhelming - Parents describe "big learning curve in navigation and learning how to customize things" - Users report being "overwhelmed by vocabulary being in different places, navigating through a variety of buttons" **Social stigma** - Peers and extended family avoid communication with AAC users due to "perceived disability signaling" - Parents report that "no one comes" to play dates when AAC devices are involved - Children spend most communication time with adults, rarely with same-age peers - AAC in public draws unwanted attention and marks the child as different **Cost and maintenance anxiety** - SGDs cost $5,000-$15,000; even iPad apps run $250-$300 plus the iPad itself - One parent described receiving "this eleven and a half thousand dollar machine, and nobody in [the state] could give me any kind of support" - Fear of damage penalties leads some schools to restrict children's AAC access - Insurance and funding processes are byzantine and demoralizing (see Section 10) #### Tier 3: Significant but Less Discussed (Reported by 20-40% of parents) **Grief and emotional readiness** - If AAC is a child's first speech device, "parents may be experiencing some degree of denial or grief that they must move through in order to be ready to try AAC" - The autism grief cycle (shock, denial, anger, bargaining, depression, acceptance) directly impacts AAC readiness - This grief is not linear and can be re-triggered by milestones, school transitions, or seeing typically developing peers - Parents who are in the denial or bargaining stages may sabotage AAC implementation unconsciously **"I can understand them without it" syndrome** - Family members who have adapted to reading the child's gestures, behavior, and vocalizations see no need for AAC - This is particularly dangerous because it removes the incentive precisely when practice is most needed - Communication partners' belief that they can understand natural speech is a documented factor in abandonment ### Which Barriers Are Most Addressable by an App? | Barrier | Addressable by App? | How | |---------|---------------------|-----| | Fear AAC prevents speech | **High** | In-app education, research citations, progress tracking showing speech + AAC growth | | Feeling overwhelmed | **High** | Progressive disclosure, minimal first-run setup, guided daily routines | | Lack of training | **High** | Built-in tutorials, modeling demonstrations, contextual tips | | Device complexity | **Very High** | This is a design problem. Scene-based navigation directly solves it | | Social stigma | **Medium** | Modern, kid-friendly design that doesn't look "medical" | | Cost | **Low** | Pricing strategy, not app design (but bundling with QuickTalker Freestyle helps) | | Grief/readiness | **Low-Medium** | Gentle onboarding, parent community features, SLP partnership | | "I understand them" | **Medium** | Show communication breadth the child CAN'T express without AAC | ### Design Implications for QuickChat AAC - **Address the speech fear directly in onboarding.** Not buried in settings or help docs. On first launch, before anything else: "AAC does not prevent speech. Research shows it accelerates it." With a link to the evidence. This is the #1 conversion barrier. - **Ruthlessly minimize initial complexity.** Proloquo2Go's 80% misconfiguration rate is a design failure, not a user failure. QuickChat must work well out of the box with zero configuration. - **Build the "overwhelm circuit breaker."** If a parent hasn't opened the app in 3 days, the re-engagement must be lower-effort than the previous session, not the same or higher. Meet them where they are. - **Design for public use without shame.** The app's visual design should look like a beautiful children's app, not a medical device interface. A child using QuickChat in a restaurant should look like a child playing a game, not a patient using equipment. --- ## 3. The "It Won't Work for My Child" Belief ### The Expectation-Reality Gap Parents approach AAC with a wide range of expectations, and the gap between expectation and reality is a primary driver of abandonment. **What parents expect:** - Child will start using the device quickly (days to weeks) - Communication will be clear and functional from early on - The device will "fix" the communication problem - Progress will be linear and visible **What actually happens:** - **Weeks 1-4**: Child explores device, may press buttons randomly, may push it away. Meaningful intentional communication is rare - **Months 1-3**: With consistent modeling (caregiver using the device to communicate WITH the child), first intentional uses appear. These are often requests ("want" + item) — the most motivating communication function - **Months 3-6**: Vocabulary expands beyond requesting. Child begins commenting, protesting, greeting. This is when parents typically report the "aha moment" - **Months 6-12+**: More complex combinations emerge. Child begins to generalize across contexts **The critical insight:** There is no published research establishing a precise "weeks to first word" timeline because it varies enormously by child, diagnosis, age, modeling frequency, and device fit. But clinical consensus suggests: - **Minimum 3-6 months** of consistent AAC exposure before expecting intentional, functional communication - **Minimum 6-12 months** before multi-word combinations - **1-2 years** before fluent use across contexts ### When Parents Lose Hope The research identifies a dangerous window: **between weeks 2-8** when initial novelty has worn off but meaningful communication hasn't appeared. Parents in this window are asking "Is this working?" and receiving no visible evidence that it is. Key factors that accelerate hope loss: - **Comparison to peers** — seeing other children communicate naturally - **Professional ambiguity** — SLPs who cannot give specific timelines or reassurance - **Inconsistent modeling** — if the parent isn't modeling daily, results are slower, creating a negative feedback loop - **Focus on deficits** — seeing what the child CAN'T do rather than incremental progress Parents describe communication as a "guessing game" with frequent misinterpretation, and report "slow learning progress with skills fluctuating over time." The fluctuation is particularly demoralizing — a child who used the device well on Tuesday may refuse it on Thursday, and parents interpret this as regression rather than normal variability. ### The "Magic Box" Moment Research on early AAC motivation reveals a critical psychological tipping point: when the child first realizes "this thing gets me what I want." One SLP described it as the child thinking "Wow, this is like this magic box that gets me whatever I want. I wanted to watch that YouTube video, and I got it." This moment — when the child connects device use to real-world outcomes — is the most powerful motivator for both child and parent. It transforms AAC from an abstract therapy tool into a functional communication channel. ### Design Implications for QuickChat AAC - **Engineer the "magic box" moment into the first session.** The app's first use should guide the parent through a scenario where the child taps something and immediately gets a tangible, desirable result. Not a tutorial. A real communication moment. - **Build visible progress tracking from day one.** Even before intentional communication, track and celebrate: number of explorations, time spent, buttons pressed, parent modeling sessions. Show parents that activity IS progress, even when it doesn't look like communication yet. - **Set expectations explicitly.** During onboarding: "Most children begin intentional communication after 4-8 weeks of daily modeling. This is normal. Here's what to look for in the meantime." Concrete, honest, with milestones to watch for. - **Normalize fluctuation.** When usage drops or patterns change, the app should reassure rather than alarm: "Communication skills naturally fluctuate day to day. What matters is the overall trend." - **QuickChat Mode directly addresses this.** The speak-choose-speak loop creates immediate, visible communication flow. Even if the child is pressing buttons semi-randomly, the conversational structure makes it LOOK and FEEL like communication, which sustains parent motivation through the effort valley. --- ## 4. SLP Role in Adoption ### SLPs as Gatekeepers and Champions Speech-language pathologists play the central role in AAC screening, assessment, diagnosis, and treatment (ASHA Practice Portal). Their influence on adoption outcomes is profound — and variable. ### How SLPs Influence Adoption **Positive SLP behaviors that predict success:** - **Family-centered practice**: Listening to families' experiences and concerns rather than prescribing solutions - **Collaborative device selection**: Trialing multiple options with the family rather than defaulting to personal preference - **Ongoing coaching**: Regular check-ins and problem-solving after initial setup, not just at delivery - **Modeling aided language stimulation**: Demonstrating HOW to use the device in real interactions, not just explaining it - **Connecting families**: Facilitating connections between AAC families for peer support - **Setting realistic expectations**: Providing concrete timelines and milestones **Negative SLP behaviors that predict failure:** - **One-and-done training**: Delivering the device with a single training session and no follow-up - **Therapist-preference device selection**: Choosing the device they know best rather than the best fit for the family - **Deficit-focused communication**: Emphasizing what the child can't do rather than building on strengths - **Insufficient AAC expertise**: Many SLPs report feeling under-trained in AAC. Research found SLPs "do not always feel confident in their AAC knowledge and skills, and current continuing education offerings may not be adequate" - **Imposing prerequisites**: Some SLPs still (incorrectly) require children to demonstrate cognitive or motor readiness before offering AAC - **Inadequate family engagement**: SLPs varied in the degree to which they remained family-centered following AAC rejection or abandonment ### The SLP Training Gap A critical finding: SLPs themselves identify **caregiver buy-in and carryover across providers** as the most significant barriers to AAC implementation. Yet many SLPs receive insufficient pre-service training in AAC, creating a competence gap at the most critical intervention point. The multi-stakeholder study found: - **90% of educators** ranked knowledge deficit as a top-3 barrier - **55% of clinicians** ranked it as a top-3 barrier - **44% of parent-carers** ranked it as a top-3 barrier ### Evidence on Parent-Implemented AAC The evidence base strongly supports parent involvement: "Early intervention with AAC leads to improved expressive and receptive language abilities, and this is also true for AAC programs that are effectively implemented by parents as opposed to SLPs." This is a key finding — parent-implemented AAC can be as effective as SLP-delivered AAC when parents receive adequate training and support. ### The Tele-AAC Opportunity Research on teletherapy for AAC implementation shows promising results: - Parents perceived "positive change in their device operation, management, and interaction skills" - Parents also perceived "positive changes in their children's AAC device performance" - "Tele AAC can be as good as, if not more effective than in-person therapy" for coaching communication partners - The SLP can observe and advise while a facilitator (parent) guides the AAC user in real-life contexts ### Design Implications for QuickChat AAC - **Build the app so SLPs want to recommend it.** Clinical defensibility (evidence-based vocabulary, developmental staging, core word emphasis) is the entry ticket. But ease of recommendation is the differentiator — an SLP should be able to say "download this, set up a profile, and start with the Kitchen scene" in 60 seconds. - **Support SLP-parent collaboration in-app.** Usage data, progress reports, and goal tracking that an SLP can review remotely. This extends the SLP's reach between sessions without adding burden. - **Make aided language stimulation effortless.** The #1 clinical intervention (modeling) should be built into the app's interaction design, not left as a separate instruction manual. QuickChat Mode inherently models conversational flow. - **Don't depend on SLP support for basic success.** Many families don't have regular SLP access. The app must be usable and valuable even for families navigating AAC alone. The guided onboarding and contextual tips serve this population. --- ## 5. Device Complexity and Abandonment ### The Complexity Paradox AAC devices face a fundamental tension: **simple devices are easier to adopt but limited in expressiveness; complex devices are more powerful but overwhelming to learn.** The research reveals this isn't a simple linear relationship. ### Evidence on Complexity as a Barrier - **Device fit was rated as a top-3 barrier to AAC use**, with specific issues including "poorly customized fit, sensory overwhelm, and having too many distracting icons" (Frontiers in Psychiatry, 2024) - **High costs and complicated training** required to operate high-tech AAC devices hinder access and usability - **Operational difficulties** limit AAC potential, especially for users who are simultaneously physically impaired and speech-disabled - **Proloquo2Go data**: Over 80% of users misconfigure; 40% choose <20 buttons per page (self-limiting to escape overwhelm) ### The Complexity Sweet Spot Research does not support "simpler is always better." Instead, the evidence points to a **staged complexity model**: **Stage 1 — Entry (First contact through Week 2):** - Minimal choices (4-9 high-interest items per screen) - Direct cause-and-effect (tap = speech output) - No configuration required - Success within first session **Stage 2 — Exploration (Weeks 2-8):** - Expanding vocabulary within familiar contexts - Introduction of core words alongside fringe vocabulary - Parent begins modeling - Child discovers device gets them what they want **Stage 3 — Construction (Months 2-6):** - Multi-word combinations become possible - Sentence templates scaffold language building - Core word bar becomes primary interaction mode - Vocabulary spans multiple contexts **Stage 4 — Fluency (6+ months):** - Full vocabulary access - Self-directed navigation - Generalization across contexts - Communication partner strategies become natural ### Multimodal Reality An important finding: **AAC users still predominantly use combinations of unaided (gestures, vocalizations) and low-tech methods together with high-tech devices**, adapting their strategy to the context and conversation partner. This means the device is never the ONLY communication channel — it's one tool in a multimodal toolkit. This has implications for how we measure "success" — a child who uses the device for some communications but gestures for others is not failing. They're communicating multimodally, which is healthy. ### The "Uncanny Valley" of AAC Complexity There's an implicit "uncanny valley" in AAC design that no study has formally named but the data clearly shows: - **Too simple** (4-8 buttons, only "I want" + items): Works for initial engagement but rapidly becomes frustrating. The child has thoughts they can't express. Parents see the ceiling and lose motivation. - **Too complex** (100+ buttons, folder navigation, grammar features): Overwhelms before any communication happens. Parents can't learn it, can't teach it, abandon it. - **The valley**: Medium-complexity devices that are too complex to be intuitive but not powerful enough to justify the learning investment. These have the highest abandonment rates. - **The sweet spot**: Systems that LOOK simple but have depth. Low floor, high ceiling. Immediate value with progressive revelation of capability. ### Design Implications for QuickChat AAC - **QuickChat's scene-based architecture directly solves the uncanny valley.** Each scene is a bounded, visually coherent context with a manageable number of choices. Complexity grows by adding scenes, not by making any single screen more complex. - **The core word bar is the progressive complexity lever.** It's always available but doesn't demand attention until the child/parent is ready. This is textbook progressive disclosure. - **Never show the full system on first launch.** The child profile should determine which scenes are visible initially. Start with 2-3 scenes based on interests. Reveal more over time. - **QuickChat Mode eliminates the "blank canvas" problem.** Instead of staring at 50 buttons wondering what to say, the child is always presented with 3 contextual options. This is complexity management through curation, not reduction. - **Track and reveal.** The app should show parents: "Your child's vocabulary has grown from 12 words to 47 words" — making the growing complexity feel like progress rather than overwhelm. --- ## 6. Technology Adoption Models Applied to AAC ### TAM (Technology Acceptance Model) Davis (1989) proposed two core variables predicting technology acceptance: 1. **Perceived Usefulness (PU)**: "Will this help my child communicate?" 2. **Perceived Ease of Use (PEOU)**: "Can I actually learn and use this?" Applied to AAC, both variables are necessary but not sufficient. A parent who believes AAC could help (high PU) but finds the device impossibly complex (low PEOU) will abandon it. A parent who finds the app easy to use (high PEOU) but doesn't believe it will help their specific child (low PU) won't adopt it. **The AAC-specific wrinkle:** In AAC, there are TWO users — the child and the parent/caregiver. Both must perceive usefulness and ease of use, but their definitions differ: | Variable | Parent Perspective | Child Perspective | |----------|-------------------|-------------------| | Perceived Usefulness | "This will help my child communicate and develop language" | "This gets me what I want / lets me be understood" | | Perceived Ease of Use | "I can set this up, learn it, model it, and maintain it" | "I can find what I need and produce speech quickly" | ### UTAUT (Unified Theory of Acceptance and Use of Technology) Venkatesh et al. (2003) expanded TAM with four dimensions: 1. **Performance Expectancy**: Does this technology deliver results? 2. **Effort Expectancy**: How much effort does it take? 3. **Social Influence**: Do important people in my life support this technology? 4. **Facilitating Conditions**: Do I have the resources and knowledge to use this technology? UTAUT accounts for **70% of variance in behavioral intention to use** and about **50% in actual use** — stronger predictive power than TAM alone. Applied to AAC: | UTAUT Factor | AAC Application | QuickChat Design Response | |--------------|----------------|---------------------------| | Performance Expectancy | "Will my child actually communicate?" | Quick wins in first session; visible progress tracking | | Effort Expectancy | "How much daily effort does this require?" | Minimal setup; integration into existing routines | | Social Influence | "Does my SLP recommend this? Do other parents use it?" | SLP recommendation pathway; parent community features | | Facilitating Conditions | "Do I have the iPad, the knowledge, the support?" | Runs on standard iPad; built-in tutorials; offline-first | ### Scherer's Matching Person and Technology (MPT) Model Scherer (1986, updated through 2014) provides the most assistive-technology-specific framework, organizing adoption around three factors: 1. **Environment**: Where will the technology be used? With whom? Under what conditions? 2. **Person**: User preferences, expectations, motivation, psychosocial factors 3. **Technology**: Device features, functions, reliability, aesthetics Key insight from Scherer: "One of the major causes for AT mismatch (and consequently abandonment) is the myth that 'a user's assistive technology requirements need to be assessed just once.'" AAC needs evolve. The technology must evolve with them. ### Capability Approach Model (Johnson et al., 2023) The most recent theoretical advancement reframes abandonment through Amartya Sen's capability approach. Rather than asking "Is the device being used?" it asks "Does the device expand the person's real freedoms and capabilities?" This reframing matters because: - A device that is technically "in use" but only for one communication function (requesting) isn't expanding capability meaningfully - A device that is "abandoned" because the child developed speech may actually represent SUCCESS, not failure - The goal is not device use per se, but communication capability ### Design Implications for QuickChat AAC - **Maximize Perceived Usefulness in the first 60 seconds.** The onboarding must show (not tell) the parent what communication will look like. A demo video of a child using QuickChat Mode — tapping, hearing speech, getting a response — is worth more than any feature list. - **Minimize Effort Expectancy to near-zero for launch.** The child profile (age + interests) should auto-configure everything. No vocabulary selection, no grid size decisions, no navigation setup. - **Leverage Social Influence aggressively.** SLP recommendations are the primary social influence channel. The app needs an SLP recommendation program, clinical case studies, and easy sharing. But also: parent testimonials and community features. - **Design for evolving needs (Scherer's insight).** The app must grow with the child. What works at 2 must still work at 4, with more capability unlocked. This validates the "design the final layout first, reveal progressively" approach in the spec. - **Measure capability expansion, not just device usage.** Track communication functions (requesting, commenting, protesting, greeting, asking), not just button presses. Show parents their child's communication BREADTH is growing. --- ## 7. Success Stories and What They Share ### The Kyle Study: Toddler to Teen The most detailed longitudinal AAC case study tracked "Kyle" from age 2 to 15 (PMC, 2021). Key findings: **What predicted success:** - **Strong parental advocacy**: Kyle's parents "pushed for inclusion in general education during elementary school and consistently sought newer technologies" - **Early intervention**: AAC began at age 2 through a parent-coached program with bi-weekly augmented language intervention - **Consistent professional support**: "SLP services to support AAC were also integral to Kyle's communicative success" - **Self-determination**: Kyle exercised autonomy in choosing communication modalities, eventually preferring text-to-speech over symbol-based communication - **Technology evolution**: Kyle's family transitioned through 9 hardware systems and 5 software systems over 13 years — adaptability, not device loyalty, was key **Outcomes:** - Parent perception of communication success improved by 20% and communication difficulty decreased by 40% from age 2 to 15 - Despite nonverbal IQ remaining below average (75-78) across 13 years, Kyle achieved functional communication independence - By age 15, Kyle used: facial expressions, gestures, vocalizations, signs, speech approximations, text-to-speech, phone (text, FaceTime), Google Search, and internet chat rooms - Kyle's case demonstrated that "the ability to use AAC is not dependent on prerequisite cognitive abilities" ### Common Factors Across Success Studies The ASHA Leader (2007) and subsequent research identify consistent success factors: 1. **Family members are the key players**: "Family members, including parents, siblings, and grandparents, are most frequently the key players in determining successful outcomes" 2. **Strong parent advocacy and high expectations**: Participants whose parents "were considered strong advocates and set high expectations for achievement tended to have more positive outcomes" 3. **Early introduction**: Parents who succeeded "articulated that they had realized both the importance of trying AAC and beginning intervention as early as possible" 4. **Inclusive educational placement**: Children in inclusive classrooms fared better than those in segregated settings 5. **Early literacy instruction**: Those receiving literacy instruction beginning in kindergarten had better outcomes 6. **Multimodal acceptance**: Successful families accepted that AAC would be ONE part of a multimodal communication toolkit, not a replacement for all other communication ### What Failure Looks Like The inverse pattern is equally instructive: - Parents who waited for speech to develop before trying AAC - Families who received the device without training and were told "use it" - Settings where AAC was used only in therapy, not in daily life - Children whose devices were locked away to prevent damage - Families where only one person (usually the mother) knew how to use the device ### Design Implications for QuickChat AAC - **Make the whole family AAC-capable.** The app should be learnable by grandma in 5 minutes. If only one parent knows how to use it, that's a single point of failure. QuickChat Mode's simplicity (tap one of three options) means ANYONE can facilitate a conversation. - **Support device/modality transitions.** Kyle went through 9 hardware systems. The app should make data export, backup, and migration trivially easy. Lock-in is an anti-pattern in AAC. - **Celebrate multimodal communication.** Don't frame gesture or vocalization as "not using AAC." Frame them as "communication wins" alongside device use. - **Enable family advocacy.** Progress reports that parents can share with schools, new therapists, and family members. Make it easy for the parent to be the expert on their child's communication. --- ## 8. The First Week ### Why the First Week Matters Disproportionately The first week with an AAC device sets the trajectory for the next year. Research and clinical guidance converge on a set of critical first-week activities and common first-week failures. ### What Should Happen (Evidence-Based First Week) Based on PrAACtical AAC's "Stepping into AAC" program and clinical consensus: **Day 1-2: Setup and Orientation** - Select a starter AAC tool appropriate for the child - Parent/caregiver understands the basic concept: "Give language to get language" - Device is physically accessible to the child during all waking hours - Identify 3-5 high-motivation words/phrases for the child (favorite foods, activities, people) **Day 3-4: First Modeling** - Parent begins aided language stimulation: speaking while pointing to symbols on the device - Focus on diverse communication functions, NOT just requesting (also commenting, greeting, protesting) - Model during natural routines: mealtime, play, bath time - Child may explore the device independently — this is good, even if random **Day 5-7: Building Habit** - AAC modeling becomes part of at least 2-3 daily routines - Parent connects with SLP or support network (online community, tutorial) - Parent shares AAC plan with other caregivers (partner, grandparents, daycare) - Track: Has the child shown any interest in the device? Have they pressed any buttons? These are early positive signals. ### What Actually Happens (Common First-Week Failures) 1. **Device arrives, no training provided.** Parent opens the box, stares at 100+ icons, feels overwhelmed, puts it on a shelf. 2. **Over-configuration.** Parent spends the entire first week trying to customize vocabulary, change icons, reorganize layouts — and never actually uses the device with the child. 3. **Testing mode.** Parent holds the device in front of the child and waits for them to say something. The child stares blankly. Parent concludes "they're not ready." 4. **Toy mode.** Child grabs the iPad and plays with it — pressing buttons randomly, watching videos, navigating away from the AAC app. Parent concludes AAC won't work. 5. **One-person show.** Only one parent uses the device. The other parent, grandparents, and daycare don't know about it or how to use it. ### The "First Word" Milestone Clinical guidance emphasizes that the first intentional AAC use is typically a **request** — the child presses a button for something they want and gets it. This is the "magic box" moment. Designing for this moment means: - Having high-motivation vocabulary front and center (not buried in folders) - Ensuring the speech output is immediate and clear - Having the environment respond (parent provides the requested item) - Celebrating the moment without over-reacting (natural reinforcement, not a parade) ### Design Implications for QuickChat AAC - **The first-run experience is the most important screen in the app.** It should: 1. Take <2 minutes to complete (child profile: name, age, interests — nothing more) 2. Immediately show a relevant, motivating scene based on the child's interests 3. Guide the parent through their first modeling moment ("Tap 'want' then 'cookie' — now say it out loud while pointing") 4. Produce speech output that makes the child look up - **Lock out configuration for the first week.** Or at least hide it behind a "For later" label. The #2 first-week failure is parents customizing instead of using. - **Prevent toy mode.** Guided Access (iOS feature) integration should be suggested during onboarding. The app should recommend: "Lock this iPad to QuickChat so your child stays in the app." - **Multi-caregiver onboarding.** "Share QuickChat with family" should be a prominent Day 1 action. A 60-second video explaining the app to grandma/babysitter/teacher. - **QuickChat Mode is the ideal first-week interaction.** It eliminates the "blank canvas" problem. The child doesn't need to know WHAT to say — they choose from 3 options. This creates conversational flow from the first session, even with a child who has never used AAC. --- ## 9. Cultural and Socioeconomic Factors ### Racial Disparities in AAC Access The evidence for racial disparities in AAC is stark and damning: **Access to devices:** - **84% of white families** had access to an AAC device, compared to **only 32% of racial and ethnic minority families** (Children's Hospital Los Angeles study) - **55% of families from racial/ethnic minorities** reported having **no prior knowledge** of AAC devices — versus just **12% of white families** - Only 30% of minority families currently had a device, and only 2% had ever had one in the past **Intervention intensity:** - **63% of white children** received 90+ minutes weekly of AAC intervention versus **only 29% of Black children** at study initiation - At 2-year follow-up: **52% of white children** received 90+ minutes weekly compared to **25% of Black children** - By study end, **75% of Black children received less than 60 minutes weekly** — insufficient for meaningful progress - These disparities existed despite no baseline differences in child characteristics (age, language skills, diagnosis) **Systemic factors:** - Underfunding of schools serving Black communities results in higher SLP caseloads and less money for AAC systems - African Americans with disabilities have "a documented history of denied access to AT funding sources" - Income directly influences accessibility and feasibility of home modifications and supports needed for AAC ### Bilingual and Multilingual Families AAC for bilingual families faces compounding challenges: - Historically, AAC systems only supported one language, forcing families into monolingual communication - Spanish has regional variations (Mexican Spanish vs. Castilian vs. Argentine) that make "standardized" AAC boards culturally inappropriate - Families report "difficulty obtaining AAC resources for non-English speaking clients" - For bilingual children, adding AAC is perceived as adding a "third language" — which appears overwhelming - **Forced monolingualism through AAC may lead to "poor communication between AAC users and their families and may impede learning opportunities"** — this is a clinical and ethical concern, not just a convenience issue Modern AAC apps like Proloquo support bilingual features, but the implementation is complex: "English is a Germanic language and Spanish is a Romance language with fundamentally different grammars" — symbol-based systems must accommodate both, which "developers essentially had to learn by doing since there were no real-life examples." ### Socioeconomic Barriers - Lower-SES families have less access to iPads/tablets, making app-based AAC inaccessible - Insurance/Medicaid coverage for AAC is inconsistent and requires extensive documentation - Parents in hourly jobs cannot attend daytime therapy appointments as easily - SES disparities in language socialization may be cultural differences, not deficits — assessment practices must distinguish between language differences and disorders ### Design Implications for QuickChat AAC - **Bilingual support is not optional — it's an equity issue.** Spanish-English at minimum for the US market. The app's symbol-based approach is better positioned than text-based apps for multilingual support, but grammar and sentence templates need language-specific logic. - **Representation in symbols matters.** ARASAAC symbols (used in POC) have reasonable diversity, but culturally relevant vocabulary and scenes are needed. A "Kitchen" scene should reflect diverse food cultures, not just Western defaults. - **Price accessibility affects who can use it.** If QuickChat is bundled with QuickTalker Freestyle (a funded device), it may reach underserved populations through insurance channels that wouldn't fund an app alone. This is a strategic distribution decision. - **Minimize dependency on SLP access.** Families with less access to SLPs (disproportionately families of color and low-income families) need the app to be more self-guiding, not less. Built-in tutorials and coaching prompts are equity features, not just nice-to-haves. - **Cultural competence in onboarding.** Don't assume English-speaking household, two-parent family, or familiarity with therapy terminology. Keep language plain and accessible. --- ## 10. App-Specific vs. Device-Specific Abandonment ### iPad AAC Apps vs. Dedicated SGDs The shift from dedicated SGDs to iPad-based AAC has been the biggest technology transition in the field. Here's what the evidence shows about how this affects abandonment. ### Advantages of iPad-Based AAC (Factors Reducing Abandonment) 1. **Social acceptance**: iPads are "normal" devices. Children prefer the look and feel of an iPad over medical equipment. Using an iPad in public doesn't mark the child as different the way a dedicated SGD does. 2. **Cost**: iPad + AAC app ($500-$800) vs. dedicated SGD ($5,000-$15,000). Lower financial commitment means lower psychological barrier to trying and potentially abandoning. 3. **Portability**: iPads are lighter and more convenient. "The weight of traditional SGDs is a common factor mentioned related to device abandonment." 4. **Familiarity**: Parents and children already know how to use iPads. The device learning curve is eliminated — only the app learning curve remains. 5. **Multi-purpose**: The same device can run other educational apps, entertainment, and communication apps, increasing daily carry/use. ### Disadvantages of iPad-Based AAC (Factors Increasing Abandonment) 1. **Distraction**: The iPad is also a toy, video player, and game console. Children navigate away from AAC apps. Parents struggle to keep the child in the communication app. 2. **Durability**: iPads break more easily than ruggedized SGDs. A broken iPad means no communication. 3. **Lack of dedicated support**: SGD manufacturers provide training, customization, and tech support. App developers typically provide documentation and email support at best. 4. **Insurance/funding barriers**: Dedicated devices are more reliably funded by insurance and Medicaid. iPads are sometimes funded if "bundled" by a vendor, but the parent must refer to it as a "tablet-based dynamic display communication device" rather than an "iPad" to avoid rejection. This absurdity creates real access barriers. 5. **No built-in accessibility**: Dedicated SGDs often include switch ports, eye gaze, and other access methods built in. iPads require separate accessories. ### Effectiveness Comparison A meta-analysis of iPad/iPod-based AAC found that of 46 participants with autism and developmental disabilities: - **23 participants** (50%) showed highly effective results - **12 participants** (26%) showed moderate improvement - Results were comparable to dedicated SGDs for the studied populations More than half of SLPs now recommend tablet-based AAC for many clients, especially when cost or insurance limitations make dedicated devices harder to obtain. ### The Hybrid Model AbleNet's QuickTalker Freestyle represents a **hybrid approach**: a dedicated device (fundable by insurance, ruggedized, supported) that runs iPad-compatible apps. This is strategically smart because: - It captures insurance funding that pure apps cannot - It provides the durability and support of a dedicated device - It runs modern, well-designed apps rather than proprietary legacy software - It eliminates the distraction problem (dedicated to communication) ### Design Implications for QuickChat AAC - **The QuickTalker Freestyle integration is a major competitive advantage.** An app that works on both a dedicated funded device AND a personal iPad covers both markets. Design for both form factors. - **Address the distraction problem in-app.** Recommend Guided Access during onboarding. Consider a "focus mode" that makes it harder to accidentally exit. Maybe a parent-locked "AAC only" mode. - **Leverage the iPad advantage: familiarity.** Don't fight the platform. Use standard iOS gestures, standard navigation patterns. Parents shouldn't have to learn a new interaction model on top of a new communication system. - **Support the "bundled device" funding pathway.** If QuickChat is available through AAC funding channels (not just the App Store), it reaches families who can't afford direct purchase. AbleNet's distribution network is the channel. --- ## 11. What Parents Actually Want ### Survey Data and Qualitative Research Across multiple studies and parent surveys, consistent themes emerge about what parents wish AAC tools provided: ### Most Requested Features **1. Simplicity That Doesn't Sacrifice Depth** - Parents want to "start simple and build complexity over time" - Adjustable grid sizes, customizable icons, easy navigation - But NOT at the cost of long-term capability — they don't want to outgrow the app - Quote: "The pictures are too hard" AND "the system is too simplistic" — parents experience BOTH complaints, often about the same app at different stages **2. Speed of Communication** - "The biggest challenge for AAC device users is the number of keystrokes or touches required to construct sentences" - Conversation takes too long compared to natural speech - Parents want prediction, shortcuts, and pre-built phrases to reduce effort - This is the #1 functional complaint about all AAC apps **3. Collaboration Features** - Parents want "multiple caregivers, teachers, and family members to edit and manage boards remotely" - Consistency across home, school, and therapy is a top concern - Current apps are single-device, single-user — creating silos **4. Language Diversity** - "Parents hoped that high-technology systems, especially apps, will eventually be available in more local languages" - Not just translation — culturally appropriate vocabulary and symbols - Bilingual toggle (speak both languages) for bilingual households **5. Affordability** - Ongoing frustration with $250-$300 app prices on top of device costs - Subscription models (like Avaz at $10/month) get mixed reactions — lower entry but ongoing cost - Parents want to try before committing significant money **6. Durability and Reliability** - "Frequent device breakdowns and slow repair processes" are top complaints - Parents are anxious about damaging expensive equipment - Schools sometimes restrict device access to prevent damage **7. Modern, Non-Stigmatizing Design** - Parents don't want their child's communication tool to look "clinical" - The app should look like other children's apps — bright, playful, modern - Voice output should sound natural, not robotic - Customizable voices reflecting the child's identity (age, gender, accent) **8. Built-In Guidance** - Parents want the app to teach them how to use it, not just provide a manual - Contextual tips, tutorials, and modeling demonstrations - Progress tracking that shows what's working ### What Parents Explicitly Do NOT Want - **Complicated setup wizards** — they want to start immediately - **Clinical jargon** — they're parents, not therapists - **Rigid structure** — every child is different, and they need flexibility - **Dependency on an SLP for basic use** — they want autonomy - **Apps that feel like homework** — communication should be natural, not a therapy exercise ### Design Implications for QuickChat AAC - **QuickChat Mode directly addresses the speed-of-communication complaint.** Three-option follow-ups mean the child communicates in 1 tap instead of 5+ taps to construct a sentence. This is the app's strongest competitive differentiator. - **Multi-caregiver support should be a launch feature, not a roadmap item.** If grandma can't use the app, that's a single point of failure. At minimum: shareable profiles, simple enough for anyone to facilitate. - **Price sensitivity is real.** The bundled QuickTalker Freestyle pathway helps (insurance covers it), but the standalone app needs a compelling entry price. Consider: free trial period, limited free version, or tiered pricing. - **Voice quality matters more than parents can articulate.** iOS built-in TTS (AVSpeechSynthesizer) is adequate for POC but may not satisfy parents long-term. A 2-year-old's communication device shouldn't sound like Siri. Plan for premium voices. - **"Don't make it feel like therapy" should be a design principle.** The scene-based, visually rich approach achieves this. The Kitchen scene should feel like a children's book, not a clinical tool. Language like "practice your vocabulary" should be avoided in favor of "let's talk about snack time." --- ## Synthesis: The 10 Design Principles That Beat Abandonment Based on the totality of this research, here are the principles that — if followed — give QuickChat AAC the best chance of beating the 60% abandonment rate: ### 1. Engineer the First Win The child must have a visible, meaningful communication success within the first session. Not the first week. The first session. QuickChat Mode makes this possible by structuring conversation flow from the first tap. ### 2. Minimize Time-to-Value Zero configuration. Profile-driven auto-setup. The app works out of the box in under 2 minutes. Every second of setup is a second closer to abandonment. ### 3. Design for the Family, Not the Child The child is the communicator, but the family is the customer. If the parents can't use it, learn it, and sustain it, the child never will. Every feature should pass the test: "Can grandma do this?" ### 4. Address the Speech Fear First Before any other educational content, before tutorials, before tips: "AAC does not prevent speech. It accelerates it. Here's the research." This is the #1 conversion barrier and it should be the #1 onboarding message. ### 5. Build for the Effort Valley Months 1-3 are when most families quit. The app needs: progress celebrations, gentle re-engagement, lower-effort alternatives when motivation dips, and visible evidence that "this is working" even when it doesn't feel like it. ### 6. Progressive Complexity, Never Regressive Simplicity Start simple, add capability over time. But never take capability away. The layout should be designed for the end state and progressively revealed — preserving motor planning and spatial memory. ### 7. Make Modeling Automatic Aided language stimulation is the #1 clinical intervention. It shouldn't require a separate instruction manual. QuickChat Mode, contextual sentence examples, and the core word bar all model language inherently. ### 8. Look Like a Children's App, Not a Medical Device Social stigma drives abandonment. Modern, playful, beautiful design is not aesthetic vanity — it's an anti-abandonment strategy. A child using QuickChat should be indistinguishable from a child playing an educational game. ### 9. Support the Ecosystem The child doesn't communicate in isolation. The app must support: SLP collaboration, multi-caregiver access, school-home consistency, and data portability. Walled gardens kill AAC adoption. ### 10. Measure Capability, Not Compliance Track communication breadth (functions, vocabulary diversity, conversation length), not just device usage (sessions, button presses). Show parents their child's communication world is expanding. That's what keeps them going. --- ## Sources ### Primary Research Articles - Johnson, J.M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech language pathologists regarding success versus abandonment of AAC. *Augmentative and Alternative Communication*, 22(2), 85-99. - Millar, D.C., Light, J.C., & Schlosser, R.W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities. *Journal of Speech, Language, and Hearing Research*, 49(2), 248-264. - Scherer, M.J. (2005). Living in the state of stuck: How assistive technology impacts the lives of people with disabilities. Brookline Books. - Banajee, M., DiCarlo, C., & Stricklin, S.B. (2003). Core vocabulary determination for toddlers. *Augmentative and Alternative Communication*, 19(2), 67-73. - Sennott, S.C., Light, J.C., & McNaughton, D. (2016). AAC modeling intervention research review. *Research and Practice for Persons with Severe Disabilities*, 41(2), 101-115. ### Systematic Reviews and Meta-Analyses - [Parents' Perceptions and Experiences with Their Children's Use of AAC: A Systematic Review and Qualitative Meta-Synthesis](https://pmc.ncbi.nlm.nih.gov/articles/PMC9266194/) (PMC, 2022) - [Parents' Perspectives on Communication and AAC Use for Beginning Communicators on the Autism Spectrum](https://pmc.ncbi.nlm.nih.gov/articles/PMC11186330/) (PMC, 2024) - [Comparing and Contrasting Barriers in AAC Use: Multi-Stakeholder Perspectives](https://pmc.ncbi.nlm.nih.gov/articles/PMC11197385/) (Frontiers in Psychiatry, 2024) - [A Scoping Review of Aided AAC Modeling for Individuals with Developmental Disabilities](https://link.springer.com/article/10.1007/s40474-023-00275-7) (Springer, 2023) - [A Systematic Review of Augmented Input Interventions](https://pmc.ncbi.nlm.nih.gov/articles/PMC10110354/) (PMC, 2023) ### Longitudinal and Case Studies - [Growing Up with AAC in the Digital Age: A Longitudinal Profile from Toddler to Teen](https://pmc.ncbi.nlm.nih.gov/articles/PMC8281386/) (PMC, 2021) - [Supporting Families of Children Who Use AAC](https://leader.pubs.asha.org/doi/10.1044/leader.FTR1.12102007.17) (ASHA Leader, 2007) ### Racial and Socioeconomic Disparities - [Black Children With Developmental Disabilities Receive Less AAC Intervention](https://pmc.ncbi.nlm.nih.gov/articles/PMC9458617/) (PMC, 2022) - [Study Reveals Wide Gap in Awareness of AAC Devices](https://www.chla.org/blog/experts/research-and-breakthroughs/study-reveals-wide-gap-awareness-aac-devices-children-autism) (Children's Hospital Los Angeles) - [Assistive Technology Access and Usage Barriers Among African Americans](https://pmc.ncbi.nlm.nih.gov/articles/PMC7985985/) (PMC, 2021) ### Technology Adoption Models - [Rethinking Device Abandonment: A Capability Approach Focused Model](https://www.tandfonline.com/doi/full/10.1080/07434618.2023.2199859) (AAC Journal, 2023) - [Assistive Technology Abandonment: Research Realities and Potentials](https://link.springer.com/chapter/10.1007/978-3-319-94274-2_77) (Springer, 2018) - [Understanding Psychosocial Barriers to Healthcare Technology Adoption: TAM and UTAUT](https://pmc.ncbi.nlm.nih.gov/articles/PMC11816427/) (PMC, 2025) ### Clinical Practice and Guidelines - [ASHA Practice Portal: Augmentative and Alternative Communication](https://www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication/) - [Speech-Language Pathologists' Practices in AAC During Early Intervention](https://pmc.ncbi.nlm.nih.gov/articles/PMC9549491/) (PMC, 2022) - [Prescribing Assistive Technology: Focus on Children With Complex Communication Needs](https://publications.aap.org/pediatrics/article/156/1/e2025072216/202154/) (AAP, 2025) - [Stepping into AAC — Week 1](https://praacticalaac.org/stepping-into-aac-week-1/) (PrAACtical AAC) ### Bilingual and Multilingual AAC - [Bilingual AAC](https://www.assistiveware.com/blog/bilingual-aac) (AssistiveWare) - [Multilingualism and AAC: A Review of the Literature](https://pubs.asha.org/doi/10.1044/2024_PERSP-23-00111) (ASHA Perspectives, 2024) - [Cultural-Linguistic AAC Intervention Framework](https://praacticalaac.org/praactical/cultural-linguistic-aac-intervention-a-framework-for-consideration/) (PrAACtical AAC) ### Parent and Stakeholder Perspectives - [A Comprehensive Scoping Review of Caregivers' Experiences With AAC](https://pubs.asha.org/doi/10.1044/2024_LSHSS-23-00117) (LSHSS, 2024) - [Preventing Abandonment of AAC Devices: Parent Perspectives](https://scholarworks.uni.edu/ijc/vol54/iss1/7/) (IJC, 2022) - [AAC and Families: Dispelling Myths and Empowering Parents](https://pubs.asha.org/doi/abs/10.1044/persp1.SIG12.10) (ASHA Perspectives) - [Parents' Experiences and Acceptance Factors of AAC Intervention](https://www.e-csd.org/journal/view.php?doi=10.12963/csd.20729) (CSD, 2020) ### iPad vs. SGD and Funding - [The iPad and Mobile Technology Revolution: Benefits and Challenges for AAC](https://www.tandfonline.com/doi/full/10.3109/07434618.2013.784930) (AAC Journal, 2013) - [Fundable iOS-Based AAC Devices](https://omazingkidsllc.com/2021/03/12/fundable-ios-based-aac-devices/) (OMazing Kids, updated 2025) - [Use of iPad/iPods with Individuals with Autism: A Meta-analysis](https://link.springer.com/article/10.1007/s40489-014-0018-5) (Springer, 2014) ### Industry and Practitioner Resources - [Beating the Odds in AAC Device Abandonment](https://www.medbridge.com/blog/beating-the-odds-in-aac-device-abandonment) (Medbridge) - [Effective AAC Implementation in the Home](https://quicktalkerfreestyle.com/blog/aac-implementation-in-the-home/) (QuickTalker Freestyle / AbleNet) - [10 Strategies to Train Parents and Improve Carryover](https://leader.pubs.asha.org/do/10.1044/10-strategies-to-train-parents-and-improve-carryover-for-students-using-aac/full/) (ASHA Leader) - [Coaching Communication Partners in AAC Teletherapy](https://www.avazapp.com/blog/coaching-communication-partners-in-aac-teletherapy/) (Avaz)