DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY, 2018

VOL. 13, NO. 4, 353–365

https://doi.org/10.1080/17483107.2017.1324526

ORIGINAL RESEARCH

Designing augmentative and alternative communication applications: the results

of focus groups with speech-language pathologists and parents of children with
autism spectrum disorder
Jamie B. Boster and John W. McCarthy
Department of Communication Sciences and Disorders, Ohio University, Athens, OH, USA

ABSTRACT ARTICLE HISTORY

Purpose: The purpose of this study was to gain insight from speech-language pathologists (SLPs) and Received 10 February 2017
parents of children with autism spectrum disorder (ASD) regarding appealing features of augmentative Revised 25 April 2017
and alternative communication (AAC) applications. Accepted 25 April 2017
Method: Two separate 1-hour focus groups were conducted with 8 SLPs and 5 parents of children with
ASD to identify appealing design features of AAC Apps, their benefits and potential concerns. Participants KEYWORDS
were shown novel interface designs for communication mode, play mode and incentive systems. Speech-generating device;
Participants responded to poll questions and provided benefits and drawbacks of the features as part of autism spectrum disorder;
structured discussion. interface design; speech-
Results: SLPs and parents identified a range of appealing features in communication mode (customiza- language pathology;
tion, animation and colour-coding) as well as in play mode (games and videos). SLPs preferred interfaces stakeholders; augmentative
that supported motor planning and instruction while parents preferred those features such as character and alternative
assistants that would appeal to their child. Overall SLPs and parents agreed on features for future AAC communication
Apps.
Conclusion: SLPs and parents have valuable input in regards to future AAC app design informed by their
experiences with children with ASD. Both groups are key stakeholders in the design process and should
be included in future design and research endeavors.

ä IMPLICATIONS FOR REHABILITATION

 AAC applications for the iPad are often designed based on previous devices without consideration of
new features.
 Ensuring the design of new interfaces are appealing and beneficial for children with ASD can poten-
tially further support their communication.
 This study demonstrates how key stakeholders in AAC including speech language pathologists and
parents can provide information to support the development of future AAC interface designs.
 Key stakeholders may be an untapped resource in the development of future AAC interfaces for chil-
dren with ASD.

The Apple iPadV has become a familiar tool in homes, work set-
R
tings, classrooms and recreational activities since its release in
2010. It is frequently used for daily work-related tasks, networking
and entertainment, but it is also serving individuals with complex
communication needs (CCN). There are estimates that over 3.5 mil-
lion individuals across the United States cannot use their natural
speech to communicate and rely on augmentative and alternative
communication (AAC) strategies such as gestures, alphabet
boards, picture exchange communication systems and computer-
based devices with voice output [1]. Approximately 1 million of
these individuals are children [2]. There are a range of diagnoses
that can result in children’s inability to use their natural speech
such as cerebral palsy, intellectual disabilities and autism spectrum
disorder (ASD). Recent estimates suggested that about 50% of
children with ASD do not develop speech adequate to meet their
daily communication needs [3]. Research has shown that AAC can
provide a variety of benefits related to language and social
skills. However, children who must use a device in order to
communicate may feel isolated from their peers [4]. The use of an
iPad as a communication device can allow children to feel more
confident and inconspicuous as it is a recognizable tool in our
society [5]. However, the mainstream connectivity of iPads can
also create a distraction. Although mainstream connectivity can
be locked out, another option is to create highly engaging AAC
applications (Apps). Although a range of Apps is available, each
differs greatly in design. There has been limited research con-
ducted on the appeal of many AAC Apps [6], and most are
designed by adults with little input from children or those who
know children best. In order to develop new Apps that meet
children’s communication needs, it is necessary to identify design
features that will provide the best experiences for them. If chil-
dren are uninterested in or unable to operate an AAC App, they
will be less likely to use it effectively [5]. With the rapid produc-
tion of new Apps, it is important to inform developers, professio-
nals and parents about features that engage children in the most
successful manner.

CONTACT Jamie B. Boster jb643713@ohio.edu W218 Grover Center, Ohio University, Athens, OH 45701, USA
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
354 J. B. BOSTER AND J. W. MCCARTHY
AAC and children with ASD
The definition of ASD was recently redefined in the DSM-V to
include individuals previously diagnosed separately as having
Asperger’s Disorder or pervasive developmental disorder and calls
for the level of support required (very substantial, substantial and
requiring support) to be specific along with accompanying intel-
lectual and language impairments [7]. It is still primarily defined
as a social communication disorder characterized by repetitive or
limited interests present in early development. Skill-based inter-
ventions with individuals diagnosed with ASD include applied
behavioral analysis, discrete trial training, pivotal response train-
ing, provision of AAC, the picture exchange communication sys-
tem, peer-mediated strategies, incidental teaching and joint action
routines [8]. In a meta-analysis of AAC-based single-case research
with children with ASD, it was found that picture exchange sys-
tems and speech generating devices had higher effect sizes
for targeted behavioral outcomes than other picture based
approaches [9].
In conceptualizing the benefits of AAC strategies with individu-
als with ASD, there are three critical modes through which these
strategies may be effective: the Visual Expressive Mode (for
expressive communication); the Visual Instructional Mode (to
teach a new skill or concept); and the Visual Organization Mode
(to portray a schedule or event). The idea of using visual supports
with individuals with ASD is not a new one [10], however, Shane’s
perspectives on the critical nature for AAC strategies to integrate
several modes was something new.
Current research related to the appeal of AAC systems
Several research studies have been undertaken to bring the per-
spectives of children into AAC system design [4,11–15]. In
responding to children leaving communication Apps in favour of
more “fun” Apps on a device, it is informative to study other
research that sought to improve the appeal of AAC systems. For
example, children had previously been asked to design an ideal
communication system [13]. One key finding was to not limit an
AAC system solely to communication functions. Systems designed
by children had games, lights and even beverage services. A com-
parison of the hardware features of typical AAC systems with
those of toys reported on the differences toys had in appealing
lights, sounds and customizable options compared to existing
AAC systems [11].
Snyder and McCarthy examined appealing features of popular
Apps for children and then followed with potential applications
for AAC in focus groups with children and adults without disabil-
ities [13,15]. The results indicated that parents viewed designs
that were practical for daily use most valuable while children fav-
oured designs incorporating game scenarios such as building
blocks. Both parents and their children favoured game interfaces
that included popular characters and incentives as well as physical
interactions (i.e., gestures and shaking). For this study, no distinc-
tion was made between designs for a daily communication mode
and a play mode. The results of this study informed the present
study in that an explicit difference between these modes was
necessary.
Research questions
Present research has indicated a need to further explore design
principles for future AAC Apps. First, it is important to identify fea-
tures that key stakeholders value most to efficiently address future
designs. The primary goal of this study was to involve professional
speech-language pathologists (SLPs) and parents of children with
ASD in the process of evaluating potential interface designs to
optimally integrate features and capabilities of mobile devices
with AAC Apps. In order to identify these design principles and
gather suggestions on how to improve the design as well as
appeal of AAC Apps, the following research questions were posed:
1. What do SLPs and parents of children with ASD consider
appealing features to be incorporated into AAC Apps?
2. What do SLPs and parents of children with ASD perceive as
benefits to designs that incorporate these features?
3. What are SLPs and parents of children with ASD concerned
about when incorporating such features?
Method
A focus group methodology was used to elicit discussion of
thoughts and opinions regarding design principles of AAC Apps.
A qualitative methodology was selected given the preliminary
nature of the evidence base in this area. A focus group specifically
allows participants to answer questions and provide feedback in
an interactive setting [16]. This style of gathering information
seeks to identify suggestions, opinions and ideas. Focus groups
have been used in previous investigations to gather information
about key stakeholders in AAC design and service delivery in
AAC [15,17].
Participants
Two key stakeholder groups in service delivery related to AAC
Apps are SLPs and parents of children with disabilities. Because
the technology needs of children who require AAC can vary
widely depending on the needs and skills associated with their
disability impact [1], and because individuals with ASD are fre-
quently cited as using mobile technologies, this project specifically
focused on individuals with experience or relationships with
children with ASD [18].
Speech-language pathologists
Approximately 3000 SLPs were contacted through an announce-
ment on professional listserves such as LinkedIn, American
Speech-Language Hearing Association and the United States
Society for Augmentative and Alternative Communication. SLP
participants had licensure in the United States, experience with
AAC in the form of training, class, or therapy with a client using a
device in the past 3 years and experience with a child with ASD
that used a high-tech communication systems or mobile device as
a form of AAC in the past 3 years. A total of 10 SLPs contacted
the primary investigator with interest in participating, met the
inclusion criteria, completed a test session and provided times
and dates for the 1-h focus group session. Based on scheduling
and availability, a total of 8 SLPs participated in the 1-h focus
group session. All 8 participants were asked to complete a
demographic survey to collect information regarding their age,
ethnicity, number of years in the profession, work setting and
approximate caseload of children with ASD, see Table 1.
Parents of children with ASD
Parents were contacted through the Autism Society of Ohio and
announcements through national organizations serving parents of
children with ASD. SLPs were asked to share the announcement
with parents whom they felt would be interested in participating
in the focus group. A total of 8 parents contacted the
 DESIGN PRINCIPLES OF AAC APPS 355

Table 1. Demographic information of speech-language pathologists participants.

Participant Age Ethnicity Years in profession Setting Caseload of children with ASDa App development
1 27 White 4 Outpatient 75–100 Yes
2 54 White 31 School 30 No
3 35 White 13 School Cooperative 7 No
4 25 White 2 Outpatient 40 No
5 49 White 13 School 5 No
6 29 White 4.5 School FT Private Practice PT 30 No
7 43 White 13 School 5–10 No
a
SLPs provided estimates of the number of children with Autism they had worked with using an iPad or app as a communication device.

Table 2. Demographic information of parents of children with autism spectrum disorder.

Participant Age Ethnicity Age of child AAC strategies used App development
1 47 White 4 PECS, Sign Language, LAMP No
2 43 White 4 and 6 PECS, Sign Language, LAMP No
3 40 White 6 and 9 PECS, Sign Language, Vantage Lite with Unity, LAMP No
4 35 White 6 and 8 PECS, Sign Language, Vantage Lite, LAMP No
5 49 White 17 and 19 PECS, Sign Language, Proloquo2Go No

primary investigator. During scheduling, 3 parents did not com-
plete scheduling resulting in a group of 5 parents. Parents pro-
vided information regarding the age of their child/children, and
the AAC strategies they used as well as whether they had been
involved in App development. Autism diagnosis and severity was
based on parent report. Children’s ages ranged from 4 to 19. All
parents identified the use of multiple AAC strategies in the demo-
graphic survey, see Table 2. Additionally, four out of five parents
had multiple children diagnosed with ASD. A group of 4 parents
completed the one-hour focus group session with the primary
investigator. Because of scheduling conflicts, the remaining parent
participated in an individual session with the primary investigator.
Setting
The focus groups were conducted online using AdobeV
R
shapes, message construction supports and alternatives to a grid,
see Figure 1.
Play mode
Play mode designs referred to game interfaces that children
would have access to as a space “play” with language concepts
and symbols. These designs offered a chance to explore language
representations within the context of familiar games or meta-
phors. Participants were asked to think about how children who
use AAC can play with language as well as whether the designs
would be appealing or engaging for children. Features examined
in play mode included symbol sets, location of play mode, errors,
popular game characteristics, gestures, character assistants, videos
and points, see Figure 2.

ConnectTM, a web conferencing platform that allows for hosting Incentives

meetings, video conferencing and webinars1. All participants were
Incentives can be a potentially motivating tool in a traditional
contacted to perform a test session with the primary investigator
behavioral paradigm to increase the likelihood of a behavior con-
to ensure their computer supported the audio and visual compo-
tinuing. Participants were asked their opinions regarding different
nents of the program. Participants were able to troubleshoot
types of incentives as well as how they felt they could be incorpo-
problems as well as learn to navigate the platform. If participants
rated, see Figure 3.
did not have access to a working microphone on their personal
computer, a headset was mailed to them.
Procedures
Materials SLPs and parents of children with ASD participated in separate
focus groups but viewed the same stimulus items and followed
Materials for each focus group included visual representations of the same procedures. Participants completed individual 5–10 min
possible AAC app designs created using MicrosoftV PowerPoint,
R

test sessions with the primary investigator where they provided

poll questions and discussion points. Visual representations were
created for a daily communication mode, play mode and incen-
tives. Materials were developed based on previous work reviewing
features of popular children’s Apps [6] and focus groups of chil-
dren without disabilities and their parents [15].
Communication mode
Communication mode referred to designs that would be used as
a child’s daily communication system. The majority of current AAC
Apps make use of a grid format. While the grid is an efficient lay-
out, participants were asked to think about how it could be made
more fun and engaging for a child. Specific features explored
were enhanced cursors, animation, message window orientation,
available dates and times for the 1-h focus group session, gave
their informed consent, completed a demographic survey and
received instructions for using the program.
For the 1-h focus group session, participants joined the Adobe
Connect meeting using a link sent to their email address and their
personal computer. The sessions lasted approximately 1-h.
Participants could type their responses in a message window or
respond verbally. The message window was available during the
session, and all participants were able to view messages from fel-
low participants. The session began with a brief introduction of
the purpose of the group and the structure of the questions that
would be asked. Each group viewed the communication mode
designs followed by play mode and incentive designs. The pri-
mary researcher led the discussion. For each design, participants
356 J. B. BOSTER AND J. W. MCCARTHY
Figure 1. Example communication mode interface designs.
were asked for their initial thoughts and opinions, benefits and
drawbacks of the design and what could be altered. Discussion
was also directed to specific aspects of a design following the ini-
tial remarks. The primary researcher would provide a summary of
the group’s opinion to end a discussion, ensure that all partici-
pants had provided their opinions and determine agreement on
specific features. Discussions were followed by poll questions. The
discussion was recorded using Adobe Connect and transcribed for
analysis. Participant’s discussions were categorized according to
each design feature, and benefits and concerns were identified
from comments. Data were also collected from responses to poll
questions.
Results
Communication mode
Enhanced cursors
SLPs and parents viewed enhanced cursors as a potentially benefi-
cial feature. One parent stated, “I like the wand, I think it makes it
more fun than just your finger pointing to different things.” The
SLP group felt enhanced cursors would be helpful for children
using eye gaze and indicated preferences for additional features
the enhanced cursor could facilitate such as hi-lighting cell bor-
ders and enlarging cells for direct-selectors. An SLP stated, “I really
like anything that highlights the area around the box to make it
very clear which icon is selected.” SLPs and parents also provided
drawbacks of using an enhanced cursor. Discussion in each group
indicated this feature might be distracting for some children, for
example a parent stated, “My kids personally would concentrate
more on the look of it, the different colours, than they would the
actual communication choices.” Based on a poll, all participants
agreed that the enhanced cursor feature should be a customizable
option.
Animation
Overall SLPs and parents were receptive to the use of animation
in AAC Apps. In the interface example, animation was used to
draw attention to the symbol selected. SLPs viewed this as a
potentially motivating aspect of design. SLPs were interested in
expanding the animations to symbols (“I really like the animation
for the symbols.”) and text (“I would also like the option of
sending the symbol and text or just the text to the message
window.”). Parents also saw potential benefits of animation
(“I like seeing that because I think it helps the child see what
they’re saying.”). Drawbacks SLPs and parents identified to this
feature were efficiency, (“For my kids the more important factor
is that it’s instantaneous.”), visual distraction and unclear commu-
nicative intention (“It could become visually distracting-children
preferring the animation rather than actually creating genuine,
communicative messages; I can see some of my children select-
ing icons based on the animations they enjoy instead of the
meaning.”).

Figure 2. Example play mode interface designs.
Additionally, SLPs viewed this feature as a potential teaching
tool (“ … for teaching it would be a great tool.”). Using animation
in this way could potentially slow communication down, which
for some may be a drawback, but SLPs identified this as a poten-
tial strength of the feature, “I kind of like that it might slow you
down a bit, if you have to wait for the icon to move up before
selecting the next one. That could be good.” All SLPs were in
agreement that this feature should be customizable to best meet
individual needs.
Message window orientation
In regards to message window orientation, 7 SLPs and 4 parents
agreed that the message window should be oriented left to right.
When discussing the vertical arrangement with SLPs, literacy was
a primary focus. “It doesn’t enforce literacy development,” one
SLP said of this design. Parents also attested to this point, “I like
left to right because I feel like it prepares them better for writing
later in life, and they’d already be familiar with the left to right.”
While participants were in agreement, discussion around children
with visual impairments in the SLP focus group revealed that 3
SLPs had found it necessary to use a vertical arrangement in the
past, “I have had to use or set up vertical for some students
because it is a more viable option for them and they use the
device and application more with the vertical set-up versus the
horizontal.” “ … a couple of students that I serve find the vertical
arrangement more appealing and more engaging.” “ … at times it
DESIGN PRINCIPLES OF AAC APPS 357
is necessary to have a vertical display.” As a result of this discus-
sion, SLPs agreed a vertical display was a possible customizable
feature.
Shapes
Participants were asked to identify benefits and drawbacks of
using shapes in the message window and as a categorization tool.
SLPs favoured this feature and stated, “Shapes are an interesting
idea and would definitely be distinctive, if only because colour-
coding has become so standard.” The idea of using this design as
a teaching tool was supported by SLPs, “I do like the idea of
shapes as a teaching tool.” One parent also favoured the use of
shapes in the message window, “I like that concept of them hav-
ing to put the right piece in the right shape, and it also teaches
matching." A drawback to this design identified by an SLP was its
ability to be used long-term, “It may help as a teaching tool, but
it would take up a fair amount of real estate on the grid long-
term.” Two parents identified lack of communicative intent as a
potential drawback, one stating in reference to her son, “I think
he would concentrate more on the shape than the actual commu-
nication part of it.”
Message construction supports
Participants viewed the design that incorporated the use of colour
categories and puzzle pieces to support message construction
and again identified both benefits and drawbacks. The benefits of
358 J. B. BOSTER AND J. W. MCCARTHY
Figure 3. Example incentives to incorporate into interface designs.
this design were noted in the following comments by SLPs, “I like
it for teaching.” “Some of my kiddos using a topic display could
benefit.” “I think within a topic display like grid this could poten-
tially be helpful.” In the individual parent session this design was
also seen as a potential game interface, “I’d rather see this as a
game.” The general consensus for the group was that this design
would be more suited as a game or learning tool compared to a
daily communication design. Drawbacks included limited variabil-
ity in sentence structure a puzzle design could offer and limitation
of novel utterances: “I think it would potentially promote a type
of sentence rather than true generative language,” “It makes me
feel that novel utterance could be more difficult, I see some of
my students becoming more rigid in connecting the puzzle pieces
rather than making meaning of their intent.” Parent participants
were primarily concerned that this design could be visually con-
fusing for children. The use of colour-coding in the design was
identified as an important component within this design, one par-
ent stated, “I’ve always liked that. My son doesn’t quite get verbs
so the colour helps them understand which one is an action
word. So I like that.”
Navigation
Alternate navigation options were explored based on an interface
in which a child could move through vocabulary items with the
swiping gesture available on the iPad. A benefit of this design
was identified during the SLP group, “I like the idea of swiping as

Figure 4. Preferred features in communication mode.
a feature. A lot of students want to swipe anything with a screen.”
SLPs also favoured the idea of incorporating this feature as part of
a game. Parent participants did not identify benefits with this
design. The drawbacks identified by SLPs and parents centered on
the lack of a consistent organization pattern. The majority of par-
ticipants, 5 SLPs and 2 parents, felt that if this design were cre-
ated a consistent organization pattern for the symbols should be
used. SLPs were primarily concerned that no consistent motor
plan would be developed and that speed would be negatively
impacted by this design. One SLP stated, “Swiping possibly to get
to more vocabulary, but swiping in general doesn’t allow for a
motor plan to develop for access.” Additional SLPs agreed and
added their comments: “I am also concerned about the motor
planning in learning to construct messages quickly and
efficiently.” Visual distraction, overstimulation and efficiency were
also identified as primary concerns by both parents and SLPs.
Comparison poll of features in the daily communication mode
Coloured categories emerged as being the feature preferred most
in the daily app designs for SLPs and parents. The majority also
favoured grid displays with only 1 participant identifying the use
of an alternative to a grid layout as a possible route for a daily
app. Other features received support from less than half of the
participants, see Figure 4.
Play mode
Location and availability of play mode
The majority of participants, 4 SLPs and 3 parents, selected play
mode as a separate app instead of an embedded feature. Having
an in-app play mode option was viewed as beneficial by only 2
SLPs due to funding. One stated, “I agree that teaching Apps
should be an in-App feature versus their own app because some-
times insurance doesn’t allow us to open the iPads purchased
through insurance.” In contrast, 2 SLPs stated their preference on
having a separate app for play mode. The concern identified was
that an in-app play mode would limit a child’s access to their
communication system, “I tend to use other technology to teach
or play so that their communication or words are always available
to the end user. If you include games within the app then their
access to language while playing is gone.”
Errors
SLPs were in favour of allowing children to create both correct
and incorrect messages in play mode, an SLP stated, “Playing with
DESIGN PRINCIPLES OF AAC APPS 359
language is critical. That is what all children do!” A second SLP
added, “I like when children are allowed to get it wrong and must
rearrange to get it right, there’s a lot of thinking going on there.”
Another SLP suggested errorless learning in a beginning level of
games but greater flexibility as the child progresses, “Why not
both? Have multiple levels in the game, an early level that is lim-
ited to correct word order (errorless learning), and a later level
that allows children to arrange words in various orders, hear the
playback and get feedback.” In response to the poll question
regarding which types of messages children should be able to
construct 5 out of 7 SLPs chose both incorrect and correct mes-
sages and 3 out of 5 parents chose only correct messages.
Popular game characteristics
SLPs and parents identified motivation as a benefit for designs
incorporating popular game characters. An SLP commented, “It
would definitely be a high-interest game for some kids.” A parent
stated, “We've actually never played Angry BirdsTM oddly, but I
would think for kids who do, just the fact that they're there would
make this appealing.” In response, 3 additional parents agreed
with this statement. When asked whether it would be helpful for
the symbols to fall to blanks according to where they fit in the
sentence, SLPs generally felt this was a good idea, “I could see
that being a benefit; “I think that’s a good idea, especially for an
early learning mode.” Parent participants also favoured this idea.
SLPs added additional opinions regarding potential changes to
the game, “ … maybe in a later mode they have to arrange the
words in the correct order, but then they get extra points for it.”
This brought about the idea of scaffolding the game to build
children’s skills in the SLP group, “You could initially even set up
where they have to release them in a specific order, so that it has
to be correct, later they can release them in any order and earn
points for putting it into sentence construct that’s appropriate.”
Concerns regarding motor difficulty were the primary drawback
for SLPs. Additional drawbacks identified by SLPs included access
issues, the order a child may hit a word, and obsessive behaviors.
Point systems
Participants were asked their thoughts regarding earning points in
play mode. Five SLPs and 5 parents felt this would be appealing
to children; however 2 in each group felt points should exist only
in play mode. During their discussion, participants appeared to
like the idea of earning points to unlock levels in the game rather
than as a means of earning incentives, “I think points to unlock
levels and short videos of the Angry Birds actually acting out the
360 J. B. BOSTER AND J. W. MCCARTHY
sentence constructed.” One SLP felt the game itself was the incen-
tive/motivator, “I'm not sure that would really be rewarding, I
think earning points to unlock higher levels for kids who are
gamers makes sense. I think earning points for other kids is not
really a motivator just playing the game is the motivator.”
Gestures
An interface was presented in which stacked symbols would fall
when the iPad was shaken. A benefit identified in the SLP group
was the incorporation of the effect to clear the message window.
Parents favoured this design compared to SLPs and began to dis-
cuss it as a possible game. All 5 parents found this design appeal-
ing, one stated, “My kids would find this incredibly appealing and
enjoyable.” They have an App called Stack the StatesV, and they
R
know the states on the map simply because they can sit and do
this. Additional parents supported the design and provided con-
structive feedback, “I think my daughter would like this if you had
to build a sentence and then it played a video of whatever sen-
tence you made,” “I feel like if there were blanks up here, like for
a noun, pronoun or verb, they could just play with it or they
could even line them all up and read the words.” Parents contin-
ued to build on this idea and suggested additional modes of the
design, “If it had both modes where they had to make a sentence,
or we can just play.” In contrast, the majority of SLPs were not in
favour of this design concept. Drawbacks identified included vis-
ual confusion, lack of consistent motor plan, and lack of a learning
component. The only drawback identified by parents was poten-
tial excessive shaking of the communication device.
Character assistants
SLPs and parents felt including popular children’s characters
would appeal to children and benefit future AAC Apps. One par-
ent stated, “If it was customizable, and if there were 100 cartoon
characters and you got to pick the one your child loves, that
would be huge.” In response, 3 additional parents agreed stating
their child would “love having a character they like.” Parents pro-
vided ideas regarding the character assistant stating, “he would
want to move him around or line him up, and he could click on
the words and say them out loud.” Parents also provided the idea
that the character should “say the words,” and that his lips could
be moving. A potential idea for this design also evolved during
discussion in the SLP group, “Maybe if the child touched the icon
the superhero could get it and deliver it to the sentence area.” A
drawback identified by SLPs was lack of motor planning and a
potential drawback mentioned by a parent was that a child may
Figure 5. Preferred features in play mode.
not understand the job of the character assistant, “I don’t think
my son would understand that that person is there to help him.”
Videos
SLPs and parents each identified benefits when presented with
the idea of having a stage where children could drag symbols
and see a video of the message they create. SLPs stated, “Helping
to add meaning is beneficial, I like it,” “I like this to reinforce sen-
tence construction,” “Yes, I like it. Videos are of high interest with
many of my students. I would like to have the option to have ani-
mation and/or real people.” In the parent group 2 participants
stated their children would love this game. A drawback men-
tioned by SLPs for this design was related to motor abilities,
“Dragging can be hard, selecting may be better.” The only draw-
back identified in the parent group was the simple sentence struc-
ture in the example interface. A parent proposed longer
sentences, “you could just match a few, say three words out of
the sentence structure, that way they would get more language
than just the three words.”
Comparison poll of features in play mode
Popular game characteristics and video clips of messages were
the features of play mode that received the greatest support from
both SLPs and parents, see Figure 5. Although in the discussion,
parents supported the use of character assistants it was not
recorded as a preferred feature in the poll results.
Incentives
SLPs felt incentives would appeal to some children more than
others. It appeared to be a feature that would be highly depend-
ent on the child and need to be customizable. An SLP stated “ …
I would think this need to be an option as with other things.”
Visual distraction was a potential drawback. Parents stated con-
cerns that their child would focus only on the character, “If a char-
acter is present, my son only sees the character, he’s not going to
notice Elmo’s eating, just Elmo,” “My son would really pay atten-
tion to that … he would also only look at the character.”
Discussion revealed parents favoured the character assistants com-
pared to the character sets.
Features of the iPad
Specific features of the iPad itself were examined, see Figure 6.
Touch screen controls such as swiping and dragging features
were identified as being an area of interest for inclusion in AAC
Apps. However, only 3 SLPs identified responses to movements as

a desirable feature to be incorporated into AAC Apps. While these
movements can be attractive and interesting to children, SLPs
stated this could be a distracting feature. Other possible features
were discussed in the SLP group including feedback in the form
of vibration. This was a desired feature by several SLPs, “I still
think some feedback such as a vibration for icon selection could
be a good feature.” A final idea brought up in the SLP discussion
was the use of character voices for auditory scanning, “Also audio
scanning, could character voices be used,” “That would be great,”
“Character voices would be a fun incentive!” All participants felt
the camera should be incorporated into future AAC Apps. A par-
ent participant also identified the microphone, as another feature
of the iPad they felt should be incorporated, “microphone for kids
would be cool to record their voice.”
Discussion
The responses to discussion points and poll questions during the
focus groups provided insight on appealing design features for
future AAC Apps. SLPs and parents of children ASD provided sup-
port for their opinions and actively expanded upon the ideas and
thoughts presented by others. The groups agreed on several fea-
tures that should be customizable such as cursors and animation.
They also identified features that would be appealing such as col-
our-coding, and agreed that certain features were not as import-
ant including alternative navigation abilities and incentives.
Results showcased the range of stakeholder opinions, how they
overlap and also how they converge. This input can be used to
further guide future developments in AAC interface design.
Appealing features and their perceived benefits
Communication mode
Based on the results of both focus groups, the primary appealing
features associated with designs for communication mode were
customization options, animation and colour-coding. Benefits
were noted for each of these features as well.
Customization capabilities that allow for changes to be made
for teaching purposes and daily use were appealing to SLPs. This
result is not surprising as SLPs would have perspectives on mul-
tiple children and their call for features to be customizable likely
reflects their desire to options for a variety of children on their
caseload. It is possible that the parents’ agreement reflects the
fact that many children with ASD vary in their ability to handle
certain stimuli. Parents may also be especially sensitive to their
child’s changing needs and interests that may necessitate frequent
changes to their AAC system. Customizable options could also
support the need for children to have additional supports early
on in the teaching process that can be faded later. Having the
ability to include features during an instruction session and then
Figure 6. Appealing features of the iPad to incorporate.
DESIGN PRINCIPLES OF AAC APPS 361
turn them off could be a potential avenue to explore. The inclu-
sion of menus that allow features to be quickly turned on or off
would allow for experimentation to best meet a child’s individual
needs. The desire for customization also appears to reflect a desire
for “easy” customization. This process as it exists now in AAC
Apps and devices is often time consuming and may or may not
benefit an individual’s experience and there has been a call for
Apps to incorporate Just in Time (JIT) solutions that allow for
rapid changes. Removing the time it takes to include customized
features can only benefit a child’s experience with their communi-
cation device. Customization may also allow an AAC App to “grow
with a child.”
Animation also emerged as an appealing design feature for
parents and SLPs. Although studies have found value in animation
[19–21] the optimal way to realize animation within AAC displays
is not yet clear. As an increasing amount of research is generated
relative to animation in AAC, it will be important to translate the
research into options within AAC interfaces. In the current study,
participants appeared to like animation as it related to feedback.
The use of animation as a feedback mechanism appears the most
logical place to start as it is a relatively easy to customize feature
already available in varying forms on some Apps. For example,
the app, Avaz2, includes feedback on selection in an animated
form as an option, where the item grows bigger to indicate that
an item was selected. This feature is consistent with research from
McCarthy et al. [19].
Finally, based on the results of discussion and polls, colour-
coding was identified as an appealing feature among both SLPs
and parents, with 4 SLPs and 2 parents in agreement. As this fea-
ture has been included in many AAC devices to date it may be a
feature that not only helps a child but also those assisting them
with their communication. Colour-coding was viewed as a helpful
teaching feature and may be a type of visual cue to help children
construct messages correctly. Colour has been implicated as
important particularly as it relates to a logical match with the col-
our of the desired item [22] or the means it may organize displays
and reflect the underlying emotional content of items [23]; how-
ever, there is not necessarily consensus on the exact colours to
use to organize items beyond conventional and arbitrary designa-
tions of orange for nouns and green for verbs [24]. The ability to
change backgrounds and line colours is currently possible but can
vary in difficulty from being done per individual symbol or page
to being something that could be chosen at the outset, but not
necessarily be changed globally with ease.
Play mode
The results of the focus groups indicated that both SLPs and
parents viewed play mode as a positive support for a child who
requires AAC. The interface designs that aimed to support lan-
guage learning and message construction with popular game
characteristic and videos were seen as both appealing for children
and beneficial. These designs received the largest support from
participants in comparison to other features displayed in play
mode, 6 of 7 SLPs and 4 out of 5 parents selected the Angry Birds
design as preferred and all participants selected movie clips of
messages as a preferred feature.
Spaces that allow children to play with language can be
powerful teaching tools and allow parents and SLPs to work with
children while playing games that are interesting and motivating
for children. Use of popular game characteristics and characters is
potentially motivating and appealing to children. Several parents
felt that including these characters would interest their child. This
sentiment of interest also supports the idea of children who “lose”
362 J. B. BOSTER AND J. W. MCCARTHY
interest in AAC Apps and go elsewhere on the device. As [11]
noted, taking lessons from toy manufacturers rather than trying to
re-invent, or out-invent them might be a better means toward
developing more appealing systems.
The use of videos embedded into AAC Apps was also an
appealing feature with associated benefits. Both SLPs and parents
favoured these designs as a means to represent messages a child
created and as a tool to help children learn semantic and syntac-
tic concepts. Researchers explored the use of YouTube style vid-
eos that represented concepts such as “on” or “in” [25]. Videos
such as this may be incorporated for instructional purposes to
teach concepts. These findings also support the findings in that
children with Autism benefit from visual materials and video rep-
resentations [18]. Once children display an understanding of such
concepts, videos can be expanded to further provide children
practice. For example, children may only receive one word and
view the corresponding video initially, additional words can be
added to further emphasize meaning and then provide increasing
levels to practice with the word. Providing a means for children to
see what they create may also help them to see whether the mes-
sage they create is what they intended. Further investigation is
necessary to examine whether including video representations of
constructed messages would support acquisition of vocabulary
items and use of grammatical structures.
Concerns
Communication mode
A primary concern of SLPs evident in the discussion of daily com-
munication interface designs was “motor planning.” SLPs were
concerned that cursors and alternative navigation capabilities
would interfere with the creation of a “stable motor plan.” This
preference most likely comes from the background several SLPs
had in the Language Acquisition through Motor Planning
(LAMPTM3) approach [26]. Parents did not appear to have a prefer-
ence for a particular organization pattern for symbols and did not
discuss motor planning as a priority despite the fact that many
parent’s children had experience with this approach. This may be
because the parents included in these groups were not as attuned
to this concept as the SLPs. In keeping with features that support
motor planning, SLPs also preferred consistent organization pat-
terns for symbols.
Consistent location approaches frequently use a feature of sim-
plifying a grid by reducing the number of items in a selection set
but leaving gaps for new items to be added. For example, in
learning to type an individual could see a QWERTY keyboard with
only the “j, h, f” and “d” keys shown and blank spaces for the
remaining letters. The idea of a grid that could eventually be
populated with other concepts in a predictable way while not
moving items already learned was not presented for consider-
ation. While the idea of reinventing the current grid design or
developing alternatives appeared to be more controversial, SLPs
and parents felt designs presented in the daily communication
mode could be suited as teaching tools for language learning.
Exploring whether these designs are more suited as teaching
tools compared to daily communication solutions is needed. It is
also important to investigate alternative designs that take advan-
tage of additional features of the iPad that may currently be
underused in existing designs (e.g., touchscreen pressure sensitive
response, gestures, etc.). It is important to investigate whether
there is merit in adhering to current grid designs. Current research
into Visual Scene Displays for children relies on embedded sym-
bols underneath photographs of actual scenes [27]. It is likely that
an interface would need to return to a grid format for efficiency
purposes, such alternatives could potentially be incorporated as
part of a hybrid display or transition from a visual scene. Without
further investigation it may remain unknown whether such
changes can positively impact children’s abilities to navigate their
AAC devices as well as whether children find such interfaces more
appealing than current designs.
Play mode
Despite positive feedback on play mode designs, SLPs and parents
did note potential concerns. Specifically, the SLP group indicated
concern regarding how children would communicate when
engaged in a play interface. A possible reason for this is their
focus on the importance of maintaining constant access to the
communication device for a child. SLPs felt that having access to
play mode as an in-app feature would separate children from their
ability to communicate. It is important to consider how games in
play mode can be developed to best support children’s learning.
Currently there are reports of children having multiple tablets
with different covers where one is designated as the videos and
games iPad and the other as the communication iPad [28].
Because play mode appears to be a valuable feature, it is import-
ant to further investigate how children can move back and forth
between play and communication modes. The exact marking of
how to switch between modes was not explored in the current
study. It is possible it could be done through a physical event
such as shaking the device or pressing the home button a desig-
nated number of times. Also uncertain is who should be in charge
of being able to switch back and forth between communication
and play mode.
A second concern regarding play mode was the availability of
the feature for children. The concern that play mode should not
be available at all times was evident in both SLP and parent ses-
sions. However, it may be necessary to further examine reasons
why children navigate away from their daily App. If they are navi-
gating away from their daily communication App, one could
argue that the option of a play mode that supports language
learning is preferable to other Apps with no educational supports.
Incorporating popular characters and games may also aid in
including children who use AAC with their peers. Peers may find
the inclusion of these characters interesting and participate in
popular games with children who are involved with an app that
includes recognizable features. Same-age peers familiar with
popular game constructs could also be potential models for chil-
dren who use AAC. If the Apps are appealing to same-age peers,
this could also be motivating for the child. The shared experience
of playing a game with a peer invites a variety of communication
skills and psychosocial skills and could be an overarching benefit
of having a play mode available.
Appeal, benefit and concerns regarding incentives
The most appealing incentives for SLPs and parents were those
that included popular children’s characters. Play mode itself was
viewed as an incentive and parents were interested in incorporat-
ing popular characters within games. Parents viewed character
assistants as more appealing that character sets (symbol sets
incorporating a popular children’s characters) but SLPs supported
each equally. Parents felt their children took great interest in any
activity that incorporated their favourite character. SLPs favoured
characters as well and agreed characters embedded in an AAC
interface would be appealing and motivating feature for children.
These results are consistent with findings that found that popular

character customization was desirable. The concerns identified
regarding inclusion of characters were related to customization
and symbol representation [11,15], These concerns were raised by
parents only. Parents discussed how their children’s favoured char-
acters often changed weekly. If characters were to be included, it
would be important to support the ability to change them quickly
based on children’s preferences. In terms of symbol representa-
tion, parents preferred character assistants to character sets
because they felt altering symbols may blur their meaning. They
were also concerned their child may focus only on the character
and not understand the action or concept the character is
attempting to convey as part of the symbol.
Currently, many AAC Apps do not offer characters unless
they are customized and included by those setting up the
device. Characters may be included in a variety of manners
such as in symbol sets, operating as a separate assistant, or
incorporating their familiar voices. It would be of interest to
explore how children would like characters to be added to AAC
Apps as well as whether this inclusion would impact children’s
ability to understand a symbol’s meaning. In order to determine
the best way to include characters into AAC Apps, future
designs may need to be developed and presented to children
for their feedback.
Appeal, benefit and concerns regarding features of the
iPad
Overall features of the iPad that were seen as beneficial by SLPs
and parents were the camera and touchscreen capabilities. These
features are not only unique to the iPad, but are included in
many technologies with which children have experiences:
Phones, tablets, and some children’s toy make use of cameras
and touchscreens. Children may observe their parents using
these devices on a regular basis and take interest in learning
how to control them. Many parents also provide these devices
to their children at an early age to allow them to play games
and watch cartoons. The ease with which the camera can be
accessed through Apps likely plays a role in the desire to con-
tinue to include the camera in future Apps. Many AAC Apps
interface with the iPad’s onboard camera allowing users to
import their own pictures into interfaces and personalize their
systems. Identifying additional uses for the camera beyond cus-
tomizing buttons would be a potential avenue to explore. The
touchscreen capabilities of the iPad also offer additional options
for AAC Apps. It is important to consider how this specific
aspect of the iPad impacts interface designs. It is imperative to
capitalize on new features of technology that can provide add-
itional benefits to children who use AAC. Limiting interfaces to
their current designs based on devices without touchscreen
capabilities may exclude designs that help children navigate and
create messages.
Comparison of SLP and parent responses
Overall SLPs and parents appeared to share opinions regarding
design features of AAC Apps. The opinions of both groups in
terms of appealing features, benefits and concerns overlapped for
both communication mode and play mode. Divergence of opin-
ions occurred primarily regarding the importance of motor plan-
ning and the specific use of characters as incentives. Differences
in opinions may have occurred due to specific experiences with
Apps SLPs and parents have used before as well as an awareness
of the particular features incorporated in current Apps. Potential
DESIGN PRINCIPLES OF AAC APPS 363
disagreement between SLPs and parents may have arisen based
on trainings and beliefs about which features are most important.
For example, those with experiences with LAMP may be more apt
to support designs, which foster motor planning. Due to the
nature of the profession, SLPs may also be more focused on only
the speech and language benefits of an App design whereas
parents may be more considerate of other factors such as moti-
vating characteristics for their children. Parents also appeared to
draw their opinions from known interests of their children while
SLPs based their opinions on clients. While SLPs did remark that
desired features were dependent on a particular client’s abilities,
their responses were often more general in nature. The overall
agreement between SLPs and parents allows for designs that
meet both groups expectations without sacrificing features pre-
ferred by one group over another. The opinions of children should
also be explored to assess how their values and preferences com-
pare to SLPs and parents.
Limitations
A limitation of this study lies in the small number of parent partic-
ipants. Focus groups typically consist of 6–8 participants where
this group consisted of 4. The amount of information collected
about the parent’s children is also a limitation of this study. ASD
diagnosis and severity were based on parent report without add-
itional verification. Individual characteristics, speech and language
skills of the children were also not addressed in the current study.
Participants in this study were also predominantly white females,
which may not be representative of all cultural, economic, and
social backgrounds. The preference for left-to-right message win-
dow orientation for example would likely not be seen in Arabic or
Hebrew speaking participants.
Conclusion
This study highlights important future directions based on the
input of key stakeholders interfacing with AAC Apps. The desire
for customizable interface features, games that support language
learning, and motivating designs that include popular children’s
characters are each aspects that researchers and App developers
must take into consideration. Not only is it important to develop
such features, but it is also necessary to conduct additional
research to determine which features support children who
require AAC to the fullest extent possible. Consideration should
be given to the skills that both researchers and developers offer
when preparing to design new AAC Apps. Developing a partner-
ship can ensure that future interfaces are properly informed by
the knowledge of both SLPs and developers. It is also important
for all parties involved to be open to changes. Technologies will
continue to transform over time with advances in engineering
and research. These new developments may potentially present
new opportunities that can benefit the field of AAC but only if
those involved are open to change as well.
Notes
1. Adobe Systems is a computer software company. Adobe
Systems Complex, 345 Park Avenue, San Jose, CA 95110.
2. Avaz is an AAC App developed for children who are non-
verbal or have difficulty speaking designed by Avaz, Inc.
3. Language Acquisition through Motor Planning (LAMP) is an
augmentative and alternative communication (AAC)
approach designed for speech-generating devices that focus
364 J. B. BOSTER AND J. W. MCCARTHY
on concepts such as readiness to learn, joint engagement,
unique and consistent motor plan, auditory signals and
natural consequences [26].
Acknowledgements
The study was funded by internal funding from Student Research
Award of the College of Health Sciences and Professions at Ohio
University, Athens, OH, USA.
Disclosure statement
The authors report no conflict of interest related to the study.
Funding
The study was funded by internal funding from Student Research
Award of the College of Health Sciences and Professions at Ohio
University, Athens, OH, USA.
ORCID
Jamie B. Boster http://orcid.org/0000-0001-9317-0700
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