The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review

Figures & data

Table 1. Search terms CINAHL database.

(augmentative and alternative communication) OR (AAC) OR (speech generating device*) OR (speech generating display*) OR (communication board*) OR (voice output device*) OR (voice output system*) OR (iPad^a based communication) OR (communication device*) OR (picture communication) OR (symbol communication) OR (picture exchange) OR (aided language)

AND

(speech pathologist*) OR (speech language pathologist*) OR (speech language therapist*) OR (speech therapist*)

AND

(competence) OR (confidence) OR (self-efficacy)

Note. This search was limited to articles that were published in peer reviewed journals and published in English.

^a iPad is a registered trademark of Apple Inc.

Figure 1. Study Selection Flow Chart. Note. Figure 1 has been adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Page et al., 2021).

Table 2. Confidence and competence of SLPs in AAC.

Study	Design	Focus	Definition^a	# P	Inclusion criteria	Confidence/competence
Barman et al. (2023) United States	Survey	Self-perceived confidence in skills to assess and treat AAC clients after graduation	No	726	Student enrolled in master’s in speech-language pathology and at least 18 years of age.	The majority (52%) of students disagreed or strongly disagreed that they were confident in their skills to assess and treat AAC clients after graduation; only 26% agreed or strongly agreed
Biggs et al. (2022) United States	Survey	Self-perceived confidence in AAC tele practice	No	283 SLP	Provides services to clients 3–21 years who use aided AAC and uses tele practice for at least one AAC client	SLPs were most confident following the code of ethics and least confident evaluating progress through tele practice. Overall, confidence levels about AAC tele practice were varied
Burke et al. (2002) United States	Survey	Self-efficacy for AAC intervention	Yes	27 SLP	AAC intervention specialist who primarily provides AAC intervention for the previous year and served 20 AAC clients	Self-efficacy was highest for writing brief tutorials for a new piece of AAC terminology and least for managing AAC interventions and selecting AAC technology for AAC users. Self-efficacy in AAC was high (M = 91.4; SD = 4.92)
Chua and Gorgon (2018) Philippines	Survey	Self-perceived competence in assessment and intervention for different etiologies	Yes	152 SLP	One year of clinical practice and actively practising	SLPs were most competent in assessment and intervention for clients with autism spectrum disorder and least competent in assessment and intervention for clients with Huntington’s disease. Most SLPs rated themselves as not competent in AAC assessment and intervention across client populations.
Joginder Singh et al. (2022)	Pre- and post- survey	Level of confidence supporting individuals who require AAC	No	11	Final-year speech-language pathology undergraduate students who completed the Nika^c training.	Most students rated their confidence as low pre-training but reported higher levels of confidence post-training
King (1998) United States	Survey	Self-perceived competence to provide AAC services to people with different etiologies	No	56 SLP	Employed in a health care setting.	SLPs were most competent providing services to clients with aphasia and least competent providing services to clients with developmental apraxia. Only 18 SLPs perceived themselves as highly competent
Kovacs (2021) United States	Survey	Self-perceived competence in assessment and intervention for different language domains	Yes	200 SLP	ASHA certification	SLPs were most competent in intervention for semantics and least competent in assessment of phonology. Self-perceived competence in intervention was higher than assessment. Most respondents (80%) felt competent in the assessment and intervention for pragmatics and semantics
Marvin et al. (2003) United States	Survey	Self-perceived competence in administering AAC systems	No	71 SLP	SLPs attending ASHA’s 2000 annual connection^b	Only 28% of respondents reported good to very good competence; 72% reported fair to poor competence.
Sanders et al. (2021) United States	Survey	Self-perceived confidence with feature mapping	Yes	272 SLP	Worked in education and had at least one student with CCN on caseload	SLPs were most confident determining page format and least confident in high-tech speech-generating device features. SLPs reported low confidence in feature matching for AAC
Simpson et al. (1998) United States	Survey	Self-perceived competence	No	234 SLP	School-based SLP in Nebraska	SLPs were most competent supporting clients with cognitive impairment and least competent supporting clients with dual sensory impairment. Overall levels of AAC competence were low.
Solomon-Rice et al. (2018) United States	Pre- Post- testing	Competency in providing effective services to children from diverse backgrounds who have complex communication needs	Yes	Not reported	Master of speech-language pathology students completing the Project Building Bridges program	Students were most competent in professional development and least competent in programming and intervention. Students overall self-perceived competence mean scores improved post training (M = 1.86 − 4.43) as did clinical educator ratings (M = 3.88 − 4.49)
Sutherland et al. (2005) New Zealand	Survey	Self-perceived competence in AAC service provision based on aitiology	No	214 SLP	Currently providing AAC services to children and/or adults	SLPs were most competent in supporting clients with developmental delay (paediatrics) and cerebral vascular accidents (adults) and least competent supporting clients with dual sensory impairment (paediatrics) and Huntington’s disease (adults). Only 14% of respondents rated themselves as competent in the provision of AAC services.
Ward et al. (2023) United States	Survey	Confidence in service provision for emergent bilinguals who use AAC	Yes	179 SLP	SLPs who worked with emergent bilinguals who used AAC	SLPs were most confident in intervention and least competent in assessment. The majority of SLPs “strongly agreed” or “somewhat agreed” to the statements of confidence (assessment, n = 56.1%; intervention, n = 64.8%; device selection, n = 59.3%; vocabulary selection, n = 68.5%).

^a Definition refers to the definition provided by the study for the focus area (e.g., confidence, competence, or self-efficacy). Please see supplemental material for a full list of definitions used.

^b American Speech-Language-Hearing Association (ASHA).

^c Nika Project is a nonprofit organization in the United States who provided a 2-week long AAC training program to undergraduate students in Malaysia.

Table 3. Factors impacting confidence and competence.

Study	Focus	Relationships
		Workplace	Years of experience	Clinician age	Training	Resources	Current AAC caseload	Identifies as specialist
Barman et al. (2023) United States	Self-perceived confidence in assessing and treating AAC clients after graduation^a	n/a	n/a	n/a	✓	n/a	n/a	n/a
Biggs et al. (2022) United States	Self-perceived confidence in AAC tele practice	✓	n/a	✓	✓	✗	n/a	n/a
King (1998) United States	Self-perceived competence	n/a	n/a	n/a	n/a	n/a	✓	n/a
Sanders et al. (2021) United States	Self-perceived confidence with feature mapping	n/a	✗	n/a	✓	n/a	✓	✓
Simpson et al. (1998) United States	Self-perceived competence	n/a	✗	n/a	n/a	n/a	✓	n/a
Ward et al. (2023) United States	Self-perceived confidence in providing services for emergent bilinguals who use AAC	n/a	n/a	n/a	✓	n/a	n/a	n/a

Note. n/a = study did not test this relationship, ✗ = no relationship identified, ✓ = relationship was identified.

^a Study participants were SLP students.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), 89. https://doi.org/10.1186/s13643-021-01626-4

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*Biggs, E., Rossi, E. B., Douglas, S. N., Therrien, M. C. S., & Snodgrass, M. R. (2022). Preparedness, training, and support for augmentative and alternative communication telepractice during the COVID-19 pandemic. Language, Speech, and Hearing Services in Schools, 53(2), 335–359. https://doi.org/10.1044/2021_LSHSS-21-00159

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