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Despite the many reported benefits of using AT with young children, annual state child count reports identify a surprisingly small and consistently stable percentage of infants and toddlers who have AT listed on their Individualized Family Service Plans. AT suggest several barriers that may account for the limited AT use in early intervention. Family and provider beliefs about using AT, funding issues, the availability of AT devices, a lack of providers who are trained in the use of AT devices, and attitudinal barriers (eg, negative images or a fear of technology) have all been identified as potential barriers.

The scarce use of AT may also be attributed to the relative newness of AT with infants and toddlers and a lack of research examining the selection, use, and efficacy with this population of children. Various researchers and experts have emphasized a family-centered approach as a basis for AT decision making. Parette and colleagues discuss four interrelated domains that should be considered when making decisions about AT use.

The first domain focuses on child factors such as whether AT is related to the child’s goals, whether the intervention would be practical for that particular child, and whether devices are viewed from the perspective of the child’s strengths and needs. A second domain is concerned with AT device features: a device’s potential to increase performance, and practical considerations such as cost, ease of use, comfort, dependability, transportability, adaptability, and durability. A third domain concerns service system factors, which are directly related to the service system’s ability to provide needed AT devices and services.

These factors include financing options, protection from theft and damage, EI personnel training needs, transportation, and transition needs. The final domain is family factors, in which the focus is on the family’s needs, preferences, abilities, and experiences. Team collaboration, viewed as an essential element of a family-centered approach, and the roles that each team member plays may affect the decision-making process. The role of parents as decision-making team members influences what particular device is selected and the extent to which a particular device is actually used within family routines and activities.

(Forgionne 1999) Providers’ philosophical foundations concerning AT strongly influence the way they look at infants and toddlers and their problems and may ultimately affect their decisions about what AT devices and services to use in practice. Assistive technology specialists are the professionals likely to recommend AT devices for school-aged children, but professionals of many disciplines (eg, early intervention teachers, occupational therapists, physical therapists, and speech-language pathologists) are the professionals who recommend AT devices and services for infants and toddlers. (Sengupta, -Hamid 2003)

Mistrett (2001) conducted a review of AT literature in early intervention, and although few empirical studies concerning beliefs about AT were included, she suggested that the beliefs that providers hold about AT use with infants and toddlers may contribute to the underutilization of AT in early intervention. In addition, Sullivan and Lewis (2000) suggested that the limited use of AT with very young children may be due to a common provider perspective that children with disabilities must possess an understanding of cause and effect or other cognitive skills before they can effectively use AT devices.

Similar beliefs about children needing to have specific speech and language competencies before using AAC devices have also been reported. Others have suggested that beliefs about the amount of effort required using AT devices result in underutilization. When providers believe that using AT means giving up on a child being able to learn to perform a particular skill independently, AT is not likely to be.

For example, if providers believe that AAC is a replacement for “natural” communication and not a way of enhancing a child’s communication abilities, then AAC is not likely to be used even when children have difficulty with communication. Beliefs about the costs of AT and the availability of funding for AT devices have also been suggested as potential reasons for underutilization of AT. Providers’ belief that AT is expensive may influence their recommendations when children are young and likely to quickly physically or developmentally outgrow devices.

That providers may not be clear on either the mechanisms or sources of funding for devices has also been suggested as a barrier to utilization. Although studies have reported the effectiveness of AT devices with populations of very young children, more research is needed to describe the factors that influence provider decision making about AT use and the actual decisions that providers make about using AT with infants and toddlers. (Adelman 2001)

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