Developing peer relationships in school is an essential part of growing up. Many children who have little or no functional speech are provided with augmentative and alternative communication (AAC) systems such as speech synthesizers and books and charts of symbols/pictures/words. Such children face many barriers to communication and to developing peer relationships. To date there exists little understanding of the characteristics of interaction between children using AAC and their speaking peers. This paper reports findings from an analysis of interactions between 12 children with physical disabilities using AAC systems and their speaking peers in school. Analysis identifies the primary structures, functions, and modes of communication used by both partners in one-to-one conversation.

Use of voice output communication aids (VOCAs) can be a very effective strategy to assist people with speech impairments in communicating. Despite this, people who use communication aids often express frustration with VOCAs -desiring devices that are simpler, quicker and more effective to use.Whilst it is not possible to resolve all these issues with technology, we argue that significant progress can be made. The use of contextual information is one development that could improve the simplicity and effectiveness of communication aid design. Individuals using a VOCA also face constraints related to the selection of these items.Those using text representation will need to select around 27-40 items (unless using an ambiguous keyboard 5 ), whereas those using graphic symbols may need to select from as many as 4000 items. To navigate this number of items the user is required to make a series of selections Individuals use a range of strategies to select items on a VOCA -some may be able to press directly onto a screen or keyboard (known as direct access), whereas others may have difficulties with co-ordination or control and require alternative access devices. These devices can include alternative keyboards (for example those with key 'guards'), alternative mice (for example, eye gaze or head movement selection), or other controls such as switches. Switches are binary (non-latched) 'buttons' that come in a range of types -with varying size, shape, activation force or method. When using a switch, the user will either press it to select the desired item from a list of items through which the computer is scrolling, or use multiple switches to manually 'move' through the possible selections and then select the desired item 7 .There are few studies measuring actual input or output (speaking) rates of VOCA users, however for text production an output (measured in words per minute -wpm) of less than 5 wpm for switch access 8 , or less than or around 10 wpm for AAC users using any mode 9,10 has been suggested. This can be compared to studies of typing on 'soft' keyboards that suggest rates of between 8-20wpm 11 . As the speaking rate of a typical speaker during conversation may be between 100 and 200 wpm 12,13 it can be seen that current AAC output is in the region of an order of magnitude slower than spoken speech.People who use AAC and VOCAs often cite challenges and frustrations related to the speed of communication using these systems and also in their simplicity of use 14,15 . This has been a focus of prior work carried out as part of the NIHR Devices for Dignity (D4D) Healthcare example, the iOS8 word prediction keyboard claims to take into account " your text messaging style", "who you're writing to", "what the conversation is about" and "how you email" 34 . The Use of Context for Augmentative CommunicationPeople who use AAC may be able to process and use the context of a conversation receptively in the same way as any other individual. However, their operational use of this contextual information is much mo...