Background and Context

The healthcare sector encompasses all institutions and professionals dedicated to maintaining, promoting, or restoring health. This international research project focuses on the key settings of healthcare delivery - hospitals, medical practices, and hospices - and investigates communication accessibility within these environments. Effective communication is essential for high-quality care, yet it is often compromised for individuals with Complex Communication Needs (CCN). This group includes not only people with congenital disabilities or neurological conditions but increasingly also individuals with dementia and those with limited language proficiency due to demographic and migratory shifts. In Germany, current staffing shortages further exacerbate communication barriers, not only for patients but also among migrant healthcare professionals. For people with degenerative conditions, AAC also plays a vital role in end-of-life care.

To accurately assess the needs of all stakeholders, the project applies a participatory research approach that includes healthcare professionals, individuals with CCN, and parents of children affected. While AAC is recognised as essential outside of healthcare (as per UN CRPD Article 24(3) and ICF d310-369, implemented in Germany through SGB V), it remains largely unfamiliar in medical settings. This gap forms the foundation of the project's research focus.

Project Components

The project began in 2013 with the research-based development of AAC tools using Design Thinking methods. Since then, key research areas have emerged:

1. development of visual AAC tools (communication books and apps) for specific healthcare contexts:

• Pharmacy (UK Apo)
• Nursing care (UK Pflege)
• Emergency care (UK Emergency)
• Oncology (UK Oncology)
• Pediatric pulmonology and allergology (UK Pulmonology)
• Pediatric neurology (UK neurology)
• Neonatology (UK Neonatology)
• Hospice care (UK Hospice)

2. analysis of barriers and facilitators for implementing AAC in healthcare:

• Surveys with hospital staff
• Surveys with individuals with CCN

3. analysis of barriers and facilitators for barrierfree wayfinding and orientation in clinical settings:

• Surveys with hospital staff
• Surveys with parents

The implementation of high-tech communication aids often fails due to a lack of support from the social environment (Braun, 2020; Garbe & Herrmann, 2020; Erdélyi & Thümmel, 2015). Studies show that negative attitudes and a lack of expertise among caregivers significantly increase the abandonment rate (Baxter et al., 2012; Donato et al., 2018; Johnson et al., 2006; Moorcroft et al., 2019; Soto et al., 2001). In light of the technological advancements in communication over the past five years, the question arises whether and how Generative Artificial Intelligence (genAI) can offer new solutions to this challenge in implementing Alternative and Augmentative Communication (AAC) aids. GenAI, based on machine learning and large language models, generates contextually relevant and coherent content such as text or images using extensive training datasets. In the form of conversational agents (e.g., ChatGPT), genAI is capable of maintaining dialogues on nearly any topic (Gimpel et al., 2023). Despite its broad applications in communication, its potential use in AAC remains largely unexplored (Lang et al., 2023; Li et al., 2022; Neamtu et al., 2019; Sennott et al., 2019). This PhD project aims to explore the potential of genAI for AAC, addressing both opportunities and challenges of genAI-driven assistive technologies.

• Baxter, S., Enderby, P., Evans, P. & Judge, S. (2012). Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: a systematic review and qualitative synthesis. International Journal of Language & Communication Disorders, 47(2), 115-129.
• Braun, U. (2020). Development in AAC in Germany - a systematic introduction. In J. Boenisch & S. Sachse (Eds.), Compendium of Augmentative and Alternative Communication (S. 20-33). Stuttgart: Kohlhammer.
• Donato, C., Spencer, E. & Arthur-Kelly, M. (2018). A critical synthesis of barriers and facilitators to the use of AAC by children with autism spectrum disorder and their communication partners. Augmentative and Alternative Communication, 34(3), 242-253.
• Erdélyi, A. & Thümmel, I. (2015). Help me to do it (myself)! New research-based concepts in UK professional development. Research Language. E-journal for speech and language therapy and language support, (1), 52-67.
• Gimpel, H., Hall, K., Decker, S., Eymann, T., Lämmermann, L., Mädche, A. et al. (2023). Unlocking the Power of Generative AI Models and Systems such as GPT-4 and ChatGPT for Higher Education: A Guide for Students and Lecturers. University of Hohenheim.
• 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.
• Lang, R., McLay, L. & Rispoli, M. (2023). Advanced Language Models: Potential to Improve Augmentative and Alternative Communication for Individuals with Intellectual and Developmental Disabilities. Advances in Neurodevelopmental Disorders, 7(3), 481-484.
• Li, W., Qiu, X., Li, Y., Ji, J., Liu, X. & Li, S. (2022). Towards a novel machine learning approach to support augmentative and alternative communication (AAC). International Journal of Speech Technology, 25(2), 331-341.
• Moorcroft, A., Scarinci, N. & Meyer, C. (2019). Speech pathologist perspectives on the acceptance versus rejection or abandonment of AAC systems for children with complex communication needs. Augmentative and Alternative Communication, 35(3), 193-204.
• Neamtu, R., Camara, A., Pereira, C. & Ferreira, R. (2019). Using Artificial Intelligence for Augmentative Alternative Communication for Children with Disabilities (Lecture Notes in Computer Science). In D. Lamas, F. Loizides, L. Nacke, H. Petrie, M. Winckler & P. Zaphiris (Eds.), Human-Computer Interaction - INTERACT 2019 (Vol. 11746, pp. 234-243). Cham: Springer International Publishing.
• Sennott, S. C., Akagi, L., Lee, M. & Rhodes, A. (2019). AAC and Artificial Intelligence (AI). Topics in Language Disorders, 39(4), 389-403.
• Soto, G., Müller, E., Hunt, P. & Goetz, L. (2001). Professional Skills for Serving Students Who Use AAC in General Education Classrooms: A Team Perspective. Language, Speech, and Hearing Services in Schools, 32(1), 51-56.

The transition from early childhood education and care (ECEC) to primary school constitutes a key biographical event in early childhood and is associated with profound changes on individual, social, and institutional levels (Albers & Lichtblau 2014; Griebel & Niesel 2020; Oehlmann, Manning-Chlechowitz & Sitter 2011). During this period, children are confronted with new demands, roles, and structures of expectations that require extensive processes of adaptation and coping. Against this backdrop, the ECEC-primary school transition can be understood as a critical life event that calls for active coping with new developmental tasks (Filipp 2007; Filipp 1995; Griebel & Niesel 2020; Griebel & Niesel 2011). For children with intellectual disabilities, this transition represents a particularly sensitive phase, as they often depend to a greater extent on reliable caregivers, repeated routines, and stable peer relationships and friendships in the new learning environment. This frames the transition for this group as a process that is experienced and managed in diverse, individual ways and highlights the need for a differentiated examination of children's experiences and perceptions (Hattie 2013; Pijl, Frostad & Flem 2008). However, research on transitions to date has largely been institutionally oriented, focusing primarily on cooperation practices between ECEC settings and mainstream schools as well as the continuity of educational processes (Mays et al. 2023; Then & Pohlmann-Rother 2023; Seddig 2019). Children's own perspectives are seldom considered and are captured only insufficiently in a systematic manner (Nentwig-Gesemann et al. 2017; Lundqvist 2014). This is particularly true for children with intellectual disabilities, whose perspectives remain markedly underrepresented in the research literature to date (German Institute for Human Rights 2015; Kuhl & Euker 2015; Peltomäki et al. 2026). This is where the PhD project comes in: it aims to foreground the children's perspective in this target group and to reconstruct the transition from ECEC to primary school from their point of view.

• Albers, T. & Lichtblau, M. (2014). Inclusion and transition from ECEC to primary school: competences of educational professionals. An expertise of the Further Training Initiative for Early Childhood Education Professionals (WiFF). Munich: German Youth Institute.
• German Institute for Human Rights (2015). Parallel report to the UN Committee on the Rights of Persons with Disabilities on the occasion of the examination of Germany's first state report under Article 35 of the UN Convention on the Rights of Persons with Disabilities. Available at: https://www.behindertenbeauftragter.bremen.de/sixcms/media.php/13/2015-03-09%20-%20Parallelbericht_an_den_UN-Fachausschuss%20-%20Monitoring-Stelle.pdf.
• Filipp, S.-H. (2007). Critical life events. In J. Brandtstädter & U. Lindenberger (Eds.), Developmental Psychology of the Lifespan (S. 337-366). Stuttgart: Kohlhammer.
• Filipp, S.-H. (1995). Critical life events (3rd ed.). Weinheim: Psychologie Verlags Union.
• Griebel, W. & Niesel, R. (2020). Understanding and accompanying transitions. Transitions in the educational career of children (6.). Berlin: Cornelsen.
• Griebel, W., & Niesel, R. (2011). Understanding and accompanying transitions. Transitions in the educational careers of children. Berlin: Cornelsen Scriptor.
• Hattie, J. (2013). Making learning visible. Baltmannsweiler: Schneider-Verlag Hohengehren.
• Kuhl, J. & Euker, N. (2015). Focus topic: Empirical research on children and adolescents with intellectual disabilities. Empirical Special Education, Vol. 7(1), 3-4.
• Lundqvist, J. (2014). A Review of Reearch in Educational Settings Involving Children's Responses. Child indicators researchVol. 7(4), 751-768.
• Mays, D., Quenzer-Alfred, C., Metzner-Guczka, F., Zielemanns, H., Tölle, L., Soyka, V., Krol, L. & Wichmann, M. L.-Y. (2023). The transition from kindergarten to primary school - an orientation on the state of empirical research. Journal for Primary School ResearchVol. 16 (2), 357-389.
• Nentwig-Gesemann, I., Walther, B. & Thedinga, M. (2017). Daycare centre quality from the children's perspective. A study by the DESI Institute on behalf of the Children and Youth Foundation. Available at: https://kita.rlp.de/fileadmin/kita/KiTa_in_RLP/Qualitaet_und_Evaluation/Qualitaet/Dokumente/2017_07_27_QuaKi_Abschlussbericht.pdf.
• Oehlmann, S., Manning-Chlechowitz, Y., & Sitter, M. (2011). Early educational transition research: from day care centre to primary school. Weinheim: Juventa.
• Pijl, S. J., Frostad, P., Flem, A. (2008). The Social Position of Pupils with Special Needs in Regular Schools. Scandinavian journal of educational research, Vol. 52(4), 387-405.
• Peltomäki, S, Granö, S., Rönkko, E., Pirttimaa, R. Pyhältö, K. & Kontu, E. (2026). Studying the Experiences of Children With Moderate to Profound Intellectual Disabilities in Research: A Systematic Review. Journal of intellectual disability researchVol. 70(1), 1-15.
• Seddig, N. (2019). The subjective perspective of children in the transition from day care centre to primary school. A qualitative study on the subjective experience, perceptions and assessment of children in institutional educational settings. Available at: https://publikationen.ub.uni-frankfurt.de/opus4/frontdoor/deliver/index/docId/54821/file/Seddig,+Nadine_Diss_Publication.pdf.
• Then, D. & Pohlmann-Rother, S. (2023). Transition to formal schooling of children with disabilities: A systematic review. Educational research review, 38, 100492.
• Theunissen, G. (2013). Handlexikon Geistige Behinderung: Schlüsselbegriffe aus der Heil- und Sonderpädagogik, Sozialen Arbeit, Medizin, Psychologie, Soziologie und Sozialpolitik (2nd ed.). Stuttgart: Kohlhammer.