Parent-reported benefits, barriers, and experiences of augmentative and alternative communication use among children with autism in Nablus, Palestine: a cross-sectional study

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BACKGROUND: Children with autism may have communication needs that require individualized support. Augmentative and Alternative Communication (AAC) can support functional communication, but little is known about parent-reported AAC implementation in Palestine. This study examined parent-reported perceived benefits, barriers, and experiences of AAC use among children with autism in Nablus, Palestine. METHODS: A descriptive cross-sectional study was conducted among 75 parents or primary caregivers of children with autism who were using or receiving structured AAC training. Participants were recruited from specialized autism centers in Nablus. Data were collected using a structured questionnaire covering child and family characteristics, perceived AAC benefits and barriers, and experiences during AAC implementation. The perceived benefit score was calculated from six yes/no items. The final AAC experience score was calculated from seven positively worded items after two negatively worded acceptance-difficulty items were analyzed separately. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman's correlations were used. RESULTS: The perceived AAC benefit score had a median of 6 (IQR 4-6) out of 6. The most frequently endorsed perceived benefit was increased communication opportunities (73/75, 97.3%), followed by perceived better behavior-related interaction inside the home (65/75, 86.7%) and improved understanding of the child's needs (64/74, 86.5%). Reported barriers included difficulty integrating AAC into daily routines (53/75, 70.7%) and difficulty accessing AAC programs (51/75, 68.0%). Awareness of alternative AAC systems was limited (25/75, 33.3%), and 23/74 parents/caregivers (31.1%) agreed that AAC systems are suitable for all children. The seven-item AAC experience score showed good internal consistency (Cronbach's α = 0.841) and had a median of 16.0 (IQR 12.75-19.0) out of 21. A positive correlation was observed between perceived benefit score and AAC experience score (rs = 0.426, p < 0.001). CONCLUSION: Parents/caregivers commonly reported AAC-related perceived benefits, but barriers to access and daily integration were frequent and awareness of alternative systems was limited. Findings should be interpreted cautiously because of the cross-sectional parent-report design, but they support structured parent education, individualized AAC selection, and continued professional follow-up.