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Josh has Rubinstein-Taybi syndrome (RTS). Like most people with RTS, he has an intellectual impairment, muscular/skeletal problems and complex communication challenges. Josh doesn't have functional speech so he relies on augmentative and alternative communication (AAC) methods. He uses a small computer that is programmed to generate speech. He also uses some manual sign language, pointing, gestures, and communication boards to express himself. Pam is Josh's mom, personal care attendant and advocate. Pam and Josh are a strong team who work together to successfully integrate Josh's AAC methods into their family, home and community lives. They live with Kevin (Josh's dad and Pam's loving husband) and Shelley (Josh's older sister and Pam's favorite daughter).