AACAugmentative Alternative

Communication

Cindy NankeeCESA #3

WATI Consultantcnankee@cesa3.k12.wi.us

Agenda• Share assessment experiences• Showcase low, mid & high tech AAC• Communication Symbols• Ideas for Using AAC• Set Up Success • Educational Opportunities• Planning Communication Boards –

the 80/20 rule• Boardmaker

Session Objective

• Participants will increase knowledge of low to high tech AAC materials, devices and software.

• Participants will increase knowledge of AAC implementation in therapy, in the classroom, in the home and in the community.

• Participants will understand strategies for success in using a communication system

• Participants will increase knowledge of AAC resources.

• Participants will create materials using Boardmaker software

Name some ways we communicate

Crying Eye contact Sounds Words Pointing Falling asleep Screaming Silence

Communication boards

Picture exchange system

Voice output systems

Gestures/signing Hair-pulling Body position

Augmentative/Alternative Communication

AAC*refers to the ways (other than speech) that are

used to send a message from one person to another (ASHA, 2005)

Examples• Communication boards/books/picture symbols• Voice output communication devices (VOCAs)

now referred to as (SGD) Speech Generating Device

• Picture Exchange Communication System (PECS)

• Morse Code• Eye Gaze

AAC is not….

“Giving up” on speechOnly for those of a certain IQOnly the job of the speech-language pathologistJust “HIGH TECH” devicesA “one-time only” endeavor

AAC can be a vehicle for developing:

expressive languagereceptive language

literacycontrol over the environment

communication initiation

Which leads to…• increased academic success• increased participation in social

situations• increased self-esteem• increased job

opportunities• And more…

Individuals Who Might Benefit from Visual Tools…

– Pre-Readers– Communication

Delays/Disorders– English Language

Learners– Attention Deficit

Disorder– Comprehension

Problems

– Learning Disabilities

– Developmental Delays

– Traumatic Brain Injury

– Down Syndrome– Autism Spectrum

Disorder– And many more…

Assessment

• ASNAT• AT Checklist/AT Wheel• STAGES• ATLAS• Evaluware• TASP Test of Aided-Communication

Symbol Performance• Communication Matrix

– www.designtolearn.com– Online Free/hard copy $8.00

Online Communication Matrix

• The Communication Matrix is an assessment tool designed to pinpoint exactly how a child is currently communicating and to provide a framework for determining logical communication goals.

• This online version was designed especially for parents

• The parent version is designed to be "user friendly"

• Results on a one page Profile

Showcasing Low to High Tech AAC

The WATI Continuum

Communication board or bookEye gaze frame

Simple voice output deviceVoice output device with levels

Voice output device with icon sequencingVoice output device with dynamic displayDevices with speech synthesis that use

typing

Communication Boards Should Include...

• Vocabulary that reflects all 4 categories– Wants & Needs– Exchanging Information– Social Interactions– Social Etiquette

• Using the available symbols, could you communicate about an activity in all categories?

Communication Boards

                                                                  http://www.angelfire.com/pa5/as/asteachersites.html

Communication book

www.autismshop.comwww.autismshop.com

Placement of Communication Boards

• Mount on Wheel Chair• On Desk/table• On locker• On Wall/ by bathroom/ sink• Play areas• Work area • Kitchen area

Eye Gaze Frame

Simple Voice Output Device

AbleNet www.ablenetinc.com/BIGmack Switch(800) 322-0956

Voice Output Device with Levels

http://www.amdi.net/

                                        

www.attainmentcompany.com

Voice Output with Icon Sequencing

                                      Pathfinder, Prentke-Romich Company

http://www.prentrom.com

Voice Output with Dynamic Display

                                           .

DV 4 and MT 4 E-Talk

Palmtop

Mercury

Tango by Blink Twicewww.blink-twice.com

Speaking Dynamically Pro

• AAC Software with speech output• www.mayer-johnson.com• Windows and Mac• Create personalized dynamic,

multilevel, talking boards• $649.00

Type and Talk speech Synthesis

Tablet PC Speech Assistantwww.herbi.org

Terms/definitions

• VOCA – Voice Output Communication Device

• SGD – Speech Generating Device

Companies handling dynamic display devices

• www.dynasys.com DV4, MT4, MightyMo, DynaWrite

• www.prentrom.com Pathfinder, Vantage, Vanguard, Springboard

• www.aacconnections.com Mercury, MiniMerc, Enkidu

• www.blinktwice.com Tango• www.attainmentcompany.com E-talk

More onCommunication Symbols

1. Like2. Again3. Show me4. Whole5. Past 6. Fast7. Correct8. Short9. Tomorrow10.Word11.Communication12.That’s crazy!

Communication Symbol Guideline

– REAL OBJECTS– TANGIBLE SYMBOLS– TOBIs (true object-

based icons)– COLOR PHOTOS– BLACK & WHITE

PHOTOS

– LINE DRAWINGS– PICTURE

COMMUNICATION SYMBOLS

– TEXT W/ PICTURES– TEXT & LETTERS

Object Communication System

www.adaptivation.com

Tangible Symbols• Tangible symbols are objects or

pictures that stand for or represent something about which we need to communicate.

A T.O.B.I. can be a line drawing, photograph etc. which is cut out in the actual shape of the item it represents

When Billy gets home from school…

Line Symbols

Picture Communication Symbols

Text with Pictures

Communication Board with words/letters/numbers

• In Therapy• In the Classroom• In the Home• In the Community• Behavior Regulation

Why Use Visual Tools and

Strategies…Give students information about their activities

Prepare students for what will or will not happen

Reduce the anxiety that comes from the unexpected, especially during transition times

Help students understand the concept of “finished”

Provide the structure for appropriate behavior and participation

Support communication and conversation

Hodgdon, 2002

AAC in Therapy

�Schedules and Calendars

�Tools to Give Information

�Tools to Make Choices and Requests

�Tools for Protesting and Rejecting

�Tools for Behavior Regulation

Picture Schedules

What is it? A visual representation of a span of time or of a specific activity.

When? They can be used to help cue a child as to what comes next (e.g., put on snow pants, put on boots, put on coat, put on mittens)

How? Mount picture symbols or labeled photos on magnetic board, tag board with Velcro, or tape and have the board with you during that activity. Model use of it so the child can eventually perform the task independently.

                              

               

www.autismshop.comwww.autismshop.com

Tools to Give Information“Behavior problems emerge because what the student is

expecting and what is really happening are not the same.”

Linda Hodgdon, 2002•Calming down board

•Rule Cards (“When I get to the gym, I sit on the red line.”)

•International NO

•Lightning Bolt

•Activity Termination Symbols

•Social stories w/ or without picture supports

•Card to hold (WAIT)

Making Choices and Requests

Hodgdon, 2002

*Student may need to LEARN what it means to make a

choice

*Start with highly desirable choices

*Choices often motivate the student to communicate

*Offer immediate reinforcement for their choice

*Choice-making can be practiced multiple times per day

*Adults can structure the choices provided

What to choose, what to choose…

• Which snack to eat• Which toy to play with• Which seat to sit in• Which person to walk with• Which cereal to buy• Which washcloth to use• Which job to do• Which CD to listen to• Which book to read

Tools for protesting or rejecting

                              "All Done“ Card

http://www.cesa7.k12.wi.us/sped/autism/assist/asst13.htm

                                          

     

"Wait" Card

http://www.cesa7.k12.wi.us/sped/autism/assist/asst13.htm

Teaching NO

                                 

"First-Then" Card

AAC in the Classroom

• Same as in Therapy• Vocabulary• Literacy Boards• Literacy Activities to expand language

– Customize books– You don’t have to talk before you read– Reading comprehension increases if you are

able to talk about it

Vocabulary

Literacy Boards What is it? A single page containing

pictures/words specifically relating to a particular story

Why? Used to identify key characters of the story, along with messages like “turn the page,” “more” or other story-specific comments

When? Use before, during, and/or after a story to help lead discussion and help the child fully understand the vocabulary and concepts within the story

How? Model use by pointing to characters, comments as you talk/read about them

Snack Time

Boscobel ECH

Lily Rider, Louise Hebel

Snack Time

Boscobel ECH

Lily Rider, Louise Hebel

School to home note

Boscobel ECH

Lily Rider, Louise Hebel

Software to expand language skills

• Laurette• Stages choice• Pixwriter

AAC in the Home

• Same as Therapy and classroom• Create boards for playing games • Follow a recipe • AAC systems with infrared can be used

to control anything that can be operated with a remote – Channel surf the TV– Purchase a infrared mini controller and automate

small appliances (lights, fans, computer, robotic vacuum)

– Control infrared toys & switch adapted toys

Playdough recipe with Pixwriter

AAC in the Community

• Same as Therapy/Classroom/Home• Make choices at the

restaurant/library/• Make comments about: sporting

events/movies/concerts/ plays/festivals/fashions

• Create shopping lists

?? Remember ??

The focus is not on the technology (low or high) rather, it is on communication, the academic activity and language.

??

Remember

??

The following section from CCE Creating Communication Environments

– Activities that focus on communication

– Environment that’s conducive to communication by the child

– Partner that knows how to prompt, model, elicit language, pause

Communication

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Arrange the Environment to Increase the Likelihood of

Communication

Common Strategies…. Use motivating materials and activities Materials should be in view but not accessible Student should need assistance with some

materials Provide small or inadequate amounts of

materials Sabotage Provide something the student doesn’t like/want Use communication boards/devices & visual tools

Increase Communication by being a good communication

PartnerAccept and respond to ANY

communication attempt Provide descriptive feedback instead of

praise(“You wanted paint. Here’s more paint.”)

Be silent when appropriate Be aware of use of figurative language

(“take your seat” vs. “sit”) Use a prompt hierarchy

Prompt Hierarchy• Environmental Cue

– PAUSE

• Open Question– PAUSE

• Prompt OR Request for Communication– PAUSE

• Full Model– PAUSE

• Incorporate descriptive feedback into each step

Prompt Hierarchy Step #1 Environmental Cue

• Set up the environment to signal to the student that an activity is about to begin.– Ringing bell– Lining up at the door– Art materials prepared but out of reach– Desired items visible but inaccessible– Cutting the pizza, e.g.

• After student responds, provide... Descriptive Feedback

Prompt Hierarchy--PausingPause after every step

• Focus your attention on the student (expect communication!)

A N

• PAUSE D

• After student responds, provide... Descriptive Feedback

Prompt Hierarchy Step #2 Open Question

• If the student does not respond to the pause by making a response:– Ask a WHAT, WHY, WHO, WHEN, WHERE, OR

HOW Question• “What do you want?”• “Whose turn is it?”• “Where does that go?”

• AND then…...PAUSE• After student responds, provide...

Descriptive Feedback

Prompt Hierarchy Step #3 Prompt or Request

Communication• Provide a prompt to students

– Choices, carrier phrase, initial sound, visual cue OR

• Request Communication– “Tell me what you need.”– “Tell me what goes next.”

• AND then……PAUSE

• After student responds, provide... Descriptive Feedback

Prompt Hierarchy Step # 4 Full Model

• Provide a full model for student– Use student’s AAC device– Use developmentally appropriate model

• AND then…...PAUSE

• After student responds, provide... Descriptive Feedback

PAUSEPause Pause Pause Pause Pause PausePause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause!

In other words…PAUSE!

Prompt Hierarchy—WHY?

Gives student the necessary time to process information and to formulate a message to communicate

Provides a structure for adults that encourages communication

Can be customized for individual students

Organized least to most

CCE video

• Visual Strategies – Susan Stokes www.wati.org CESA 6 - 12/20 CESA 9 2/26/07

• CCE (Creating Communication Environments) WATI Consultants

• Get A Grip On Communication www.wati.org Cesa #2- 1/26 and 4/24

• DynaVox – www.dynavoxsys.com• PECS (Picture Exchange

Communication System) Green Bay 1/4 & 5; Milwaukee 4/23 &24 www.pecs.com

Creating a Communication Environment

(CCE)

CCE is for staff struggling with the implementation of AAC systems including language boards and low tech to high tech devices, across the school environment.

Communication

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Creating a Communication Environment

(CCE)• A four part sequential intervention• A team is required (teacher, SLP, Para, OT,

PT, Parent)• CESA #2 Milton Wisconsin• $600. per 3 person team, $50. per additional

team member• Jill Gierach, CESA #2 WATI consultant• Shelly Weingarten, CESA #1 WATI consultant• www.wati.org training link

Get A Grip on Communication

• 2 part training – assessment & programming

• Severe and profound multiple disabilities

• Special educators, SLP’s, OT’s, Paraprofessionals, Parents

• $225• College credit• www.cesa2.k12.wi.us registration

forms

DynaVox Trainings www.dynavoxsys.com

• DynaVox Local Trainings – Introductory and Advanced Trainings

• Online Programming Tutorials– Video and slide presentations

• DynaVox Virtual Classroom– an online learning environment that

features a live instructor

Picture Exchange Communication System

(PECS): • PECS allow the child to spontaneously initiate a

communicative interaction by actually exchanging, or giving a visual representation system to another person.

• By making a physical exchange with another person, the child develops a concrete understanding that communication is an actual exchange of information between two or more people

• The PECS program is composed of various phases or levels, starting with simple, concrete communicative exchanges and moving to more abstract communication.

• Visual representation systems which can be used: miniature objects, T.O.B.I.s, photos, real drawings, line drawings, written words.

Visual Resources for Enhancing Communication

from the Indiana Resource Center for Autismwww.iidc.indiana.edu/irca

*Attainment Company, Verona, WI 800-327-4269www.attainmentcompany.com*Autism Resource Networkwww.autismshop.com*Don Johnston Company, Volo, IL 800-999-4660www.donjohnston.com*Imaginart Communication Products, Bisbee, AZ 800-828-1376www.imaginart.com*IntelliTools, Inc., Novato, CA 800-899-6687www.intellitools.com*Mayer-Johnson Company, Solana Beach, CA 800-588-4548www.mayerjohnson.com*Pyramid Educational Consultants I nc., Newark, DE 888-732-7462*Silver Lining Multimedia, Inc., Poughkeepsie, NY 845-462-8174*Slater Software, Inc, Guffey, CO 719-479-2255

• Planning– Assessment & Design

• Boardmaker• Speaking Dynamically Pro• PixWriter• Microsoft Word Table

www.imaginesymbols.com

80/20 Rule

Augmentative Alternative Communication is 80% planning

and 20% programming

Assessment

• Evaluware– Computerized assessment– Assesses size/spacing/visual

preferences/auditory preferences

• TASP– Hard copy assessment– An easy-to-use tool for assessing symbolic

skills,– Design communication boards– Help select Aug Communication device– Set appropriate AAC goals– Serves as a tool to benchmark progress in

aided communication performance.

Designing Communication Boards

• Physical considerations:– Size of symbols– Spacing between symbols– Physical access to all locations of board– Landscape vs. Portrait orientation

Designing Communication Boards

• Visual considerations:– Color vs. black/white– Color background– Size & spacing

Designing Communication Boards

• Language/Cognitive Considerations:– Type of message (single word vs. phrase)– Type of symbol (Photos, line drawings)– Amount of vocabulary to be displayed at a

time– Organization

Brandenburg, S., & Vanderheiden, g.C. (1988)The Vocally Impaired: Clinical Practice and Research pp. 84-

135

Arrangements for Communication Displays

Activity-Based Category-Based

Grammatically Correct-Based

Alphabet and Word Based

Activity-Based Displays

• For use with a specific activity (block play, cooking, office help)

• May necessitate repeating of symbols across multiple displays

• Should include comments and social etiquette messages

• General left-to-right progression (person-action-attribute-object-location)

• Should include problem-solving messages

Category-Based Displays

• Groupings are based on categories with vocabulary items arranged according to familiar categories

• May include a main board (e.g., I want to tell you a joke) with branching subtopic messages

• Requires knowledge of categorization and the hierarchy of language

• Difficult to express relational concepts, or complex thoughts, and difficult to use appropriate syntax

Grammatically-Correct Displays

• Groupings are based upon some knowledge of grammar

• Provide a way to generate more complex thoughts, to develop linguistic and literacy skills

• Includes semantic arrangements, grammatical arrangements, or a modified Fitzgerald Key

• Makes it possible for communication partners to model language (augmented input/aided language stimulation

• Groupings are based on the alphabet

• May include combination word-symbol messages

• Effective use depends on the student’s prior knowledge, future goals, and the message selection techniques being used

Alphabet or Word- based Displays

Color Coding

will allow user and facilitator to locate symbols

more easily

www.aacintervention.com Tip of the month

Goosens’ Crain & Elder Color Coding System

Communication Displays for Engineered Preschool Environments (1994)

• Verbs…………………..Pink• Descriptors………..Blue• Prepositions……….Green• Nouns…………………..Yellow• Miscellaneous……Orange

– “WH” words, exclamations, negations, etc.

Planning is OngoingContinue to Adjust Variables

• Expand vocabulary• Increase size & array of symbols• Increase settings: home/community/other

people/times in a day• Differ communication:

requests/labeling/commenting/questions• Multi symbol utterances• Accessible/portable• Bridge up/down hierarchy

Summary of Ideas

• Calendars• Schedules• Vocabulary• Worksheets/Quizzes

(matching/fill in)• Math/Reading/ Science/SS• Social Stories• Community

• Picture supported story/newsletter

• Literacy board• Weather Board• Snack placemats• Games (bingo)• Certificates• Greeting Cards

Category Worksheet

Kristin Whitfield DynaVox educational specialist

Boardmaker Software

• Picture communication symbols used to create communication boards, device overlays, worksheets, picture schedules

• Teacher Tool• www.mayer-johnson.com • $299.00

Boardmaker Plus Software

• This is Boardmaker plus voice• Create interactive Activities• Minus SDP bells and whistles • Student/classroom Tool• www.mayer-johnson.com • $399.00

Boardmaker with Speaking Dynamically Pro Software

• SDP is a speech output program• Use to create dynamic, talking,

multilevel communication boards• Teacher Tool• Individual Student Tool• www.mayer-johnson.com • $649.00

Boardmaker Tutorial

Word Table with

ClipArt

http://www.imagineSymbols.com

• 4000 symbols include emotions, animals, verbs, nouns, computer technology, and many more. Imagine Symbols are available for download for non-commercial use.

Created in Word with Free Image Symbols

http://www.symbolworld.org

• This is a great site for non-readers.  Everything is in symbols.  Stories, news, recipes, personal care, and much more.   There is even a newsletter that is similar to News 2 You.....but it's free.   

www.widgit.com

• Resources on symbol use • Symbols for literacy• Products• Webwide – see websites with

symbol support

ReferencesAmerican Speech-Language-Hearing Association website: www.asha.org

Burkhart, L. 1993, Total Augmentative Communication in the Early Childhood Classroom, p.38

Binger, C. & Kent-Walsh, J. (2005). Evidence-Based Language Supports for Children Using AAC: Increasing Expressive Communication. Closing the Gap conference, Oct. 2005, Minneapolis, MN.

Casey, K. & Kornfeld S. (2004). Developing language-rich light tech AAC systems for young children. Closing the Gap, October/November 2004, 23 (4).

CESA 4 & 5 Cumley, J. and Pallaske, M., CESA 1 & 2 Weingarten, M. and Gierach, J., Creating Communication Environments training, 2005

DynaVox educational specialist Whitfield, K., Planning for and supporting Meaningful Participation and Learning for children and Adults Using AAC

References

Hodgdon, L., Visual Strategies For Improving Communication: Solving Behavior Problems in Autism: Improving Communication with Visual Strategies, QuirkRoberts Publishing, www.usevisualstrategies.com P.O. Box 71Troy, MI 48099-0071

Hodgdon, L., Solving Behavior Problems in Autism: Improving Communication with Visual Strategies, QuirkRoberts Publishing, www.usevisualstrategies.com P.O. Box 71 Troy, MI 48099-0071

Karlan, George. Environmental Communication Teaching Training. Field-Initiated Research Grant Award No. H023C9005 from the Office of Special Education, U.S. Department of Education. Lafayette, Indiana: Purdue University.

Quill, Kathleen, Do-Watch-Listen-Say, Paul H. Brookes Publishing, 2000

Raising a Reader, Raising a Writer: How Parents Can Help. Washington DC: National Association for the Education of Young Children (NAEYC) #530

Teaching Our Youngest: A Guide for Preschool Teachers, Child Care & Family Providers, U.S. Department of Education