Www.CTDInstitute.org Getting Started with Augmentative & Alternative Communication (AAC) for Your...

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Getting Started with Augmentative & Alternative Communication (AAC) for

Your Child

Dana Nieder


Overview

• Introduction

• A little review

• Gathering your team

• Responding to the pro’s “no”s

• Get ready . . . (choosing the words)

• Get set . . . (preparing to start)

• Go! (implementation using 4 power strategies)• Modeling • Waiting (& acting clueless)• Babble • Responding


• Former middle school science teacher

• Maya’s (and Will’s) mom

• SLP grad student

• General AAC lover & advocate

About Me


The Basics

• AAC = Augmentative and Alternative Communication

• What do you want? A comprehensive, robust system!• begin with the end in mind• provide access to all of the words, all of the time

(not activity boards/pages)


(more basics)

• When do you want it? Now. Right now. Like, yesterday.

• There are no prerequisites to robust AAC!• not “too young”• not “too old”• not “too low functioning”• not “too behavioral”• not “too impaired in the area of fine motor skills”• not “we need to start small and work our way up”• not “we need to not give up on speech”

• Presume competence.

https://www.youtube.com/watch?v=C6JlPP725KM

(Google “Don’t Wait to Communicate webinar”)


Building A Team

Google: “Uncommon Sense Pulling Your Team Together”


Responding to a pro’s “no”s

• Claim your spot at the table.

• Your Default: Which approach has the potential to cause more damage, and which approach has the potential to

yield more success?


Responding to a pro’s “no”s: Common Sense Approach

If you hear: You can respond . . .

“too young” We start speaking to babies at birth. He’s not too young to start having language modeled in an accessible way.

If we start “too late” we are losing communication learning time-if we start “too early” nothing is lost.

“too old” “How old were you when you stopped learning?”

If we don’t try, we are denying her the fundamental human right to communicate.

“too behavioral”

If communication is not in place, the only way to communicate is through behavior. His “behaviors” are proof that he needs a better communication system, not a reason not to provide one.

With a communication system, his “behaviors” may decrease---without one, they almost certainly will not.



If you hear

You can respond . . .

“too cognitively impaired”

Non-speakers are notoriously underestimated during formal testing, even when tests are used that have been designed for non-speakers. The only way to determine true cognitive level will be to provide a robust language system and listen to what he has to say.

How we will ever know if he’s “smart enough” to use big words if we never provide him with big words?

“too motorically impaired”

• For people with use of their hands, but trouble isolating a finger or pointing, there are keyguards, targeting squares, or even gloves.

• Many children see an increase in fine motor ability and hand control from using an app/device.

• For people without reliable hand use, there are switches that can be activated with other body parts, or systems that work with eye gaze.

Our inability to solve an access issue indicates that we need more help—not that this person isn’t a “candidate” for communication.



If you hear You can respond . . .

“let’s start small and work our way up”

• He can’t learn to really use language without having access to real language.

• When we speak to infants and toddlers (who are learning typical speech) we use all of our words---not just 20 selected words.

• He has the right to learn a language system that will last---not to be re-taught every year.

• This approach will make him constantly prove that he is ready for the next step, a model of AAC implementation that was rejected 20 years ago. He shouldn’t have to earn words---he should be immersed in them.


Responding to a pro’s noes: Academic Approach

•In addition to providing an alternate method of communication, AAC is a viable intervention approach that can stimulate the development of language skills and speech.

•Negatives behaviors decrease as functional communication increases.

•(Spoken) Language input during therapy should include correct grammar and morphology.

•AAC should be introduced before the child reaches frustration level.

•Good handouts with research links: http://www.dynavoxtech.com/implementation-toolkit/learning-paths/list/?id=7 (google: “AAC Myths Revealed Dynavox”)


Responding to a pro’s “no”s: Turn the tables

• How do you think this system will allow for access to the functions of language beyond requesting? (commenting, arguing, joking, asking, etc)

• How will this system address morphology and syntax?

• How will this system grow? Will it require vocabulary reorganization as it grows? Will we need to switch systems when his vocabulary reaches a certain size?

• How will he be able to truly communicate without having access to all of the words, all of the time?


When all else fails:

• Ask what the next step will be if you reject their recommendation.

• Look into obtaining a private AAC/AT evaluation (local hospitals are a good starting point).

• Research your state’s AT/AAC Lending Library.

• Are there local (or not local) organizations that provide grants or devices?

• Can you do this on your own first, and then push it in to the school?


First Words! Initial Vocabulary Selection


First Words! (Initial Vocabulary Selection)

• A mix of core words & highly motivating fringe words

• Core words = I, you, eat, play, up, down, in, out, etc.

• Personal core words = family names, medical words, other life-centered words

• Highly motivating fringe words =


The very first words

• Very first words should be:

• frequently usable (multiple times a day, many contexts)

• highly functional (often core words)• help, more, done, go, stop, eat, drink

• or highly motivating (often fringe words)• names (family, friends, pets), favorites (foods,

drinks, toys, animals, games, music, characters)


A sample set of very first words (just a sample)

IYou

family names friend names

eat drinkwantlikegostophelp

favorites: foods/drinks characters shows/movies toys

moreyesno

(other)


Next words

• Feelings (happy, sad, angry, tired, hurt)• Pronouns (I, you, he, she, it)• Foods/drinks• Colors and other adjectives (big, small, good, bad,

nice, mean)• Position words (in, out, up, down, under, over)• VERBS (open, call, come, run, jump, sit, yell, throw)• Questions (what, where, who, when, how, why)

Think categorically and make sure that you’re not over-emphasizing nouns: AAC is for communication, not

(just) for choice making!


Next words

• Resist the urge to use phrases* (I want, I see, etc)

• Modeling will guide you toward new additions

• Pretty quickly: get a button programmed that can be used to indicate that the target isn’t there

• Model the vocabulary adding process (from “I think we need a new word” to addition)


Next words

333 alphabetized preschool core words:

http://www.minspeak.com/documents/2-MarvinList.pdf

(“Marvin core word list”)

Source: Marvin, C. A., Beukelman, D. R., & Bilyeu, D. (1994) Vocabulary-use patterns in preschool children: Effects of context and time sampling. Augmentative and Alternative Communication, 10, 224-236.


Pre-implementation

• You need to learn the language before you can use the language!

• Read a children’s book • Talk to a spouse/friend using only the talker• Look at an object and start to talk about it

-what does it look like?-what can you (or other people) do with it?


Jumping in: Modeling

• Think about the typical process of language acquisition . . .

• We speak, children listen . . . (for months or years without expectation)

• . . . .and eventually they speak back.


Modeling

We are going to apply this same approach to AAC use:

We model on the AAC system (without expectation) . . .

. . . and eventually they will use the system as well.

Aided Language

Input

Aided Language Stimulation


• Why is modeling so essential?

• To learn a language you need to hear/see it being used (especially if you aren’t fully literate):

Greek PODD pageset,source: Mary-Louise Bertram’s post on modeling, on Jane Farrall’s blog:

http://www.janefarrall.com/why-we-do-aided-language-stimulation-and-you-should-too/


Modeling

Think about the hours of verbal input that children get before using speech . . . now think about how much AAC input our users get:

“The typically developing child will have been exposed to oral language for

approximately 4,380 waking hours by the time he begins speaking at about 18

months of age.

If someone is using a different symbol set and only has exposure to it two times

a week, for 20 – 30 minutes each, it will take the alternate symbol user 84 years

to have the same experience with his symbols that the typically developing child

has with the spoken word in 18 months!”

-Jane Korsten (2011), QIAT Listserv


What modeling is . . . and isn’t

• Modeling is simply accessible language input. • Demonstrating:

• what can be said in different contexts • process of expressing a thought with AAC • word finding• conversational repair

NOT:• “It’s blue. Now you say it.” or “It’s blue. What color is it?”

We aren’t quizzing, we’re talking.


Modeling is a Marathon

“Your race . . . your pace!”


Modeling: Laid Back

• Modeling is not rocket science

• Use modeling instead of speech, or in addition to speech.

• Model the thoughts and conversation that arise naturally.

• How many words? “Model One More” (& discretionary) • http://www.speakforyourself.org/2014/01/26/simon-says-model-

one-word/ (Google “Simon Says Model One More Word”)

• Which words?-whichever ones come up in conversation

• Tip: pick an easy daily context to start with (meal time, art time, etc)


Modeling: Structured

• Designate specific times to model (or even go “voiceless”)

• Follow a core-words-of-the-month plan (PrAACtical AAC) or pick your own subset of words to target for a set amount of time

• Use brainstorming charts to pre-plan language targets in line with your child’s interests (next slide) http://www.speakforyourself.org/2013/12/16/aac-implementation-start/ “AAC Implementation: Where Do I Start?”

• If focusing on predetermined words feels limiting, focus on modeling a concept (asking “where” questions, making observations, etc)


Modeling

• Follow the leader: Video 1


Babble


Babble

• Why?• to explore the

system• to experiment with

sounds• to practice• to memorize

location information

• to memorize sound patterns

• to annoy people


Babble

Video 2:


Waiting (& acting clueless)

• Communication via AAC is a slow process, especially for a beginner---even if motivation is high!

• Also, motivation (especially for beginners) may not be super high. (Because they are used to us answering for them!)

• The bottom line:• New AAC users need to learn to step up to the conversational plate. • When you’re not there to translate, people really will be clueless.• Sometimes you think you know, but you have no idea.


Playing Dumb/ Waiting

• Video 3: Watch me make a mistake!

• Video 4: Watch me do a better job!


Final Strategy

• Q: How will my child learn that their device is speech, and not just another talking toy?

• A: When you respond to it as if it is speech, and not just another talking toy!

• Typical language development: babies learn that their sounds have meaning when people respond to them


Responding Intentionally

• Imagine this:

• This type of intentional response serves a few purposes: honors

their communication, assigns meaning to new words, adds a lot of

motivation! ReAACtion Therapy:

(http://www.speakforyourself.org/2015/03/22/reaaction-therapy-

and-the-proof-of-competence/ Google: “ReAACtion Therapy and

the Proof of Competence”)


Responding Intentionally

• Video 5: We’d been eating

Maya’s favorite cookies.

Then this happened.

• Video 6: Learning a new

word with ReAACtion Therapy.


Review

• 4 strategies:• Modeling• Babbling• Waiting & acting clueless• Responding intentionally

• Choosing Words:• High function/high interest

• Team Gathering:• With encouragement• With advocacy:

• Common Sense• Research Based

• Questions—come on Thursday!

Artist: Mohamed Ghonemi


• Uncommon Sense (blog):• http://niederfamily.blogspot.com

• Facebook: “Uncommon Sense Blog”

• Twitter: @UncommonBlogger

• email: [email protected]

Contact Information

Q&A Thursday at 7:30pm (EST)Google “Video Café Q&A Dana Nieder”


“Assistive and Instructional Technology Supporting Learners with Disabilities”


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