Starting with AAC? Here are Some Tips!

Now that some Augmentative and Alternative Communication (AAC) myths have been busted (see the previous blog post), it’s time to introduce, support, and use AAC with your child! Your speech-language pathologist and therapy team can help determine which systems and modalities are most appropriate to trial. Once you have these trial systems in place, here are some considerations, strategies, and tips to think about when supporting your child on his or her AAC journey.

Familiarize yourself with the system

Begin by familiarizing yourself with the AAC system. Borrow it during your child’s nap time, take an approved parent course on the system, observe a therapy session where the system is being used, or train directly with your child’s speech-language pathologist. The more you know, the more comfortable you will be using the system and therefore, the more likely you will be to model on the system!

 

 

 

 

 

Model, model, model

Children learn through experiences and observation, s

o it’s incredibly important to provide enriching models. We cannot expect a child to know how to use an AAC system without showing them how to use the system first.

Have fun! Then, model some more

When introducing AAC, start by introducing the system during play with motivating games, activities, and toys! Cause-and-effect games and routine based activities are great, as these activities use repetitive language and provide plenty of natural pauses in play where the child can fill-in-the-blank or request.

For the first few minutes of play, simply demonstrate how to use the system by naturally modeling during play (e.g., selecting “up” on the speech device when placing a car on the top of a race track, pointing to a picture card of an apple when pretending to eat the apple). Then, after the play routine is familiar and the “target” words are established, simply point toward the target word on the AAC system without directly selecting the word. Wait for up to 10 seconds to see if your child will imitate or select the word. After 10 seconds, model it one time then wait again. Do not be discouraged if your child doesn’t imitate right away- it takes time to learn a new system and it takes time to learn language. Keep modeling, keep having fun, and keep positive thoughts!

Focus on all functions of communication

It’s easy to default to “labeling” when modeling new words on AAC systems. However, it’s important to teach children to communicate for other functions, such as to request help, exclaim (Oh no!! Yay!!), protest (No!), ask and answer questions, greet (Hello!), and to indicate wants and needs. 

Incorporate different types of words on the AAC systems

Similar to how adults do not just ‘label’ when communicating, we do not speak using just one type of word. Read the following sentence that only consists of nouns (objects/people/places):

“Child food PlayWorks”

Now, read the sentence when other types of words (adjectives, articles, verbs, pronouns, prepositions, etc.) are added:

“The happy child enjoyed playing with her food at PlayWorks”

See the difference? When using AAC, it’s easy to get stuck on wanting to just use nouns (objects/people/places) and for great reason, objects and people that are relevant to a child are HIGHLY motivating and should be included. However, in order to appropriately model and to help the child functionally use language, we must include other types of words on the AAC systems.

Encourage use of AAC in a variety of settings

In order for AAC skills to be generalized, these skills need to be practiced in a variety of settings. This means that AAC should be accessible, available, and functional in all daily routines.

For AAC users, their systems are their voice, so we should try not take these systems away. In situations where ‘talking’ or using the AAC system is discouraged (e.g., in a quiet movie theater, while teachers are speaking, during fire drills, etc.), we should simply work with the child to teach them that expectation, rather than physically removing his or her device.

Provide meaning with what the child selects

In order to teach word meaning, always respond to what the child selects on the AAC system, even if it’s seemingly irrelevant or inappropriate at the moment. For example, if the child selects “apple”, you can say “we eat apples for breakfast!”. You can also go look for an apple in the kitchen, you can pretend to eat a fake apple, or you can ask “do you want a snack?”. If your child selects “all done”, then immediately stop what you’re doing, even if this is not what you *think* your child intended. One of the ways that children learn language is through this type of reinforcement

A great way to practice pairing meaning with your child’s selection is by providing choices to your child  (e.g., “Would you like to run or walk?”). Model these words on the system and wait for your child to make the selection! Then, immediately reinforce by doing the action or providing the choice.

Honor all communication attempts

One of the primary goals of AAC usage is to help individuals develop functional communication skills, no matter the method of communication. Therefore, it’s important to honor every communication method made by your child. For example, if your child speaks instead of using his or her AAC device, honor that communication attempt by responding to what they say. If your child selects “all done” on the AAC system but does not sign “all done” or say “all done”, honor his or her request to be “all done”! It’s important to encourage your child to communicate and we can only do this by responding to their communication attempts- no matter the system.

Be comfortable with making mistakes

Learning AAC can feel overwhelming, daunting, and generally unknown. If it feels this way to you, it likely feels this way to a new AAC user. Show your child that it’s okay to make mistakes, and even talk about your mistakes when using the system. This teaches your child that it’s okay to make mistakes, too! Trial and error is part of the process.

Note: This article is written from the perspective of a pediatric speech-language pathologist, and therefore, references ‘children’ throughout the entirety of the article. However, this information can be applied to all age-groups and populations.

Questions or concerns?

If you have questions or concerns about your child’s communication skills, please contact us at info@playworkschicago.com or (773) 332-9493. The Speech-Language Pathology team and the Assistive Technology team are available to provide individualized AAC recommendations based on your child’s needs.

 

Nicole Sherlock, MA, CCC-SLP

Speech-language Pathologist

Assistive Technology Co-Coordinator

 

Photo by PRC-Saltillo retrieved at:

https://store.prc-saltillo.com/image/catalog/ViaPro/Via-Pro-all-three-colors.jpg

Photo by AbleNet Inc., retrieved at: https://www.ablenetinc.com/quicktalker-ft-7/

Photo by Talk to Me Technologies, retrieved at: https://www.talktometechnologies.com/products/zuvo-12

Photo by Alexander Dummer on Unsplash

Photos by Tobii Dynavox, retrieved at: https://us.tobiidynavox.com/collections/low-tech-aac/products/picture-communication-symbols-pcs

Photos by Assitive Ware, retrieved at: https://www.assistiveware.com/learn-aac/planning-communication-when-aac-is-not-available

https://www.assistiveware.com/learn-aac/get-the-team-on-board

Photo by Pyramid Educational Consultants, retrieved at: https://pecsusa.com/shop/schedule-board-kit/#tab-description

Let’s “talk” about AAC!

What does smiling at a neighbor, sending a text, and ordering food by pointing to menu pictures have in common? They are all examples of AAC. By writing this blog, I am utilizing AAC to convey this message to you. So, the question is…

 

What is AAC?

Augmentative or Alternative Communication (AAC) refers to all the ways that we convey our thoughts and feelings without talking. Our world is full of AAC and for good reason- AAC is essential for well-rounded and effective communication across all stages of life. 

Individuals with speech, language, or voice disorders especially benefit from use of AAC to help increase their functional communication skills (Drager et al., 2010). Research has shown that use of AAC can increase expressive language skills, increase language comprehension, increase positive behaviors, increase social competence, and even support verbal language skills (Light et al., 2003; Millar et al., 2006).

People with communication disorders may benefit from additional support to incorporate AAC into their daily lives. Speech-language pathologists are trained to assess, recommend, and implement AAC with clients, based on their strengths and needs. At PlayWorks, we empower clients by using various types of AAC throughout therapy, as well as encourage AAC in home carryover activities.

 

What are the types of AAC? 

There are two general categories of AAC: unaided and aided systems.

Unaided AAC refers to the use of the body to communicate. Examples of unaided AAC include:

  • facial expressions
  • gestures
  • body language
  • sign language
  • non-word vocalizations (i.e., laughing, crying, cooing)

Aided AAC refers to communication supported by supplemental tools or equipment. These tools can be categorized as either low-tech AAC and high-tech AAC. Low-tech AAC includes tools that do not involve electronics or use of batteries. Examples include:

  • Writing
  • Objects
  • Pictures and symbols
  • Picture Exchange Communication System (PECS)
  • Communication boards or books

High-tech AAC refers to tools that use electricity, electronics, or batteries to operate. Some examples include:

  • Speech-generating devices
  • Recorded or digitized buttons/devices (such as the Staples “easy” button)
  • Computers (e-mail, texts, etc.)
  • AAC software on tablets, computers, phones, and other devices

Many dedicated high-tech AAC systems have supplemental equipment available that makes communication access and transportation easier. For example, certain devices have external speakers to help others better hear the speech-generated message. Cameras may be attached to track eye movements for those people who use eye gaze to create their messages. Devices may have special stands or carrying cases to make them more accessible for those in wheelchairs.

At PlayWorks, we support the use of low-tech and high-tech AAC by creating custom communication boards, using props or objects, and utilizing AAC applications on speech-generating devices.

 

Determining AAC needs

Communication is most effective when it’s multi-modal, or occurs in a variety of ways. Therefore, in order to best support individuals with communication delays and disorders, it’s important to implement and teach both unaided and aided AAC. Research shows that no prerequisite skills are required before starting AAC (Light & McNaughton, 2012; Snell et. al, 2010). However, it is important to consider a variety of personal factors when starting, including:

  • Current profile (physical/motor, language, cognitive, sensory, etc.)
  • Strengths and areas of need
  • Available communication partners
  • Setting or contexts in which the person will need to communicate
  • Resources available to both the individual and the communication partners
  • Individual preferences

Your therapy team will then use this information to determine which AAC tools and strategies will be most appropriate to trial, implement, and possibly purchase!

No matter a person’s age or ability level, AAC is a fundamental part of increasing functional communication. In my upcoming AAC blog posts, I will address common misconceptions surrounding use of AAC and expand upon ways to support an individual in their AAC journey. 

 

Questions or Concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9493. The Speech-Language Pathology team and the Assistive Technology team are available to provide individualized AAC recommendations based on your child’s needs.

Nicole Sherlock, MA, CCC-SLP

Assistive Technology Co-Coordinator

 

Citations & References:

American Speech-Language-Hearing Association. (n.d.). Augmentative and Alternative Communication (AAC). https://www.asha.org/public/speech/disorders/aac/. 

American Speech-Language-Hearing Association. (n.d.). Augmentative and Alternative Communication (AAC). https://www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication/#collapse_1

Crowe B, Machalicek W, Wei Q, Drew C, Ganz J. Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature. J Dev Phys Disabil. 2021 Mar 31:1-42. doi: 10.1007/s10882-021-09790-0. Epub ahead of print. PMID: 33814873; PMCID: PMC8009928.

Drager, K., Light, J., & McNaughton, D. Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of Pediatric Rehabilitation Medicine. 2010;3(4):303–310. doi: 10.3233/PRM-2010-0141.

Picture Exchange Communication System: Is PECS appropriate for my child?

When people think of communication, they often think of verbal communication. However, communication is not limited to one modality. In fact, communication can occur through a variety of modalities: verbal exchanges, written exchanges, facial expressions, gestures, sign language, etc. Picture exchange is another modality through which people can communicate. To capitalize upon this modality, Picture Exchange Communication System, or PECS, was created as a leading therapeutic technique for children who cannot yet verbally communicate.

As a pediatric speech-language pathologist, I often come across the question from parents, “Is PECS appropriate for my child?” Let’s dive into what PECS is, how it works, and for whom it may be appropriate.

What is PECS?

Picture Exchange Communication System (PECS) is a form of augmentative and alternative communication (AAC) that allows people to communicate using pictures. Although PECS contains a formal protocol that systematically moves through six phases of communicative exchanges, the method of picture exchange can be modified to meet the needs and skill level of the child.

How does PECS work?

  • Children using PECS are first taught a cause-effect relationship between pictures and communication. In other words, they learn that when you give a picture, you receive something in exchange.
  • Children are then taught to use pictures to communicate with different people across a variety of environments.
  • After the basic communicative exchange is established, the child learns to discriminate between multiple pictures in order to request specific objects or activities.
  • Pictures can then be combined to communicate phrases and sentences of increasing complexity, such as “I want ___.”

Who benefits from PECS?

PECS is often recommended for children who do not yet have a means of verbal communication. For PECS to be effective, however, the child must be motivated to communicate, as PECS relies upon the child initiating communication exchanges by giving pictures to another person. PECS also requires that child must have the cognitive skills to understand the cause-effect relationship between giving a picture and getting something in return. Therefore, a child who does not yet understand the cause-effect nature of a basic communicative exchange would be an inappropriate candidate for PECS until this skill emerges.

Myths Debunked

  • PECS is only for people who won’t learn to talk: The use of PECS does not imply that the child will never learn to use verbal language. In fact, the use of PECS can facilitate verbal communication by providing children with an outlet to reduce frustration and establish early communication skills.
  • PECS is only for people with Autism: PECS is frequently recommended for children with Autism Spectrum Disorder due to deficits in expressive language and social communication. However, recommendations of PECS should be child-specific and may or may not be appropriate for any child who does not have a means of verbal communication.
  • PECS only targets requesting: As a child moves through the PECS hierarchy, they can learn to use pictures for different functions, including requesting, answering questions, and ultimately, commenting independently. PECS involves high priority vocabulary to teach children that they can expand their expressive vocabulary to meet their wants and needs.

Questions or concerns?

If you have questions or concerns about whether PECS is appropriate for your child, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

References:

Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today2(2), 127.

Vicker, B. (2002). What is the Picture Exchange communication System or PECS?.

Photo Credit: sitemaker.umich.edu

Frequently Asked Questions about Augmentative and Alternative Communication (AAC)

What is AAC?

AAC is a term used to describe any method of communication that adds to or “augments” speech. This can include anything from signs and gestures, to picture symbols or even high-tech devices involving computer technology.

Will AAC impact language development?

The use of AAC will not delay or impede language development, and often can help improve spoken language. It also allows for many individuals to express themselves fully when spoken language may be difficult.

Who uses AAC?

Anyone who has difficulty expressing themselves via spoken language may benefit from AAC. AAC users may have limited spoken language, unclear speech, or find spoken language difficult in social settings. The cause of the communication impairment may be present at birth (autism or cerebral palsy), occurring later in life due to injury or illness (stroke or head injury), or may worsen throughout the person’s life.

How do I know if AAC is right for my child?

Your child’s speech-language pathologist (SLP) can help guide you through the decision process. You may notice that your child is already using simple AAC such as signs and gestures in his therapy sessions. If a more robust system would be beneficial for your child, your child’s SLP may recommend a more comprehensive evaluation in which various professionals can help select the most appropriate system.

Meryl Schnapp M.A., CCC-SLP
Speech-Language Pathologist