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

 

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

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AAC Myth Busting

Augmentative and Alternative Communication, or AAC, is instrumental for effective, efficient, and successful communication, especially for those with communication and speech disorders. Myths surrounding AAC can prevent families, individuals, and even some therapists from supporting AAC usage. Here are some of the top myths about AAC and why these myths are indeed, just myths.

Myth: Use of AAC discourages or hinders verbal speech production

Perpetrators of this myth believe that AAC will cause individuals to lose interest in talking or that they will only want to use AAC to communicate. Research studies show that AAC does not have a negative impact on verbal language (Millar et. al, 2006). Rather, AAC can actually support and encourage verbal language development. AAC is also beneficial for all-around development, as it supports expressive language skills, receptive language skills, literacy skills, play skills, social and pragmatic skills, behavioral skills, and frustration tolerance (Light et al., 2003; Millar et al., 2006).

Myth: AAC is only for pre-verbal or non-verbal individuals

Although AAC is extremely beneficial for those who do not speak, it is not exclusively reserved for these individuals. The term “augmentative” (the first “A” in AAC) refers to the use of communication systems to supplement speech. If an individual has limited verbal speech or demonstrates decreased understandability, AAC can help them effectively communicate. For example, people with motor-speech disorders often demonstrate decreased understandability due to muscle weakness, muscle incoordination, and/or planning/sequencing difficulties of the muscles involved in speech production. Even though these individuals have the ability to speak, they benefit from AAC to supplement their message when they cannot be understood or when they do not have the capability to produce the desired message. “Alternative” (the second “A” in AAC) refers to the use of systems by individuals with no-verbal communication.

Even individuals with intact verbal communication skills use AAC on a daily basis, as AAC emcompasses all of the ways that we communicate outside of talking. Use of facial expressions, body language, texting, emailing, gestures (e.g, waving, holding a finger up to the lips to indicate “shhh”), holding up objects, pointing to pictures, and writing are just a few examples of everyday AAC systems.

 

 

Myth: Children must reach a certain age or have certain prerequisite skills to use AAC

There is no evidence to suggest that children must be a certain chronological age to use AAC. Rather, introducing AAC during infancy and toddlerhood can have a positive impact on a child’s brain development. The National Scientific Council on the Developing Child (2007) reported that enriching experiences during infancy and toddlerhood (such as using AAC) establishes foundations for later brain development, which helps improve a way a child thinks and regulates emotions.

There is also no evidence that children need certain prerequisite skills to use AAC. In the past, children with cognitive or sensorimotor impairments were often excluded from AAC usage due to absent foundational skills. However, children with cognitive and sensimotor impairments have been shown to effectively implement and use AAC, provided individualized support. Further, implementing AAC with children with cognitive or sensorimotor deficits can have a positive impact on their global development (Ganz et al., 2011; Ganz & Simpson, 2018; Kasari et al., 2014; O’Neill, Light, & Pope, 2018; Romski et al., 2010; Walker & Snell, 2013). AAC can also enable children to demonstrate their cognitive abilities, especially in those who do not yet speak or have a reliable way to communicate. 

In short, no matter a child’s age or ability level, AAC promotes brain development and provides a way for a child to improve in a variety of developmental areas.

 

 

Myth: You must have good motor skills to use a speech-generating AAC device.

As stated above, there are no prerequisites for using AAC. Just as there are many different types of AAC systems, there are also a variety of ways to activate these systems. For individuals with significant motor impairments, eye gaze technology (using equipment to track eye movements) and switch scanning (activating a switch using a specific body part) are two of the most widely used access options. One of the most famous scientists of the 21st century, Dr. Stephen Hawking, lost voluntary muscle control throughout the majority of his body due to ALS. He activated his AAC speech-generating device using his thumb, then a switch mounted to his glasses, which picked up on small movements in his cheeks and face (DO-IT, 2021). Recently, researchers have helped completely paralyzed individuals activate AAC systems using just their breath and have even successfully found a way to activate devices using just the brain (Elsahar et. al., 2018; Moses et. al., 2021)

Individuals with vision, hearing, and other physical impairments are also able to access and use AAC systems, provided appropriate equipment and support. A team of professionals (occupational therapist, physical therapist, audiologist, vision specialists, etc.) should collaborate to help determine the best activation method for AAC based on an individual’s strengths and needs.

 

Myth: Children should start with low-tech AAC before moving on to high-tech AAC

Children do not have to demonstrate competence with a low-tech AAC system before moving toward a high-tech AAC system. (Don’t know the difference between low-tech and high-tech? Check out the previous blog post for more information!)

Since every child has different needs, strengths, skills, environments, and support systems, AAC should be selected based on those criteria, rather than a one-size-fits-all approach or progression. Further, since communication is most effective when it is multimodal, a combination of unaided systems, as well as aided low-tech and high-tech systems can be used in conjunction with one another to help provide the best functional communication outcomes.

A speech-language pathologist, as well as other healthcare professionals, can assist in the assessment, recommendation, and trialing of a variety of systems and modalities to determine the best fit for an individual. Even if a system is successful, modifications to the system or a replacement of the system may be necessary based on progress, changes, personal preferences, and other developmental factors. Flexibility, collaboration, and consistency is necessary for effective AAC interventions.

 

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

 

Common myths about AAC (augmentative & alternative communication). Common myths about AAC (Augmentative & Alternative Communication) – Tobii Dynavox. (n.d.). https://www.tobiidynavox.com/learn/what-is-aac/common-questions/. 

Elsahar, Y., Bouazza-Marouf, K., Kerr, D., Gaur, A., Kaushik, V., & Hu, S. (2018). Breathing Pattern Interpretation as an Alternative and Effective Voice Communication Solution. Biosensors, 8(2), 48. https://doi.org/10.3390/bios8020048

Ganz, J.B., Earles-Vollrath, T.L., Mason, R.A., Rispoli, M.J., Heath, A.K., & Parker, R.I. (2011). An aggregate study of single-case research involving aided AAC: Participant characteristics of individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 1500–1509. doi:10.1016/j.rasd.2011.02.011

Ganz, J., & Simpson, R. (2018). Interventions for individuals with autism spectrum disorder and complex communication needs. Baltimore, MD: Paul H. Brookes.

Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., … Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 635–646. doi:10.1016/j.jaac.2014.01.019

Light, J. C., Beukelman, D. R., & Reichle, J. (2003). Communicative competence for individuals who use AAC: From research to effective practice. Brookes Publishing.

Millar, D.C., Light, J.C., & Schlosser, R.W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264.

Neuroprosthesis for Decoding Speech in a Paralyzed Person with Anarthria. Moses DA, Metzger SL, Liu JR, Anumanchipalli GK, Makin JG, Sun PF, Chartier J, Dougherty ME, Liu PM, Abrams GM, Tu-Chan A, Ganguly K, Chang EF. N Engl J Med. 2021 Jul 15;385(3):217-227. doi: 10.1056/NEJMoa2027540. PMID: 34260835.

National Scientific Council on the Developing Child (2007). The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper #5. http://www.developingchild.net

O’Neill, T., Light, J., & Pope, L. (2018). Effects of interventions that include aided AAC input on the communication of individuals with complex communication needs: A meta-analysis. Journal of Speech Language and Hearing Research, 61, 1743–1765. doi:10.1044/2018_jslhr-l-17- 0132

Romski, M., & Sevcik, R. (2005). Augmentative Communication and Early Intervention. Infants & Young Children, 18(3), 174–185. https://doi.org/https://depts.washington.edu/isei/iyc/romski_18_3.pdf 

Romski, M., Sevcik, R., Adamson, L., Cheslock, M., Smith, A., Barker, R., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 53, 350–364. doi:10.1044/1092-4388(2009/08-0156)

University of Washington. (2021, April 9). Dr. Stephen Hawking: A Case Study on Using Technology to Communicate with the World | DO-IT. DO-IT: Disabilities, Opportunities, Internetworking, and Technology. https://www.washington.edu/doit/dr-stephen-hawking-case-study-using-technology-communicate-world

Myth: Young Children Must Wait Until They Can Use AAC. Tobii Dynavox (n.d.).

http://tdvox.web-downloads.s3.amazonaws.com/MyTobiiDynavox/Pathways_SCF_Myth-Young%20Children%20Must%20Wait%20Until%20They%20Can%20Use%20AAC_v1-0_en-US_WEB.pdf

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