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

Photo by Volodymyr Hryshchenko on Unsplash

Photo by Stephen Andrews on Unsplash

Photo by Palle Knudsen on Unsplash

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.

Is My Child Doing What They Should? Milestones from 1 to 5 years

 

Do you ever find yourself comparing your child to their peers at the park or playground? Or maybe even comparing them to their older sibling? Do you feel like they are behind with their motor skills? What truly is “age appropriate”? In this post, we will cover age-appropriate milestones from age 1 to 5 years and what to do if your child isn’t hitting their milestones on time. 

What are developmental milestones?

Developmental milestones are physical signs of development that provide information with regards to your child’s development. There are milestones for each age range that will slowly emerge over time. Each child will develop on their own individual timeline, so keep in mind that some children may skip over milestones, while others may need a little bit more time to get where they should be. 

1 year

At 1 year, children are crawling well and begin to pull up into standing and walk while holding onto furniture (“cruising”). They may stand alone and take a few steps without holding on. At this age, it is best to provide many safe places for your child to explore. Using furniture such as a couch, coffee table, or ottoman is great for working on standing and cruising. 

18 months

At 18 months, children are walking quickly on their own. They are able to pull toys while walking and climb up into chairs without help. At this age, you can encourage development by continuing to provide safe areas for your child to walk and move around. Provide toys that your child can push or pull and balls to kick, roll, or throw. Bubbles, blocks, puzzles, and books are great toys to use at this age. 

2 years

Around 2 years of age, children begin to stand up on their tip toes to reach for objects placed up high. They are filled with energy—running, jumping, and climbing. They are now able to go up and down stairs while holding onto the railing or wall and stepping with both feet on each step. At this age you can work on walking backwards and ball skills such as rolling and kicking a large ball back and forth. Take your child to your local park or playground and encourage climbing and walking on different surfaces. 

3 years

By 3, most children are able to ride a tricycle (3-wheel bike). They are climbing well,running easily, and jumping off of surfaces. They are also able to walk up and down stairs on their own, with one foot on each step. To encourage development at this age, actively play and exercise with your child rather than having them passively watch a screen or TV. Allow your child to help with chores and carrying things. Get outside and have your child interact and play with other children. 

4 years

At 4 years, your little preschooler is able to hop on one foot and stand on one foot for more than 3  seconds. Most of the time, they are also able to catch a playground ball that is bounced or tossed to them and are showing improved accuracy in throwing4 year olds love to try new things and participate in make-believe play. You can work on these skills while playing pretend and building imagination with your little one. 

5 years

Around 5 years, you should expect your child to run fast to a target and turn around quickly to change directions. They can catch and throw a small ball, walk on a balance beam forwards and backwards, and stand on one foot for approximately 10 seconds. They may be able to skip or this skill might still be emerging. In order to work on their motor skills, arrange play dates and trips to the park with peers. You can also explore your child’s interests in your community whether it be trips to the zoo if they’re interested in animals or joining a gymnastics program at your local gym if they love to monkey around at the playground.

What if my child is behind?

If you are reading through the above milestones and have concerns about your child, it would be beneficial to first schedule an appointment with your pediatrician for a developmental screening. If the child presents with suspected delay, your doctor can then refer your child to a Physical Therapist (PT) for an evaluation. A physical therapist can use a standardized assessment tool in order to compare your child to their same-age peers. If a delay is indeed present, physical therapy services may be recommended in order to work on motor development, strength, balance, etc. 

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. 

Elle Faerber, PT, DPT

Physical Therapist 

 

References: Important Milestones: The Children’s Hospital of Philadelphia. (2014, May 05). Developmental Milestones. Retrieved from https://www.chop.edu/primary-care/developmental-milestones 

Your Baby By Five Years. (2021, May 17). Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-5yr.html 

Photo Credit: Photo by Joshua Choate from Pixabay