Top Tips and Strategies for Teaching AAC

Top Tips for Teaching AAC

Before I jump into teaching tips and strategies for AAC, I’d like to point out that there still prevail several myths about using and teaching AAC that need to be put to rest in one’s mind before proceeding, because they are, ultimately, dangerous and misleading.
Stated in their true, factual, negative forms they are:
There are NO prerequisite skills for learning to use AAC. AAC is NOT a last resort, only to be used when all attempts at teaching verbal communication over time have failed. And, NO AAC will not prevent a child from speaking or in any way delay the development of speech in any child who has the potential to speak at ll. NO child is too young to begin working on using AAC. There is NO hierarchy of AAC systems or symbol systems through which a child needs to work before using high-technology dynamic display systems. AAC is NOT only for persons who are completely nonverbal. NO individual is too cognitively impaired to use AAC. And, NO, PECS is not sufficiently robust as an AAC system.
You can find my free handout on the myths of AAC here
 

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Now, where do I start?
The number one strategy for teaching an individual to use AAC is Aided Language Stimulation.   Aided Language Stimulation (AlgS)  Few AAC users are sophisticated enough to make the AAC system work for them immediately. Aided Language Stimulation (ALgS) is a strategy in which a communication partner teaches the AAC user the meanings of symbols, their locations, and how/when to use them through modeling their use while providing verbal input for genuine communication interactions. 
In order for a child to learn to use pictures to communicate they need to have models of people using pictures to communicate.  It has been likened to foreign language immersion - in order to learn a new language, one needs models of people using that language.  Speaking children learn to talk by listening to others talking.  Picture-based communicators need to learn to use their mode of communication by watching other use pictures to communicate effectively. I can’t stress this enough. Partners should use pictures while talking, producing messages for a wide variety of communicative functions (e.g. questions, comments, greetings, requests, responses, giving and asking for information, telling, directing), using as much of the available vocabulary as is possible/practical.  Using aided language for commands or questions should be minimized; maximize use of statements and comments.  In order to do this, partners must be familiar with the location of vocabulary in the system. They should practice with other partners to get comfortable with it.

 

  • Get my free handout on how to Be a Good Partner to an AAC User
  • What is Augmentative-Alternative Communication?  

        

    According to the American Speech–Language–Hearing Association (ASHA), it is, “…a set of procedures and processes by which an individual’s communication skills (i.e. production as well as comprehension) can be maximized for functional and effective communication.  It involves supplementing or replacing natural speech… with aided… and/or unaided symbols…”

        

    Note that this definition refers to communication approaches that augment speech or serve as an alternative refers to all methods that make communication easier or possible may include facial expressions; gestures; an alphabet, words or picture board; a computer; and other similar systems.

  • Ultimately, the most effective communication is achieved through spontaneous novel utterance generation (SNUG). 

    SNUG allows someone to say anything they want, by combining words, word combinations, and commonly used phrases.  It’s based on normal language (moving from single words to word combinations), and on the notion that most sentences we use we’ve never used before. 

  • Consider:  if most sentences we use we’ve not used before, then how can we predict which number of limited number of sentences someone else will want to use?  

    In fact, pre-stored messages (as have been found on many AAC users’ systems) are rarely used in social contexts by AAC users, according to the research (Hill, K, and Balandin & Iacono).

     

    So, how do we design AAC systems so that individuals can learn to generate whatever ‘novel - or repeated - utterance’ that they want to?

    We need to give them a system that has sufficient vocabulary to meet all of their communication needs.  This vocabulary needs to be organized in a manner that makes linguistic sense, is easy to navigate, is easily added to without disturbing the organization, and allows the user to find vocabulary easily for a variety of messages.

     

    There are a variety of options available when it comes to organizing vocabulary in AAC systems.  Organization of vocabulary has been one of the most hotly debated topics in AAC discussions.  Recently, however, we as a field have come to the conclusion that a combination of core word and pragmatic based communication is the most functional.

  • Core Words and Pragmatic Function

     

    Core vocabulary boards and books focus on providing students with those words that research has shown to be the most-used to generate language responses.  

    Core vocabulary is a small set of words, in any language, that are used frequently and across contexts (Cross, Baker, Klotz & Badman, 1997). Core vocabulary is re-useable vocabulary, and consists of high-frequency words that are multi-purpose and are used over and over in multiple contexts and with clear meaning.  Core vocabulary is consistent across place and topic, and is independent of cognitive ability.  Core vocabulary includes a variety of parts of speech - nouns, pronouns, verbs, adjectives, adverbs, prepositions, conjunctions, and interjections; although there are very, very few nouns and none in early core word lists. 

    Regardless of whether core words will be built one at a time or a dozen at a time, it is important to start with a display that is larger than it needs to be in the beginning – one that is approximately a size that will be functional for the individual for a while. The grid can then have just the single word, or few words, to begin with, with more core words added as language and communication grow.  What is important about this concept is that the vocabulary be placed in its permanent location from the beginning, so that it remains stable throughout learning.

        

    As a new word is added, emphasize it more than others in Aided Language Stimulation and elicitation strategies.  Provide activities that focus on that word more than others, while still maintaining use of words that have been established.  

     

    Beyond contextual use, begin to add practice activities that practice locating and using the word in decontextual activities.  

     

    Modify traditional games so that the words needed to play them are the words you’ve been building.

  • Take a look at my activities for teaching core words use through interactive books, games, activity and environment simulations.

    Activities to Teach a Year of Core Words

    Teach Me Core Words

     
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Core word teaching serves as a great method for teaching language; particularly generative language teaching.
What kind of technology or system do we use?
When asked the question, “Does this individual need a low-technology system or a high-technology device?” the answer is “Yes.  All of the above.”  At all times we should remember to focus on the individual and their communication; NOT the technology.
No tech is also considered to include object-based systems, as well as paper based systems that may or may not be created with a computer, using letters, words, and/or picture symbols.  Some examples include:     
1. Object boards (with or without symbols or text).  Object boards are sometimes used for individuals who relate better to concrete objects, or those who have severe vision impairments, or who are deaf-blind, and who have difficulty understanding the symbolic nature of pictures.  This often limits those students’ available vocabulary and restricts their access to a variety of communicative intents.     
2. Single pictures (or photographs) that are good for labeling items in the environment or for making simple requests. Even without technological solutions and equipment there is a lot that can be done in classrooms for students who need AAC (but might not yet have it) using pictures taken from software, websites, magazines, or other educational sources.  
3. Single communication boards; which can be created in several different styles and means of vocabulary organization. 

For some sample core word-based communication boards for a variety of users, look at my Core Word Communication Boards sets:

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Where to Begin?
 

  • There are a variety of schools of thought about how to begin to provide intervention and where to begin with AAC.  

    While there are NO prerequisites to communication, many people believe there is a logical order of developmental sequence (with the exception of many practitioners of applied behavior analysis and consistent providers of aided language stimulation).  Too often this leads to underestimation of the learner and restraints on the system provided.

  • The research shows that teaching words with a variety of uses and functions for communicating is important for AAC users to become effective communicators.  Unfortunately, too often the first thing taught to children with complex communication needs is nouns.  The focus is often on meeting basic wants and needs, or avoiding behavioral problems by providing what the child wants to ask for.  However, a close look at the child’s environment shows that, for the most part, basic needs and wants are met, and caregivers know what the child wants when it is a concrete or preferred item or activity.  As a result, the AAC user ends up being able to label items without being able to tell whether he likes them or not, wants them or not, has a problem with them or not, needs them moved, wants something different instead of them, or had one of them yesterday.

  • The second thing often taught to children with complex communication needs is specific sentence structures, whole message units, and/or specific carrier phrases.  The result is that they have little opportunity to learn language structures, little opportunity for spontaneous generation of novel utterances (SNUG), little opportunity to project their own intent upon messages, and that they have artificial sounding speech or voice output.

     

    Some of the first phrases taught to AAC users are “I want,” and “I see.”  But how about “I don't want,” “Go away,” “Leave me alone,” “Something different,” “I need a break,” “Need help,” “He’s bugging me,” “Want to go,” or “It mine.”?

     

    Even students with complex communication needs need a sufficiently robust communication system to be able to communicate all of their needs, all of the time.

  • Motivation is critically important for AAC users to put forth the significant effort needed to learn to use the AAC system.  AAC users may tend, without sufficient motivation, to restrict the effort they make.  The AAC user needs to feel that the goal for this communication instance is worth the effort it will take, and that the goal is attainable and desired.

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A Word About Partner Training
    
 

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AAC Assessment
Lightening the AAC Assessment Toolkit

 

  • “The ultimate goal or outcome is to design a system that matches a child’s abilities and communication needs.  Components of the system should enable the child not only to communicate, but also develop expressive language performance.”  (Bruno, AAC, April 2005)

        

    Unfortunately, there is a “Catch 22” to the assessment process:  “We can only see what the individual is doing with what they have been provided.  If we think that this all they can do, we don’t provide them anything more.  If we don’t provide them with anything more, the individual never learns more.” (Gayle Porter, 1995, paraphrasing Goosens, 1989)

  • Elements of an assessment include:  

  • Case history and preparation: collecting background information and preparing for a customized session
  • Language & communication assessment: assessing receptive and expressive language and/or general communication skills
  • Symbol assessment: includes ability to identify and use a variety of symbols, and to navigate in order to find them within the system(s)
  • Device trials: use of a variety of different devices through multiple opportunities of use in natural activities
  • Access method: assessing as needed alternative modes of creating messages, for those who cannot use direct selection consistently
  • Multi-modal approach: the use of a variety of different levels of system components, from no tech through high tech, to find the best combination of solutions for a system that is useable in different contexts
  • AAC instruction: includes teaching the individual and partners how to operate the system and how to make decisions about which system to use
  • Personalization: use of individualized communication opportunities that meet the client’s interests and needs.
  • A comprehensive AAC assessment involves compiling, discovering, and then integrating this wide range of information about the individual and his needs, in order to make appropriate AAC system and implementation recommendations.

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  • The process of AAC evaluations has been changing in recent years.  While the type of information we need to gather certainly stays stable, the method for gathering some of it has changed.  The field of AAC is moving away from evaluation sessions that are more like testing sessions than communication interactions. 

    Beukelman & Mirenda (2005) addressed the need for assessing the individual’s participation patterns and communication needs during typical routines and in natural settings.  This Participation Model is based on the functional participation requirements of peers without disabilities and is designed to assess and intervene across all environments.  We should choose the materials and activities that interest the individual, provide opportunities for the individual to use multiple communication functions, and provide sufficient symbols to express all of those functions.  We should not provide just those symbols that meet the individual’s current communication targets, but also vocabulary symbols that provide for the next levels of skills and for partners to use to model language expansion.  By using genuine activities to engage the individual while providing sufficient vocabulary with which to interact, we can get a better picture of what he can do currently and what he has the potential to do with scaffolding.

  • Having access to a wide variety of communication systems can be challenging for most clinicians.  SLPs working in school districts or private practice rarely, if ever, have access to a selection of dynamic display devices in order to make comparisons.  The use of iOS devices with a range of AAC apps has made that aspect of assessments easier, in some ways, but many clinicians do not have even a range of robust AAC apps to use.

  • To get my resource on Lightening the AAC Evaluation Toolkit: iOS devices in evaluations, go hereIt explains ways to use an inexpensive AAC app to create a variety of evaluation pages that answer most of the basic questions in contextualized and motivating activities.

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