The Speech Pathologist’s Battle Cry: Model! Model! Model!

Modeling. We talk about it a lot when working with children with an assortment of “special needs.”  But I don’t think we ever really aggregate all of the different skills we model for.

• AAC use: We encourage and direct communication partners to use Aided Language Stimulation to teach AAC users how to use their AAC system and how to use the vocabulary and language it contains. Modeling use of the AAC system has been given various names, but it most often called Aided Language Stimulation (Goosens et al 1992) or Aided Input. This modeling takes the form of the communication partner pointing to symbols on the communication display simultaneous with speaking and any language input/stimulation in order to demonstrate use of the symbols for interaction. 
• Language skills: Our use of a variety of vocabulary and syntactic structures act as models for children to learn to use that vocabulary and syntax.  We use a variety of supporting strategies - such as recasting, self-talk, and others - to enhance our models and reshape them.  We model complete syntax back to children when their response is fragmented or telegraphic or otherwise restricted. These models build language.  Every interaction provides an opportunity for the child to practice language.  Providing models of asking and answering questions, organizing details of a topic/experience, gaining attention, etc. all are critical for the child learning to interact competently.

• Narrative structure: We tell stories and we (hopefully) read stories, giving children models of conversational structure and story structure so that children can learn how to tell about experiences and tell good stories.  Narratives for AAC users often begin with single word utterances, used sequentially, and develop as we provide models for expanded responses, descriptive language use, and story grammar.
• Social skills: One of the skills I see parents and teachers making sure to model is good manners. Use of ‘please,’ ‘thank you,’ ‘you’re welcome’ are not vital when children are emergent communicators, but as they become more competent and more interactive, use of those socially accepted niceties becomes important.

So, no matter how you’re supporting a language learner, remember to be a good model and to model specifically those skills the child needs to learn.

AAC Users Communicate wile Sheltering in Place

The world has changed dramatically in the past few weeks.  And - overnight it seems - we’ve become instant homeschoolers.  I know many parents who are scrambling to keep therapy going, and speech pathologists who are scrambling to provide teletherapy and digital resources.

But I don’t think parents of kids with complex communication needs, parents of AAC users, need to rush about doing anything different or more. I think it’s time to relax and enjoy your child; not try to replace his teacher.

So, what do I suggest you do?

Keep the routine.  

If you’ve read this blog often, you know I’ve written a lot about building language thought routines.  Routines are at the heart of early language learning.  Routines provide multiple opportunities to hear and practice the same language sequences over and over again.  Routines in our lives are repetitive, and the steps we follow and the words we use during those steps are predictable.

Research tells us that routines are at the heart of symbol and language development. Routines are reliable, consistent, constant, and repetitious frameworks that provide us with the opportunity to provide consistent language targets.  Routines identify predictable vocabulary and activities that use the same context-specific vocabulary consistently.  They also identify consistent core vocabulary.  Routines, in short, provide a consistent schedule of multiple opportunities to learn communication.

Every routine can be broken down into smaller and smaller components. Each of these components is influenced by the responses and reactions  of those involved.  The reactions and responses become symbols that are used in this interaction to signal to each other.

When the routine always follows the same sequence, the signal between the two people involved become shared symbols. Routines help us build symbolic awareness, and symbols become communicative when they come to have a more standardized or conventional meaning among a larger group.

We want to use consistent vocabulary and sequences within frequently occurring routines.  Utilize simple scripts within routines so that you are consistently modeling the same vocabulary and sentence types.  Make sure to model vocabulary used during routines that goes beyond requesting; to include commenting, providing information, asking questions, and other communication functions.

Play.  

Have fun with your child doing what interests and engages him/her.  One way to “prompt” communication is to create temptations.  Place the toys near you or in your lap.  Look at your child expectantly, letting him know you want him to do something.  Model commenting, requesting, or labeling.  Or join him when he is playing and facilitate talking about what he is doing.  Play alongside him and talk about what you are doing.  Gradually integrate your play with his.  Make comments, ask questions - and answer them if necessary. 

Think about what you can do with this toy.  Is there more than 1 way to play with it? Can you have your child follow directions? Ask or answer questions? What are the opportunities for dialogue with this toy? Can your child construct a narrative around what he is doing with the toys/toy pieces? Can he tell about the function of each part?

If your child can follow 1 step directions, can you help him to follow 2-steps? If e can answer what doing questions about his play, but not who or where; then focus on asking those questions about who is doing the acting or where something is, etc.  If he can name objects but not describe them, focus on adjectives.  Remember, pronouns, actions, describing words, and spatial concepts are all core words.

Follow your child’s lead. Remember, genuine communication comes from the child talking about what (S)HE wants; not what you’ve decided.

Read.  

This is always my top advice for parents wanting the time they spend with their child to be meaningful and helpful.  Reading to children is crucial for their social and academic success.  Reading to children with complex needs is crucial for providing them with context and background information that they haven’t gotten through real-life experiences.

Think out loud about what you are reading. This models how to deal with the vocabulary that is unfamiliar to the child.  Stop throughout the story to predict what might happen next. Offer opportunities for the child to turn the page - or ask you to do it.

If you are going to ask questions during reading, know that binary choice questions are the easiest to answer (giving 2 choices), followed by cloze procedures (fill in the blank), then open-ended Wh-questions.

Provide supports by making references to the text (“Look at the___”), providing that fill-in opportunity (“The boy is_”), using expansion (“Yes, the boy is_”), and modeling on the AAC system.

Read a variety of books; including leveled books with simple storylines, books with repeated lines (such as “Brown Bear”), books on a variety of topics.

I have a  variety of free resources in my Teachers Pay Teachers store that address shared reading and building language through play. You’ll also find some free activity calendars originally meant to fill the summer months, but certainly useful at this time.

You can find them here.

Don’t stress about making school at home with your nonverbal or minimally verbal child.  Just spend time engaging with your child. Model language and AAC use in whatever you do. That’s actually the most perfect thing you can do.

Stay safe.   And keep on talking.

All Aboard! Getting Everyone on Board with AAC

One of the biggest hurdles in AAC implementation is, sadly, getting all of the child’s communication partners on board with using and modeling and…….. well, just plain accepting the AAC system.

This can  be especially true for children who have some speech but are either unintelligible much of the time or who simply don’t have enough words to meet their communication needs.

I remember one child whose family I worked with over a period of a couple of years.  Initially, I recommended a high tech AAC device for this 9-year-old girl with  autism who had a few words, but not nearly enough to be a functional communicator.

The family were resistant to the idea of her carrying around a device and pointing to pictures to make it talk for her.  The school, too, took a “wait and see if she develops more speech” stance.  Unfortunately, we were talking about a child who was 9, then 10 years old.  Already she was miles behind her peers in terms of communication development.

Both  the family and school were, however, interested in how to adapt and modify materials and activities to meet her language development needs.  So we focused on that and I provided many of the same activities I would have for an AAC user.  Eventually, the family went off on their own, and I lost track of her.  In a way, I feel like I failed her, as I failed to get her communication partners to accept that the AAC device would, in the long run, have stimulated her verbal output  more than any of the other activities we were engaging her in.

On the other hand, I have my most favorite story, of a young man with autism who was completely nonverbal and was, at the time I met him, using a PECS board with about a dozen of his favorite reinforcers. This young man was seriously self-injurious and has done permanent neurological damage.

After the evaluation, while waiting for the ordered high tech device to make its way through the labyrinth of school district funding processes, I made him a PODD (Pragmatic Organized Dynamic Display) communication book.  

The teacher and his aide took one look at the 125-page book when I walked into the classroom with that deer-in-the-headlights look.  But they were game for anything to help this student.  They listened as I explained how the book worked, the navigation conventions unique to PODD, and the process of Aided Language stimulation.

Within just a couple of weeks, this young man was engaged with  the power the book gave him.  In one particularly stress-inducing situation, rather than engaging in the SIB that had harmed him, he stopped and grabbed and book, navigated from page to page to find all the words he needed, and constructed a perfect message that consisted of a string of single words that told a narrative.  His aide responded to the communication, he got what he needed, and everyone in the district got on board with PODD!

It’s not always that easy to get buy-in. In fact, it’s rarely that simple or fast.  But sometimes it is and those are the wins we’ll take any day.  The bottom line is that staff and family, just like the students themselves, need to see the power of alternative and augmentative communication.  They need to see the benefits in action.

I was recently told that I could not share that second story with a group of parents, because it would give them false hope, and they had been bitterly disappointed in the past with other “promises” and claims that, in the end, did not work for their severely involved children.  I was saddened by that attitude but understood completely.  Nobody is too disabled to be able to communicate.  We just need to find the way in.  

Don’t stop looking.  It can be done.  And the resulting power we give our students is worth it!

Do You Do This? Read Aloud Strategies You Can Use with Your AAC Users

The “word gap” is real. You’ve heard this before if you read this blog regularly.  In fact, here is a link to my post on the 30 million word gap.

The fact is that children who are not read to come to school with far less vocabulary knowledge than kids who are. And children with fewer words in their vocabularies understand far less of what they read than their peers.

Our AAC users are particularly vulnerable.  Far too often parents and teachers alike underestimate their nonverbal child’s interest in or attention to books.  And yet books are the perfect way to boost an AAC user’s vocabulary.

BUT - and I’ll bet you know what I’m going to say - they need a robust AAC system with lots of room for a growing vocabulary.

So, you’ve settled your AAC user down with a pile of good books, all based on his interests.  You’ve had him choose one to start with, and off you go.

Vocabulary needs explicit instruction.  Illustrations and context are wonderful for comprehension, but children often need explicit structured instruction for word meanings.

So, when you come across a new word, stop and offer a child-friendly definition, using the context and pictures from the story.  Talk about the word and its meaning. See if you can relate it to something familiar. Provide other examples. And try to use the word in other contexts, as well.

And don’t forget to find the word in the AAC system.  Where is it? What kind of word is it? Where does it belong and what does it relate to? Talk about its features as you determine whether it belongs with the describing words or the action words or….

We need to give our AAC users the opportunity to love books and to learn from them. We need to provide them every opportunity to learn what their peers are learning and say what their peers are saying.  Books are one way in.  Read. And….keep on talking.

You might also be interested in my post about teaching vocabulary in themes.

Is it Story Time Yet? Why We Read to Children

The wrapping paper is gone, the boxes have been recycled, and - hopefully - the kids are still enjoying their presents.  It’s a new year, and perhaps we can build some new skills.

One of the things my children could always count on receiving as presents was books.  My kids loved being read to and I loved doing it.  I read to my children even before they were born, and instilled a love of books in them very early.  Even my ADHD poster boy would sit still for reading time.

Reading aloud to our children is so important. Research says they should be read to at least 15 minutes per day.  Which doesn’t seem like a lot. My kids would rarely settle for anything under 30 minutes - and they could be happy for hours being read to.

Reading to children opens up so many worlds.  For one thing, reading comprehension is based on understanding vocabulary.  By listening to stories with varied vocabulary in an illustrated context provides children with much-needed understanding of different words than they hear throughout their day.

Reading comprehension also requires a degree of background knowledge.  It is difficult to understand a story about a topic or event that you have no frame of reference for. But children can’t experience everything first-hand.  Reading a variety of books to them provides some background knowledge on a variety of subjects.

Screen time is a hotly debated issue, and we know we want kids to have quality screen time. What better way to harness their interest in technology than with the many quality book apps on the market.  The Nosy Crow apps have always been among my favorite; their stories are interactive and have some great humorous elements that keep kids engaged.

For students who want a bit more independence, the low reading level and high interest of the TarHeelReader.org books are attractive to many of our students.

Dial in to your child’s interests and find a variety of books - both fiction and nonfiction - to keep them engaged. And make sure to keep their AAC systems accessible so they can talk about the books. Encourage comments and opinions, and make a game of retelling the stories.

Books are our window to the world and, for many of our children, the only way they will experience some things. Open the window, let in the light, and pave the way for literacy skills.

And keep on talking.

You might also like to read my posts on reading instruction for AAC users.

Is Telepractice the Solution?

Lately, I’m seeing more and more of my colleagues doing teletherapy.  For many speech-language pathologists, it is the ultimate solution for busy lives with kids. As one therapist states: “teletherapy is still a GREAT fit for me and my young family.  The ability to work from home and be present and available for my kids at the end of their school day is extremely important to me and being a teletherapist has allowed me to do just that.” (https://bvgslp.com/teletherapy-what-to-know-before-starting/).

Therapists enjoy setting their own schedules and determining how many hours they will work.  For the most part, teletherapists are contract employees - self-employed rather than salaried employees.  There are, however, a few exceptions to that.

A friend of mine, Sarah Wu from Speech is Beautiful even wrote a guide called “Is Teletherapy Right for Me?” (https://speechisbeautiful.com/2017/03/is-teletherapy-right-for-me/), talking about the pros and cons and things to consider.

Recently, a company providing teletherapy reached out to me, in an attempt to spread the word about affordable speech therapy provided on their telepractice platform. They’re called Expressable, and are committed to providing “high-quality speech therapy services at a fraction of the cost of traditional therapy.”

This is what they have to say: “Expressable’s one-of-a-kind technology platform connects families to dedicated SLPs specialized for their speech therapy needs. Live therapy sessions are administered online with modern video conferencing software that clients can access from the convenience of their home.

In addition to providing a cost-effective alternative, Expressable also offers many advantages only available in their online platform. These include the ability for clients to securely message their therapist 5 days/week, personalized and recorded home exercises for continued skill building and parental involvement, and flexible scheduling with easy cancellations. “

The owner of Expressable has this to say, “The American Speech-Language-Hearing Association (ASHA) approved teletherapy as an appropriate method of service delivery in 2005. The lack of overhead costs in teletherapy means that a family’s money can go further. Without the barrier of geography, a clinician with a specialty is able to provide for a client living across the state. Teletherapy checks so many boxes for both clinicians and the families they serve.”

I don’t know a lot about them, and I am personally not embarking on a telepractice journey; having retired to the quiet life of creating curriculum resources, but if you’re a speech pathologist considering a change of pace or a parent looking for a therapist in an underserved area, you should check them out.

“Research demonstrates that online speech therapy is just as effective as therapy delivered in a practice-based setting.”  And, in case you have this unanswered question - yes, it is available to AAC use.

So, check out the possibilities of teletherapy. The world is changing with technology.

And of course, keep on talking!

p.s. If you are considering or already doing teletherapy, take a look at my BOOM card decks for use on tablets, computers -even smartboards. 

Where is the Opportunity for Control with AAC? Communicating in Group Homes.

I recently had a mom whose adult child is living in a group home ask me to provide some guidelines for staff to help them with using AAC.

For more than 20 years I have provided consultation to an agency that runs a few dozen group homes for adolescents with autism and adults with a variety of developmental disabilities and dual diagnoses.

Many adults with intellectual or developmental disabilities do not develop sufficient speech to meet their communication needs.  And once outside the school system, they are often unlikely to receive any direct services for speech-language therapy.  

Many do not have any speech. Many of those who do have speech lack adequate speech in many contexts.  And for all of these clients, we need to consider how to provide them with improved communication.

Adults with developmental disabilities are vulnerable for an inability to get their needs met.  They have the least access to sufficient communication systems or skill-building.  And even those who have had some alternative system when they were in school have frequently lost access to a system as they transition to adult services.

What we have is a system with

• Unique clients: who may have had no prior language interventions. (This is particularly true for older clients who were in school when there were fewer options and services.)  These clients may have developed ways to communicate that are not universally understood but have been established over a long period of time.
• Unique environments: where life is highly routinized, needs are all met, opportunities to exert control may be very limited, and there are frequently few opportunities for communication interactions.
• Unique partners: Staff in adult programs may have minimal education and training, often do not understand communication needs, have difficulty with consistency in the face of having to provide services to several clients at once, and who need strategies to use that give them step-by-step directions.

Our goal is to increase communicative intent, to increase communication in a way that we understand intent, and to improve quality of life by reducing frustration and anxiety.

The biggest bottom line is that communication needs to be motivating.  This can be difficult in group homes where needs are met routinely and opportunities for a single individual to exert control over what happens are limited by staffing ratios and other clients’ wishes.

I urged staff to consider what their clients - including this young man - want or like, what the environment allows them to have unique to themselves, what alternative response they can use to tell staff and how staff can consistently require that they use that response to indicate what they want.

I remind the staff to think of communication as power.  It is about having control over the environment.  Our clients need to learn that they can have this power.  Staff needs to consider ways and times when this is possible within the structured environment of a group home situation.

Until next time.... Keep on talking!