Sunday, August 20, 2017

AAC: 7 Ways to Get Started with Young Emerging Communicators

One of the classrooms I was consulting to over the past couple of years was a class of medically fragile students with Complex Communication Needs. At the time, there was not a lot of AAC going on.
Fortunately, for both myself and the students, the teacher was very open to adding more Assistive Technology. So, here are a few of the elements we added to her classroom:

1. At circle time, the teacher used a Big Mack button to have students respond to taking attendance. Access was an issue for many of the students. So, where the BigMack button was held was a big issue. And this was just 1 single response.

2. One of the students had the motor skills to touch a target with her hand independently, and the ability to use more words. I made her a PODD book, and demonstrated how to provide Aided Language Stimulation consistently. I provided support monthly throughout the school year.

3. At one point, this student needed to have something that was more compact. Aides were having a difficult time dealing with her behavior in the room, which included trying to contain flailing arms and legs and head butts.
       So, since they told me they couldn’t handle the PODD book, and I wanted to make sure whatever AAC I was providing was getting used consistently, I backpedaled and went to a small (20 symbol) core word board, with some activity specific fringe words (presented in pages of 6 symbols) for the 2-3 favored activities she would spend some time in.

       This student had some cortical vision issues, so these symbols were printed with bright red and yellow and high-contrast symbols where available.

4. For other students, I looked at adapting books and encouraged the teacher to do more read aloud and shared reading with specific objectives in mind. For the students in this class who were going to be involved in shared reading activities, she needed a way for them to respond to questions or make comments. For most, this involved using eye gaze.
       So, we went from the teacher holding up a 2-choice array to a version of an E-tran board with 4 choices, and then 8. Thus, student response choices were quadrupled in a short period of time. And, with multiple boards with this many choices, there was a bigger array of responses possible.

5. Speaking of read aloud time, this was another opportunity to use the Big Mac buttons or a Sequencer. Recording the repeated line of text gives students a way to participate. Recording sequential lines gives them even more opportunities.

6. Access was the biggest problem with this group of students. I added visual cues and communication opportunities in as many places as possible. We looked at a variety of different switches for them to use and I pushed Partner Assisted Scanning as a no-tech mode. (District purchasing processes are still a mystery to me. All I know is it usually takes forever.)
       We looked at SCATiR switches, toggle switches, sip-n-puff, pillow switches, and more. Fortunately, we also had access to the California Assistive Technology Exchange (CATE) loan program. This allowed trials of a wider variety of switches we would have had access to.

7. I made large, 3X5 card sized symbols so that there was a classroom sized communication board that was core word based, that was large enough for all the students (with the exception of those totally blind) to see, that was high contrast for students with vision disorders, and whose symbols were easily removed one at a time during instruction time to emphasize use of the target core word. Any opportunity to use a core word is important.
       Access to symbols needs to be as easy as possible. Putting these cards into a large pocket chart provided that quick and easy access to enough core words that the teacher could use them seamlessly in instruction.

       Using aided input during routines is a great way to introduce the core vocabulary in consistent formats. With this particular group of students life was full of routines. Between changing diapers and clothes, washing up, feeding (which for a number of them was via G-tube), and other daily care routines there were a lot of times throughout the day when the same sequence was carried out and talked through. Perfect opportunities to provide aided language.

In my 40+ years of working with children with little or no speech, I’ve learned a lot. The field of AAC has learned a lot. I like to think we now know enough to give every child, no matter the disability, a voice.
I’ve seen it happen. I’ve seen it work. And my hat is off to all those SLPs and teachers and paraprofessionals who make it work every day, even when it seems a Sisyphean task. We just need to continue to provide the input and presume competence.

And……keep on talking, with pictures.

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