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Sunday, July 28, 2019

What Have You Got to Say for Yourself?

Teaching a child to use AAC requires a level of familiarity and comfort with the AAC system itself.  Using the pictures while simultaneously speaking to the child provides a level of direct modeling that verbal children receive from birth.  And just as we provide verbal input 1 or 2 or 3 words at a time, we also model use of 1 or 2 or 3 symbols, keeping our models just 1 step ahead of where the child's expression is currently.

This Aided Language Stimulation - also called Partner Aided Input - is crucial to the child learning to use their aac system.
Language is learned through models. Children learn spoken language by listening to others using it. A child using picture-based communication is learning an entirely different language. They need to see models of people using it effectively. And models provided in response to their communication are most powerful.

What else can we do? 
  •  create a positive communication environment
  •  respond to all communication attempts

There is a positive communication environment when we respond to all of a child’s communication attempts, provide support as needed, focus on positive results, and find solutions to challenges. Even when you respond to an undesirable behavior, if you do so while also modeling how to use the correct message in the AAC system you take advantage of a communication opportunity.

As much as possible, do NOT ask yes/no questions, do NOT ask closed-ended questions

DO ask Wh-questions or other open-ended questions. If necessary, ask multiple choice questions.

Strategies to create opportunities to communicate include:
     providing choices, 
     sabotaging the environment, 
     giving small amounts of desired item/activity, 
     briefly delaying access, 
     using pause time, 
     using fill-in-the- blank activities.

Respond to all Communication Partner’s Attempts:

All children communicate. They don’t all communicate symbolically - that is, with pictures, words, text. And some of their nonsymbolic communication is undesirable.

Think about how this child responds to his/her own name; what (s)he does when a routine is interrupted; what (s)he does when wanting an item, action, attention, or help; or tells you when something is wrong. What we’re talking about is how this child communicates to reject/protest, request, comment. Those are some of the main, early functions of communication. The earliest communication behaviors are social regulatory - regulating another’s actions.  What we need to do is to respond to those other communication behaviors, while shaping them into more acceptable or understandable forms.

The more you practice using the aac system during real contexts, and increase the number of those contexts in which you use the aac system, the more automatically the child will learn to use the system.  

More to come.....
Keep on talking!

Sunday, July 21, 2019

Please! Don’t Believe That!

Once upon a time, Romski and Sevcik wrote an article about the myths of AAC . They wrote that “Despite the advances, the inclusion of AAC services and supports into early intervention service delivery for young children has been hampered primarily by myths about the specific types of roles AAC plays.”

That was more than a decade ago and the myths of AAC are still running rampant through our practice.  Here we are, years later, and many of these myths are still found throughout our service delivery - or lack of it.

So, I think dispelling those myths bears repeating.

Romski and Sevcik listed 6 myths of AAC:

1. AAC is a “last resort” in language intervention and shouldn’t be used until all hope of being verbal has been given up.  Research has shown that it is actually important to introduce AAC before the child fails so that he has a communication mode before frustration sets in.

2. AAC hinders or stops further speech development. Research again has shown that use of AAC can actually help children develop speech.  
Many children with significant communication needs do have some words they use.  However, if speech is not functional to meet all communication needs, if there is not sufficient vocabulary, if the child is not understood by all partners, if the child only repeats what he has heard - then he needs AAC intervention.

3. Children must have a certain set of skills to be able to benefit from AAC. While the exact relationship between cognition and language is unknown, we do know that many children cannot demonstrate their abilities without a way to communicate.

4. Speech Generating Devices are only for children whose cognition is intact. 
Advances in technology mean that advanced cognitive skills are not necessarily needed to use high tech systems and, as a wide range of options are available, there are many tools that children can bee taught to use effectively

5. Children have to be a certain age to benefit from AAC. Again, research shows that providing children a mode of communication early is beneficial and will not hinder speech development.  
AAC has been cited as an evidence based strategy for facilitating speech in young nonverbal children.
Waiting too long to provide AAC intervention in the belief that the child is too young denies the child the opportunity to learn language, acquire vocabulary, and express himself appropriately.  Research shows that intervention provided after 3 years has a less significant impact.

6. There is a representational hierarchy of symbols from objects to written words. Romski and Sevcik site the research that shows that children do not actually learn less abstract symbols better or faster. To the child, all symbols work the same way. We just need to teach them consistently.
Requiring the child to use multiple systems as they work their way through some artificial hierarchy only makes learning to communicate harder.  Having different displays, different arrays, and constantly moving vocabulary targets is discouraging to some children and takes the emphasis off of communicating and puts focus on the system - which is not where it belongs.

In fact, according to ASHA (the American Speech-[Language]-Hearing Association), all individuals are considered potential candidates for AAC.   ASHA and the Joint Commission for Persons with Disabilities have a “zero exclusion” criterion and consider not whether an individual is eligible for services, but rather consider where along the continuum they are currently operating as a starting point .  As long as there is a discrepancy between needs and abilities, an individual qualifies for services in AAC. 

Voice output is closer to the back and forth of the natural language learning process, it provides auditory feedback while the child is learning symbol meaning, and allows the child the opportunity to “play” with his voice, the way that typical children do.  The high tech system also provides better opportunities in most cases for scaffolding and modeling.  Only a ‘smart partner’ assisting in scanning or a good provider of aided language stimulation provides more feedback and models.

One more misconception is that teaching the student to identify and discriminate the pictures is all that is needed by way of teaching students to use them.  Too often, students are given this skill training, provided with a communication system, then deemed to have “failed” because they don’t use it effectively.  We must remember that we are EDUCATORS.  We need to provide appropriate intervention; including operational, linguistic, social, and strategic use.  We need to teach these kids to communicate with this mode - one that they have no prior experience with.

For a brief handout explaining these myths, click here to download.

Get ready for the new school year with confidence. 
And, keep on talking!