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Sunday, March 29, 2020

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.

Sunday, March 22, 2020

AAC Users Communicate While 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.

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.

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.

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.

Sunday, March 8, 2020

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!