Is This Routine? Why Not?

I’m trying not to sound like a broken record, but some strategies are so important that they need to be said over and over again:  We begin to build language with routines.

Research tells us that routines are at the heart of symbol and language development.  Routines are sequences of actions or events that are repeated over and over again.  

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.  [Remember, symbols are signals that are interpreted the same way by at least 2 people.]  

When the routine always follows the same sequence, the signals 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.  

This helps us realize why it is important to develop routines in thinking about intervention for AAC (Lonke, 2014) and for understanding the impact of aided language stimulation.

Aided Language Stimulation is a strategy I have written and spoken about repeatedly, because it is the single most important strategy for getting AAC users started as communicators.

Once use of Aided Language Stimulation has been established to introduce word use to the individual, explicit teaching activities need to be implemented to teach the new words.  Facilitators need to teach explicitly, then elaborate on the meaning and use of the word through a variety of meaningful activities.  The AAC user needs to be exposed to the word repeatedly and consistently.

Von Tetzchner (1997) and Porter (2009) both refer to the differences in language environments between typically developing children and AAC users.  Children are typically surrounded by examples of others using the communication systems they are learning.  Typical 3 year olds in middle class families hear 6 million words per year.  Typical deaf children with deaf parents see 6 million signed words per year.  Typical AAC users see others using symbols to communicate effectively approximately 0 times per year.  

“The average 18 month old child has been exposed to 4,380 hours of oral language at the rate of 8 hours/day from birth.  A child who has a communication system and receives speech/language therapy two times per week for 20-30 minute sessions will reach this same amount of language exposure in 84 years.” (Jane Korsten).

Hart and Risely (1995) found that typical children in working class families hear approximately 1,250 words per hour and accumulate a listening vocabulary of 6 million words by the time they are 3 years old.  Miranda (2008) then posited that children with ASD who are using AAC need to be presented with, literally, hundreds of opportunities to have symbol use modeled throughout the day.

According to Von Tetzcher (1997) “the difference between their own expressive (and for some also receptive) language and the language used by significant people in their immediate surroundings” is a critical factor in the acquisition of language for AAC users.  There is an assumption in all major theories of language learning that the individual is surrounded by others in the environment using the same language system.    Even in second language learning the importance of immersion has been noted. Learners of second languages need to participate in an environment that exposes them - immerses them - in experiences with that language in order to become competent communicators. 

The opportunity to be immersed in an environment using aided language is very rare.  For AAC users and learners, there is little if any opportunity to even observe others using an AAC system, let alone be immersed in an environment of AAC users. But without this, children learning to use AAC systems constantly need to figure out how to use a language system they have rarely - or never - seen used to communicate.  Not having models of others using aided language results in the student not knowing how to use a language system they have never seen used.

Because this type of immersion environment is rarely provided (although beginning to find foothold) to learners of AAC, there is a great discrepancy for them between the language environment to which they are exposed, which uses verbal language, and the language system they are being asked to use, which is a picture-based language.

Whatever the environment you are in, you need to think about the activity you want to engage him with, think about the language skill you are targeting, and plan what support is needed for the student to achieve the target.

Language intervention techniques that increase early expressive communication skills include Aided AAC Modeling, Expectant Delay, Open-Ended Wh Questions, Brief Verbal Prompting, and Increased Responsivity.

The same strategies used for all students/children apply to your AAC user. In a read aloud activity, for example, you can reference the text (“Look at the boy running!”), a cloze procedure (“The boy is _”), expansion (“Yes, the boy is running”), binary choice (“Is the boy sitting or running?”), modeling (in this case posting to pictures in the AAC system rather than verbal only model), open-ended questions (“What is the boy doing?”).

The Bioecological Model of Human Development. Bronfenbrenner, Urie; Morris, Pamela A. Lerner, Richard M. (Ed); Damon, William (Ed), (2006). Handbook of child psychology (6th ed.): Vol 1, Theoretical models of human development. , (pp. 793-828). Hoboken, NJ, US: John Wiley & Sons Inc, 1063 pp.

Bruno J, Trembath D. (2006)  Use of aided language stimulation to improve syntactic performance during a weeklong intervention program. Augment Altern Commun. Dec;22(4):300-13. 

Goosens, C., Crain, S., & Elder, P. (1992). Engineering the preschool environment of interactive, symbolic communication. Southeast Augmentative Communication Conference Publications. Birmingham, AL.

Hart, B. and Risely, T. (1995)  Meaningful Differences in the Everyday Experience of Young American Children. Brookes Publishing, 1995 

Henneberry, Solana, Jennifer Kelso, and Gloria Soto. "Using Standards-Based Instruction to Teach Language to Children Who Use AAC." ASHA, Perspectives.Web.

Kent-Walsh, Jennifer, Cathy Binger, and Zishan Hasham. "Effects of Parent Instruction on the Symbolic Communication of Children Using Augmentative and Alternative Communication During Storybook Reading." American Journal of Speech-Language Pathology 19 (2010): 97-107.

Light, J. (1989). Toward a definition of communicative competence for individuals using augmentative and alternative communication systems. AAC. Vol. 5, No. 2 , Pages 137-144

Light JC, Beukelman DR, Reichle J (Eds.). 2003. Communicative competence for individuals who use AAC: From research to effective practice. Baltimore: Paul H. Brookes Publishing Co.

Lonke, F. Augmentative and Alternative Communication: Models and Applications for Educators, Speech-language Pathologists  Plural Publishing. 2014

Pragmatic Organization Dynamic Display Communication Books: Designing and Implementing PODD Books. Porter and Burkhart 2009. Seminar

Von Tetzchner, S. (1997) The use of graphic language intervention among young children in Norway. International Journal of Language & Communication Disorders

Volume 32, Issue S3, pages 217–234, December 1997

Also:

American Speech-Language-Hearing Assoc (2001a). Competencies for speech-language pathologists providing services in augmentative communication. Asha, 31(3), 107-110.

Banajee,M., DiCarlo, C., Striklin, S.B., (2003). Core vocabulary determination for toddlers. Augmentative and Alternative Communication, 19, 67-73.

Binger,C. & Light, J. (2007). The effect of aided aac modeling on the expression of multisymbol messages by preschoolers who use aac. Augmentative and Alternative Communication, 23(1), 30-43

Musselwhite,C.R., Erickson,K., Zoilkowski,R. (2002 ). The Beginning Literacy Framework. Don Johnston Inc.

Musselwhite,C.R. (2006).  R.A.P.S. Writing Tips!  Learning Magic Inc.

www.asha.org/docs ASHA’s site contains position documents, and documents outlining their stand on the knowledge and skills, roles and responsibilities of slp’s regarding aac

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