Think of everything you did today. How much of it involved communication with another person? Could you have performed these same tasks if you were unable to communicate? Probably not. We communicate with others for many different reasons. To connect, to share information, to comment, to ask questions, to make plans, to express needs and wants and likes and dislikes. Communication is a human right.
But for some, communication doesn’t come as easy as it does for others. Imagine how isolating it would be to be unable to express yourself. Imagine how frustrating it would be to constantly be misunderstood. Imagine how dependent you would be on others for absolutely everything. Gestures and grunts and pointing can only get you so far. Each person deserves so much more.
I have two boys with autism. When my oldest son Greyson was first diagnosed, I was paralyzed by the “what ifs” I feared would never come true. The biggest What if he never talks? That thought took my breath away. At three years of age, Greyson had severe expressive and receptive language delays, and when he did talk, it was difficult to understand him. In Applied Behavior Analysis (ABA), he was responding well to Choice Boards and Pictures, and this seemed to decrease some of his frustrations. Our ABA company suggested looking into another form of AAC- a Speech Generating Device.I wasn’t ready to give up on him speaking, so I didn’t pursue it. After several more years, I thought about it again. Greyson was now 7 and had an official diagnosis of Childhood Apraxia of Speech in addition to autism. Apraxia is a Motor Planning Disorder. Motor Planning allows us to know, remember and perform small steps that make a particular movement happen. Motor plans are needed for everything from brushing our teeth to speaking. In Childhood Apraxia of Speech, the Motor Plans needed to create intelligible speech are faulty. Your mouth muscles work fine, but your brain can’t tell your tongue, jaw and lips what they need to do to produce certain sounds. Children with this disorder have low speech intelligibility, which is understandably accompanied by high levels of frustration. I decided then that I would “give up” on my hopes and dreams of him speaking and having conversations and telling me about his day.
Now in over an almost three-year span, Greyson will blow you away with how well he can navigate his device. In addition to using it to express himself, he is learning all the letter sounds, he can read, and he is an emerging writer. He can tell me he wants to ride on a rocket to the moon, he can ask for very specific (and very expensive) Disney Pixar planes on Amazon, and he can tell me where he got hurt-all with his device. People are also constantly saying how much more he is talking now too. It’s remarkable to see how far he has come, and how much he had to say. This never could have happened without tons of modeling and buy in from every individual that works with Greyson. My only regret is that we didn’t start sooner.
When we first started using a device, I worked with Natalia Lopez, owner of Empower Speech Therapy and Life Skills Center in Fresno, California. She is a Certified Speech Language Pathologist, and is a member of special interest groups for Augmentative/Alternative Communication (AAC). In addition to her private practice, she offers hands on AAC classroom coaching and training. Basically, she’s a queen of AAC.
Natalia was instrumental in helping us select, customize and implement use of a Speech Generating Device for Greyson. What was once so intimidating – instantly become EMPOWERING with Natalia’s help. I want to bottle up that hope I felt so EVERYONE can experience that ah-ha moment when it comes to using Communication Devices, so I asked her to share some tips for successful AAC use in the classroom.
#CULTURE – This one is huge, and is a requirement. As a Teacher, you get the set the culture around AAC use in the classroom. Is it something to be excited about? Problem solve? Can you see its power and potential? Is it something your student deserves? Or is it something to be dreaded, something that is stressful, and “one more thing we have to do”. If you are the Teacher, you get to set that tone and positive expectation for the whole classroom. Support and encourage everyone on the team to be comfortable and confident with modeling. Reinforce staff for use. Even if you are not lead teacher you can lead by example. Positive attitude regarding practices that are beneficial for students are happily contagious! Set the right culture and lead by example.
#MODEL– Know the device better than anyone else, and model language like crazy. If you have multiple students using a device, request a copy of each child’s AAC layout on a separate school ipad(s). This will help classroom staff explore and become familiar with the vocabulary and layout of the devices. With classroom staff being the experts on modeling, you have important input on vocabulary and layout of the device which helps improve collaboration with the school SLP or Assistive Technology expert in charge of programming. If this is not an option, create time for yourself and classroom staff to become familiar with the device during low stress activities. Take the device home one night and only use that to speak. It IS hard work, but after an initial investment, it soon becomes second nature. If we are expecting our students to become proficient in learning their device, then we must be too. Modeling or aided language stimulation (talking to the student using his/her device or a device with the same layout) is key to successful overall AAC use, and that can only happen when vocabulary is appropriate for that student, and is not too low, not too high, but just right. #goldilocks.
You can model all the time, not just during speech, snack, or morning circle. Any time you would talk to other learners, you can also model to a person using AAC. Modeling real messages in natural interactions is a valuable way for AAC users to see the power of meaningful communication.
Now that Greyson’s ability to communicate has increased, he’s able to participate in so many activities that before just weren’t possible.
This site is a “Core Word Classroom” and it gives access to a range of resources designed for AAC implementation in the classroom. Use these materials to teach and model core words throughout the day in ways that are functional, fun and engaging.
#EDUCATION – Initial and ongoing training is extremely useful and important for all individuals responsible for working with students using AAC. Understanding key ideas such as core words versus fringe, learning successful modeling strategies, programming, ideas for expanding vocabulary and functional communication, and ways to use devices to support literacy – these are all areas that are important, empowering, and game changing when investing in a student’s development. Work with your School Speech Language Pathologist or Principal to make sure your classroom is getting trainings on latest research and findings related to best practice. If this isn’t possible, meet with your classroom staff after school and present your own training with the School SLP and Assistive Technology Expert. If you are a school SLP, you can advocate for outside training on this rapidly growing area of expertise in order to better assist your students and Classroom Teachers.
AAC can be implemented using many Evidence Based Practices for autism you are already using in the classroom and have most likely already had Professional Development in. Naturalistic intervention, Visual Supports, Prompting, Reinforcement, Modeling, and Discrete Trial Training are a few Evidence Based Practices that can support and be supported by Assistive Technology.
Here are some visual supports- (For grownups!) I made one of these- “communication prompts” for each high traffic area of the house and classroom- and focused on a few core words and conversation starters each month. We kept data on use, and made sure to model in a variety of different contexts for a variety of different communicative functions. Teachers and staff constantly have a full plate of multiple interventions for multiple students going on at once. This helps remind them to model, and makes it so it’s easier to do so on the fly.
AAC can be naturally embedded into student’s goals. You can use it to give the SD, or the cue when working on Discrete Trails. Sometimes we overthink modeling- but all we need to do is use the device to say whatever we would normally say with our mouth to a speaking child. For a student to learn to speak using a device, they need to see someone using the device to speak over and over again.
#LITERACY – It is important that comprehensive literacy instruction is integrated alongside AAC learning. All AAC users, regardless of diagnosis and perceived severity of learning challenges, should be receiving comprehensive literacy instruction.
Literacy teaching + AAC will build language for the AAC user and give them the ability to powerfully and independently communicate. Literacy skills allow fuller participation in education, enhances cognitive development & advance learning, increases access to employment opportunities, expands communication options significantly, and increases self-esteem & perceptions of competence in learners.
Adapted books are an awesome way to implement device use.
What’s On the Grill, Dad is one of our favorites. This book targets food vocabulary terms and number concepts, and is perfect to use this time of the year. You can change the level of your prompting depending on your students’ skill level. More adapted books found HERE.
AAC devices can be hugely instrumental in literacy development. Whether it’s decoding, reading or writing- AAC can support it. More info on Literacy and AAC HERE.
All AAC users benefit from increasing their knowledge of individual letter names and sounds. More information HERE. As students become able to identify letters and the sounds they make, it’s time to start putting those letters together to spell words.
AAC can also be used for shared reading by commenting about the story and pictures using key words as you read. Ask open-ended questions or pause to invite a comment in return.
I can’t imagine how it would feel to not be able to express yourself. Words heal, they connect, the build, they express, they validate, they request, they delight, they entertain, they express disgust and disdain and happiness and joy. Communication is a human right.
(Further information can be found at Praactical AAC, which has a wealth of research and information).