Implementation Strategies for AAC: How to Get Kids Really Talking

Implementation Strategies for AAC: How to Get Kids Really Talking
Cheryl Livingston, M.S., CCC-SLP Augmentative Communication Facilitator

The goal is COMMUNICATION!

Reasons we communicate –
Participation - Engagement - Requesting - Directing / Manipulating others - Commenting - Social exchange - Questioning - Sharing information –

A think about … Why & how do we communicate at school?
Why & how do we communicate at home? Why & how do we communicate in the community?

Realistic Results of AAC part 2

School Survival Skills
Interacts with adults and peers. Initiates interactions with adults and peers. Makes choices from visible and invisible references. Demonstrates turn taking in small groups. Demonstrates appropriate attention getting strategies. Expresses ideas to others. Communicates with peers and adults. Asks questions of others. Vincent, Lisabeth J.; Christine Salisbury, Gail Walter, Pansy Brown, Lee J. Gruenewald and Michael Powers, “Instructional Design for the Severely Handicapped,” W. Sailor, B Wilcox, and L. Brown (Eds.), Brookes Publishers, June 1980

Preschool Classroom Environments that Promote Communication
Interesting materials Out of reach objects/materials Inadequate portions Choice making Assistance Sabotage Silly situations From Ostrosky, M. and Kaiser, Ann. Preschool Classroom Environments That Promote Communication, Teaching Exceptional Children, 1991 Does this just apply to preschool?

They are actively engaged They are having fun!
People Learn Best When They are motivated They are actively engaged They are having fun!

The Questions: What does the individual enjoy doing?
What do others her/his age enjoy doing?

What is your student’s motivation to communicate?
A think about … What is your student’s motivation to communicate?

Quote by Jane Korsten, AT Expert
I just figured out how many hours a typically developing infant is awake and exposed to language via the spoken symbol before they begin to use the spoken symbol expressively at around months of age. If you then look at a child with an AAC system who only gets exposure to his system 2 times a week for 20 minutes with the SLP, it will take him 84 years to have experience commensurate with the typically developing child. Taking that a bit further, we don't say language is in it's 'adult form' until between 9-12 years of age. That means that for that length of time, a typically developing child is practicing using the spoken symbol, getting feedback and correction from listeners, seeing it modeled over and over.... now you look at the child with a device who only gets access to the system twice a week for 20 minutes with the SLP - it will take him 701 years to have the same amount of experience as his typically developing counter part.... and all of this assumes that no one is ever sick or takes a vacation.... So when no one wants to use a device until it is 'mastered'.... in therapy..... hmmmm... what IS wrong with this picture... One might assume that an atypical developer might need MORE time to practice, NOT less time...

Natural Language Development
Brown’s stages of language development: Single Words Two-Word Phrases Two-Three Word Phrases & Sentences Why would we expect an AAC user to develop differently? Vocabulary Acquisition Studies: 9-13 words per day from age 1½ - 6 3 year old vocabulary: over 1000 words 5 year old: up to 3000 words

106 Most Frequently Used Words
Interjections Question Words yes no thank you please okay what when where who why how Pronouns Adjectives I me you he she it we they all more big little hot cold same different pretty new old right wrong Pam Elder, 1992

Verbs (helping verbs) be am is are can could do did have had was were will would Verbs ask buy call clean come eat feel find get give go help know like look make need put remember say start take tell think try turn use want wish work

Prepositions Adverbs about at for of up down on off to from in out with not now here there much very Demonstratives Conjunctions this that and but if because

333 Most Frequently Occurring Preschool Words: The Marvin Sampling
about after again all almost already also an and another ant any are aren't around as at away baby back bad ball bathroom be bean because before being bet better big bird birds doesn't dog doing don't done door down drink duck eat eating else even everybody everything face fall find finger fire first five fixed fly foot for from found get gets getting girl girls give go goes going gonna good great green guys had hair hand hands has have haven't he he's her head hear hello help here here's hi high hill him his hold home horse hot house how huh maybe me mean messy middle mine mom mommy more most move much must my myself Name name named need never new next nice no not of off oh other ok old on one only open or our ours out over paint people pet name pick piece play please push put ready really red remember ride right room run said same saw say see she she's show shut side sit so still some somebody someone something sometimes somewhere stop stuff swing tape tell than that that's the their them then there there's these they they'll they're thing things this those three threw through time to bite black blue both box boy bugs but buy by bye call came can can't candy car catch cause chair come comes cookie corn could couldn't cup cut day did didn't different do does doctor we're well went were what what's when where where's which while who whole why with won't would ya yes yet you you'll you're your yours hum I I'll I'm if in inside is isn't it it's juice jump jumped jumping just kind know last leaves let let's lift like little long look looking lot lunch made make man many may today together too top toys trees try trying turn turtles two um up us use used very wait want wanted was wasn't watch water way we we'll At this point you may want to hand out a printed version of the Marvin vocabulary. I think it’s important that seminar participants leave with this useful list. Christine A. Marvin, David R. Beukelman, Denise Bilyeu AAC, Vol. 10, Dec., 1994

I don’t know where to start. What words do I teach first?
Teach the first words children learn Words I No Yes/yea my the want is it that a go mine you what on in here more out off some help all done finished 25 core words comprise more than 90% of the total words used by 34 toddlers whose speech was recorded Banajee, DiCarlo & Stricklin, (AAC 2000)

Target Basic Needs Physiological needs: “eat,” “drink,” “toilet,” “stop,” “need,” “sleep,” “hot,” “cold,” “good,” “bad” Safety needs: “sick,” “hurt,” “stop,” “more,” “afraid,” “mommy,” “daddy” Emotional/love needs: “love,” “like,” “happy,” “sad,” “frustrated,” “disappointed,” “angry,” family and pet names, friends names, favorite sports figure Esteem needs: “my,” “mine,” “want,” “that one,” “this one,” “what,” “why,” “where,” brand names, frequently selected objects Self-Actualization needs: “can,” “will,” “do”

How does the student learn best? What are their strengths?
A think about … How does the student learn best? What are their strengths?

Symbol Consideration Table for “dog” Object •duplicate •miniature
•remnant Photograph …of objects or activity (not person engaged inactivity) Line Drawings …of objects or activity (not person engaged in activity) Gesture/Touch Cues ex. pat hand to thigh Signs Spoken word Written word dog demanding less Symbol Set Joey and his dog demanding more “dog” Every Move Counts Clicks and Chats Jane Korsten, MS/SLP Terry Foss, M.Ed. Lisa Berry, MOTR/L (2007)

PECS Visual Schedule Objects Eye Gaze Communication Board Talking Photos

Partner Assisted Scanning

PECS Picture Exchange Communication System

Voice output Little Mack Big Mack Talking Photo Album Partner Four

Tech Talk Go Talk Tech Speak

Proloquo2go on an iPod Touch or iPad

Aided Language Stimulation
Provide input before expecting output Model, model, model Input, input, input

Core Vocabulary Makes up 75 - 85% of what we say
Only a few hundred words used over & over Same words across: Gender Age Topic Setting Disability Most are not nouns

Core Vocabulary cont. Learned for a lifetime
Same words used by 4 – 40 year old Essential for language development core words prior to 2-word utterences Reduces activity-specific programming You must have access to core vocabulary to communicate effectively

Fringe Vocabulary Thousands of words, Large % of nouns
Highly individual Activity Specific Fringe is still an essential part of communication

Fringe Vocabulary Activities Pages General or specific words
Critical Core is available Game vocabulary Specific to a game – uno, draw four, skip General for lots of games – deal, pick, roll win, cheat, lose Pages Core not readily available May program words that are available on the core Good when you need very specific vocabulary for a longer amount of time Good for scripted events – speech, play

Sample Sentences Can I have some of that jello?
I think that game is boring. I want to go with you. What are we doing tomorrow? How much is this donut? My friend Joseph has been helping me. 81% core, 19% Fringe

Access to Single Words “Communication is based on the use of the individual words of our language. True communication is spontaneous and novel. Therefore, communication systems cannot be based significantly on pre-stored sentences. Communication requires access to a vocabulary of individual words suitable to our needs that are multiple and subject to change. These words must be selected to form the sentences that we wish to say.” ASHA’s AAC Glossary

Spelling High Low Flexibility (generative power) Speed
Goossens’, C., & Crain, S. (1992). Utilizing switch interfaces with children who are severely physically challenged. Austin, TX: Pro-Ed.

PreStored Sentences High Low Flexibility (generative power) Speed

Words High Low Flexibility (generative power) Speed

Eight Sentences

Eight Words I Go Good More Not Eat Drink Stop Say: Good. Not good. I not good. Eat More. Good, Eat More. not stop. At least 30 different messages can be created using these eight words.

A Sensible use for Pre-stored Sentences?
Efficient for messages that are used repeatedly Essential for users with physical disabilities Use as a complement to a single word vocabulary May provide phrases that offer the opportunity to chunk language together.

A Think about …. “Give a man a message and he communicates for a day…
Teach a man a language and he communicates for a lifetime.”

Access to Single Words AAC users: “Let me say exactly what I want as fast as I can say it” S: Spontaneous N: Novel U: Utterence G: Generation

Navigation vs. Sequencing
Manual Navigation vs. Sequencing Master Page (Environments, Topics & Categories) Circle Time Clothes Trips to: Dr. Office Cinema Beach Zoo Zoo Animals Communication Pages Special Vocabulary Page

Navigation of Page Based Systems After 1 Year
Master Page (Environments, Topics & Categories) Circle Time Getting Dressed Days of Week/ Months of Year Weather Winter Clothes Activities Dressy / Church Zoo Dr. Office Zoo Animals Zoo Food Reptiles Holidays Birthdays School Bus Movies Grocery Store Airplane Hospital

Manual The student indicates a wide range of emotions and preferences in response to teachers and family through gestures and facial expressions, but rarely communicates beyond this circle Use of the communication aid is deemed successful though it is used only to retrieve pre-stored responses in engineered situations The student’s good pragmatics leads the staff to believe she could use a speech generating device to communicate more independently and with a broader range of people The speech generating device is less and less viewed as a tool for broad-range, independent communication The Navigation Maze Initial trial on a multi-page system encourages expectations for independent communication Engineered participation in activities replaces conversational use of the device After a short time, the vocabulary becomes too limiting New pages, designed and implemented daily, require the continuous participation of therapists, parents, teachers and aides More vocabulary pages are added with great care Searching for words across multiple pages is hard and confusing to the student. Her staff decides to do more whole-utterance programming To avoid navigation, more specialized pages are added – defeating the development of motor planning The student is unable to navigate independently to and back from environment and activity pages to find needed vocabulary

The Single Page Path to Independent Communication
Manual The Single Page Path to Independent Communication Student has good pragmatics leading the staff to believe she could use a speech generating device (SGD) Language skills assist in literacy Stop Staff broadens student’s environment Initial trial on a single page system is successful Student continues to use core vocabulary as MLU grows Staff is challenged by the complex appearance of the system Staff continues to challenge student with a broadened core vocabulary Student begins to use the core vocabulary Growth slows as student is satisfied with basic communication Staff adds specialized vocabulary Staff teaches pronouns and basic verbs

Beginning teaching strategies
Give time to explore. Hide keys Use natural settings & routines – play, work/academics, eating, activities, jobs to do in the class. Use Activity Based Objectives – Kelly Fonner Interface with the computer Interface with infrared toys that can elicit core

Language Therapy State Functions – What do you do with juice?
Must consider the client’s language abilities and issues Often same materials and methods can be used State Functions – What do you do with juice? Categorization – Tell me three things that are round. Associations – What goes with a shoe? Similarities – How are a hat and a shoe alike? Differences – How are a hat and a shoe different? Define words – What is an apple? Super Duper Publications et al. “My client with AAC can’t be grouped with my other kids.” Now they can!

Prepare Key vocabulary Expectations for each student
Be aware of how much prompting you are doing – Kelly Fonner Make “cheat sheets” For you if you need them For the student You don’t need to know all the vocabulary before you teach it You’ll learn it with the student Know the language patterns Trainings are available online and face to face Teach the associations to the pictures Teach strategies for getting the message across (ie: attributes) Use props

Advantages of Books Can control the vocabulary
Vocabulary repetition without “drill and kill” Provides carryover into the home Fits into the school curriculum Promotes literacy

Adapting Books Do not photocopy a copyrighted book!
Use images or symbols to go along with the book. Use pictures from events Use photos of students Use pictures from magazines Simplify the text

Adapting Books Age appropriate What is the goal? Say each word
Label vocabulary Comment Repeated Line Predict Answer “wh” questions

Create Original Books Identify vocabulary Use existing patterns
Brown Bear, Brown Bear Adapt and re-write for older students Ravens example Use photographs Zoo Book

Find age appropriate materials of interest:

Rewrite the story at an appropriate language level.
They worked hard all year. They were ready. They played a good game. Go Ravens!

They won the big game!

Sources of books with Core Vocabulary
DLTK – free books to download Dolch Word Teaching Ideas – Zoo Book

Topic Books - SSD’s Estories Wiki – Tar Heel Reader -
User name = estories Password = estories Tar Heel Reader -

Make a Conversation Scrapbook
(Picture of individual playing.) I am playing.

(Picture of individual working.) I am working.

(Picture of individual at school.) I am at school.

Advantages of Games Personal and Social Skills: Turn Taking
Patience – waiting your turn Honesty – not cheating Persistence – finishing the game Cooperation Team building Sharing Making friends

Advantages of Games Language Skills Vocabulary development
Following directions Commenting Requesting Answering questions Language development

Games and Toys Identify vocabulary Educational games & toys
Off the shelf games & toys Make support materials

Games to Download http://it.coe.uga.edu/wwild/pptgames/
game templates, homemade powerpoint games Jeopardy, Millionaire, Hollywood Squares, Weakest Link, Mark E. Damon Games Jeopardy Games, Hardin County Teachers Templates and pre-made games

Games to Elicit Language
Go Fish: Familiar Actions and Objects – Communication Skill Builders Barnyard Bingo Mr. Potato Head Pals – Playskool Games – Hasbro, Inc. Outburst and Outburst Jr. – Hersch and Co. Scavenger Hunt Any game that you need to interact with someone else.

Songs Repeated patterns Rhythmic Vocabulary rich Fun
Identify Vocabulary Needed Song Boards and props Augmented communicators can Choose the song Start the song Lead the repeated line Choose the next verse Start/Stop the stereo via IR control

Arts and Crafts What’s the goal?
Communication Fine Motor The product How do you balance all the materials AND the communication device? Students with good physical abilities Sabotage it Students with limited physical abilities What SHOULD the goal be? Augmented communicators should be controlling the activity vs. doing the activity

Label the Environment Job Chart Set the table Do dishes Empty trash
Water plants

Daily Schedule

Word Wall important news throw if catch because

Writing Strategies Take pictures, write captions for stories
Interface with the computer Create writing templates Fill in the blanks using their device Letter writing Story writing Report writing Journal writing

Speaking Strategies Social communication before academic communication
Consider normal language development Know when to use Single words Phrases Sentences Structure the environment to promote communication

Speaking Strategies Pause – wait for a response
Avoid yes/no questions – ask open ended questions Teach categorization skills Use photographs to stimulate language Conversation scrapbook Take pictures – tell stories

Speaking Strategies Role play – phone calls, etc.
Internet – zoo web cams Teach conversational skills – Pragmatic language cards – Wacky gift exchange Use planned experiences Do the activity Talk about what you did Role play situations

Where are you from? What do you like to do? Do you want to play? How old are you? Who are you?

I need help. Can you help me? Will you please help me? What is wrong with this? This is wrong.

Title: Wacky Gift Exchange
Description of Activity: Each child uses descriptive words to select a gift. Materials: White Elephant gifts brought from home. Wrapped in different color wrappings some with and some without bows. Objective: Each child chooses a gift using descriptive words to express his or her choice. Target Vocabulary: big, little, color words, ribbon, bows, box, object on the gift wrapping. Sample Words and Phrases: I want the box with the big blue bow. I want the little red box with the purple bow. I want the big box without a bow/ribbon. Adaptations (optional at times): · Each child takes a turn picking a toy or taking another child's toy. The children must use names, descriptor words and proper language. (i.e., "Mark, please give me your blue present. "Sally, please let me play with your truck." · Have a discussion of what each child received and use descriptive language in the discussion. · Have each child tell who chose the present they brought from home. Age: Preschool, Early Elementary, Late Elementary, Adolescent and Adult Vocabulary: Unity 128 Single Hit, Unity 128 Two Hit, Unity 128 Full Core, Unity 128 Condensed, Vanguard/Vantage Unity Single Hit, Vanguard/Vantage Unity Full Core Language Objectives

Homework Collect pictures of things you like to do
Write a story about the pictures or prepare to tell about them Read a book (to a parent or friend) Make a phone call (practice/role play first)

Homework Write a journal entry E-mail a friend or relative
Practice/review vocabulary and grammar Write sentences/paragraphs/stories Play a game

Have the Device Available
You can’t predict when the perfect communication and teaching opportunity will arise Have the device available Leave the device within access

Computer Many high tech devices have computer emulation AAC Keys
Alternative keyboard Alternative mouse Control a PowerPoint Control Intellitools activities

Environmental Controls
Consider AAC devices with ECU capabilities TV/Stereo/VCR IR Toys Ceiling fan Gas fireplace Not radio control (with a wire antenna)

Have High Expectations
“If necessity is the mother of invention, then, expectation is the mother of success.” Susan McCloskey Pennsylvania Technology Center Whether you think they can, or whether you think they can’t, you’re right!

Reasons People Don’t Use Their AAC Device
It doesn’t say what they want it to say. They don’t have anything to say. They don’t understand what’s expected. They’ve been given the message that it’s not important. They get what they want/need without it. They don’t want to appear different. People interpret for them. Familiar people can understand their speech. Access issues

Strategies for Fringe (Academic) Vocabulary:
Low-Tech AAC Strategies: Eye gaze Manual boards Vocabulary strip on the device Flip ‘n Talk Communication notebook Low tech device Word wall Ask multiple choice questions

Strategies for Fringe (Academic) Vocabulary
High Tech AAC Strategies: Substitute core words for fringe words Activity row for fringe vocabulary Use word prediction for fringe vocabulary

It Takes a Team system operator vocational rehabilitation counselor
Parents/ Caregivers system operator vocational rehabilitation counselor teacher peers occupational therapist caseworker physical therapist SLP nurse aide

Ten Wishes from a Student Who Uses Augmentative Communication
To help you understand the feelings and thoughts of a student who uses augmentative aids and techniques, children from across the United States were asked, “If you could wish for one thing your teacher would do for you, what would it be?” Below are some of their answers. 1. I wish my teacher would joke with me. 2. I wish my teacher would learn how to work my communication aid. 3. I wish my teacher would stop shouting at me like I can’t hear. 4. I wish my teacher wouldn’t have a heart attack when my machine doesn’t work. 5. I wish my teacher would remember that I don’t always spell very well. 6. I wish my teacher would have more patience with me. 7. I wish my teacher would call on me for “Share Day”. 8. I wish my teacher would give me enough time to say what I’m thinking. I wish my teacher wouldn’t hit my machine when it doesn’t work – that’s my mouth she’s hitting. 10.I wish I could walk and talk like my sister and brother.

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