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Cheryl Livingston, M.S., CCC-SLP Augmentative Communication Facilitator 314-989-8838 Implementation Strategies for AAC: How to Get.

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Presentation on theme: "Cheryl Livingston, M.S., CCC-SLP Augmentative Communication Facilitator 314-989-8838 Implementation Strategies for AAC: How to Get."— Presentation transcript:

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

2 COMMUNICATION The goal is COMMUNICATION!

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

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

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6 Realistic Results of AAC part 2

7 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

8 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?

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

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

11 What is your students motivation to communicate? A think about …

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15 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... Quote by Jane Korsten, AT Expert

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17 Natural Language Development Browns stages of language development: 1. Single Words 2. Two-Word Phrases 3. 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 year old vocabulary: over 1000 words 5 year old: up to 3000 words

18 106 Most Frequently Used Words Interjections Adjectives Question Words Pronouns yesno thank youplease okay whatwhen wherewho whyhow Ime you heshe itwe they allmore biglittle hotcold samedifferent pretty newold rightwrong Pam Elder, 1992

19 106 Most Frequently Used Words Verbs (helping verbs) Verbs beamisare cancoulddodid havehadwaswere willwould askbuycallclean comeeatfeelfind getgivegohelp knowlikelookmake needputremembersay starttaketellthink tryturnusewant wishwork

20 106 Most Frequently Used Words Prepositions Conjunctions Adverbs Demonstratives aboutat forof updown onoff tofrom inout with notnow herethere muchvery thisthatandbut ifbecause

21 333 Most Frequently Occurring Preschool Words: The Marvin Sampling Christine A. Marvin, David R. Beukelman, Denise Bilyeu AAC, Vol. 10, Dec., 1994 a 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 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 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 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 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 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 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

22 I dont 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)

23 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

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

25 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 Joey and his dog dog Symbol Set more demanding less demanding Every Move Counts Clicks and Chats Jane Korsten, MS/SLP Terry Foss, M.Ed. Lisa Berry, MOTR/L (2007)

26 Visual Schedule Objects Talking Photos Eye Gaze Communication Board PECS

27 Partner Assisted Scanning

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29 PECS Picture Exchange Communication System

30 Voice output Talking Photo Album Big MackLittle Mack Partner Four

31 Tech Talk Tech Speak Go Talk

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45 Proloquo2go on an iPod Touch or iPad

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

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

49 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

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

51 Fringe Vocabulary Activities 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

52 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

53 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. ASHAs AAC Glossary

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

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

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

57 Eight Sentences

58 IGoGoodMore NotEatDrinkStop Eight Words 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.

59 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.

60 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.

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

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

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

64 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 Initial trial on a multi-page system encourages expectations for independent communication After a short time, the vocabulary becomes too limiting 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 The student is unable to navigate independently to and back from environment and activity pages to find needed vocabulary To avoid navigation, more specialized pages are added – defeating the development of motor planning New pages, designed and implemented daily, require the continuous participation of therapists, parents, teachers and aides Engineered participation in activities replaces conversational use of the device The speech generating device is less and less viewed as a tool for broad-range, independent communication The Navigation Maze Use of the communication aid is deemed successful though it is used only to retrieve pre-stored responses in engineered situations The students 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 Manual

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

66 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

67 Language Therapy Must consider the clients 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 cant be grouped with my other kids. Now they can!

68 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 dont need to know all the vocabulary before you teach it Youll 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

69 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

70 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

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

72 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

73 Find age appropriate materials of interest:

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

75 They won the big game !

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

86 Topic Books - SSDs Estories Wiki – https://iwiki.ssdmo.org/groups/estories/ User name = estories Password = estories Tar Heel Reader -

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

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

89 Make a Conversation Scrapbook (Picture of individual at school.) I am at school.

90 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

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

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

93 Games to Download game templates, homemade powerpoint games html html Jeopardy, Millionaire, Hollywood Squares, Weakest Link, Mark E. Damon Games dygames.htm dygames.htm Jeopardy Games, Hardin County Teachers Templates and pre-made games

94 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.

95 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

96 Arts and Crafts Whats 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

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

98 Daily Schedule

99 Word Wall important news throw catch if because

100 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

101 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

102 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

103 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

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

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

107 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

108 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)

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

110 Have the Device Available You cant predict when the perfect communication and teaching opportunity will arise Have the device available Leave the device within access Have the device available

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

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

113 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 cant, youre right!

114 Reasons People Dont Use Their AAC Device It doesnt say what they want it to say. They dont have anything to say. They dont understand whats expected. Theyve been given the message that its not important. They get what they want/need without it. They dont want to appear different. People interpret for them. Familiar people can understand their speech. Access issues

115 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

116 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

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

118 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 cant hear. 4. I wish my teacher wouldnt have a heart attack when my machine doesnt work. 5. I wish my teacher would remember that I dont 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 Im thinking. 9. I wish my teacher wouldnt hit my machine when it doesnt work – thats my mouth shes hitting. 10.I wish I could walk and talk like my sister and brother.

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