Augmentative and alternative communication is also called: augmentative-alternative communication, augmentative communication, AAC, visual supports for communication, and sometimes total communication. It is a method that can be used to supplement and facilitate a students speech or to provide a way for students to communicate, develop language, learn, and participate in everyday activities. AAC can involve: gestures (e.g., subtle or apparent natural gestures or sign language systems), graphics (e.g., objects, photographs, line drawings, pictures, textured or tactile pictures), written words, and speech (e.g., vocalizations, spoken words and sentences). from Beukelman and Mirenda, 1992, 2005; Reichle, Beukelman, and Light, 2002
AAC should involve multiple ways of communicating (i.e., not just gestures, or just speech, or just graphic symbols). This is very much how normally developing persons acquire language and communicate (i.e., most people communicate using speech, facial expression, body language, gestures such as nodding or pointing, writing, and more, in various combinations). AAC can facilitate the development of speech (not hinder it). from Beukelman and Mirenda, 1992, 2005; Reichle, Beukelman, and Light, 2002
AAC strategies can be used with students who are verbal, limited verbally, or nonverbal. Since students with ASD appear to process and understand better when visual- spatial information is included, AAC strategies have been generally accepted and successfully used in classroom and other settings. AAC provides information that is concrete, permanent, and relatively predictable, as opposed to only auditory information which is sequentially coded and fades over time. AAC is portable, durable, usually inexpensive, and can be used life-long and across all environments. from Beukelman and Mirenda, 1992, 2005; Reichle, Beukelman, and Light, 2002
More AAC definitions to know: When we communicate, we use a symbolic code (language) that stands for or represents our message. Examples of AAC symbols-- to communicate eat, we could use: Printed word Picture symbol Sign/gesture Speech from Beukelman and Mirenda, 1992, 2005; Reichle, Beukelman, and Light, 2002 AAC should include any of a number of symbols, in any combination, including gestures/sign, objects, pictures, photos, printed words, and speech. Eat Lets eat!
AAC is a teaching strategy that is used everyday with all students– i.e., teachers use visual supports and other adaptations all of the time. For students with ASD, AAC strategies can be used to help them: Understand their environment Understand directions Predict future activities Learn Have independence Have structure Wait Be motivated Develop receptive and expressive language and communication to take part in every day activities.
This lesson focuses primarily on ways to use AAC to facilitate students comprehension and use of conventional or symbolic expressive language to help them participate in everyday activities in the general education classroom. Collaborate with other team members including speech- language therapists to individualize strategies that address specific needs. Aided communication strategies will be highlighted-- these are the aids or picture symbols with printed words, some of which are on voice output systems-- to help facilitate language and participation in students with ASD. Aided AAC can be in the form of low, middle, or high technology. This lesson spotlights primarily low technology AAC options. Unaided communication refers to ways of communicating in which aids are not required, such as gestures, signs, and speech.
Even though this lesson focuses on picture symbols with printed words (aided communication), it is important to remember that a single way of communicating will almost never meet all of a students communication needs. Each student will almost always use a combination of aided and unaided communication symbols, such as speech plus picture symbols, or gestures/signs plus picture symbols plus speech, etc. Consistency is a key factor. Everyone needs to agree on the types of symbols to be used at school and home.
AAC OPTIONS FOR THE CLASSROOM: Important Considerations
AAC can be designed for work on a variety of goals/objectives. AAC can be used for goals/objectives that address: Speech Communication Deficits, such as To supplement speech or cue speech To facilitate development of speech To provide a way to communicate Receptive/Expressive Language Development Needs, such as To improve vocabulary and concepts To improve syntax or grammar, including to expand sentence length and complexity Interaction and Participation Problems, such as To improve/elicit interactive or pragmatic communication To expand communicative intents To improve task completion or active participation in activities
This section includes numerous examples of ways to implement AAC strategies. As you review these examples, the following information is important to keep in mind: Everyone is capable of communicating and has something to say. The key to communication is opportunity. Dont wait for prerequisite skills, such as certain cognitive skills or demonstration of comprehension – Begin including AAC symbols in activities. Use strategies in Lessons 1 and 2 to encourage students use of picture symbols to communicate. Include motivating messages – How we teach or use visual supports can be important. There are many considerations when selecting an AAC system and teaching a student to use it, including specific teaching strategies that depend on the students language level and other needs. Work with your team members, including speech-language therapists, to individualize use of AAC.
Use the AAC symbols yourself and, where possible, with the entire classroom. Everyone needs to agree ahead of time on the types of symbols and display arrangements to use. Work with your team to: Select types of symbols based on student abilities, preferences, and classroom activities (e.g., does the student understand picture or object symbols best, what messages and concepts are important in each activity, etc.) Determine who will select messages, change symbols, program a device, etc. Plan for back-ups (e.g., what you will do if a device is not working or picture symbols are left at home). Document progress by measuring increased participation.
Resources for AAC Displays http://www.fcps.edu/ss/its/howtos/board/bdact.htm (Fairfax County Schools) http://www.fcps.edu/ss/its/howtos/board/bdact.htm http://www.adaptedstories.com/info/what.cfm http://online.sfsu.edu/~nancyr/resources.html http://www.aacintervention.com/index.htm http://www.hiyah.net/ http://www.speakingofspeech.com/ and http://www.speakingofspeech.com/AugCom_Materials.html http://www.speakingofspeech.com/ http://www.speakingofspeech.com/AugCom_Materials.html http://www.askability.org.uk/ http://pics.tech4learning.com/ http://www.do2learn.com/picturecards/printcards/index.htm http://puzzlemaker.discoveryeducation.com/ http://www.tinsnips.org/ http://trainland.tripod.com/communication.htm
EXAMPLES: Adapting activities to include picture symbols– topic boards or displays See next several slides for examples of picture symbol topic displays. In these displays, everyday activities include picture symbols for work on goals related to comprehension of concepts, expression of intents (such as to request) and more. Begin with activities of interest to the student; this is a good way to begin using AAC. Begin with a few familiar symbols (if possible) in familiar routines; and gradually introduce new symbols in these routines. Pictures/printed words or props that teachers already have can be used as picture symbols to promote receptive and expressive language. Some of the messages can be fun or motivating– i.e., words that peers might say such as awesome. Picture symbols can also be set up in the form of a script so that students can practice what to say at different times. Since symbols are chosen that relate to a single activity or topic, they are called topic communication displays or topic boards. Note that picture symbols can represent single words or an entire sentence or phrase.
Props or picture symbols for Five Little Ducks Went Swimming One Day From Carol Goosens Engineering Circle Time, Augmentative Communication Service, New York City Schools
Picture symbols for reading or story time - from Dr. Caroline Musselwhite and Julie Maros site, by Michelle Huber and Sheryl Balcair, http://www.aacintervention.com/nursery.htmlhttp://www.aacintervention.com/nursery.html
Picture symbols of people, from Boardmaker, Mayer-Johnson Company at SpeakingofSpeech.com
During roll call, students can push on a Big Mack button (single message voice output device) to say here. Or if the Big Mack can give other information, such as telling if they are a boy or girl. Another activity could include having more message choices such as telling if its hot or cold outside, answering yes-no questions, saying hello to classmates, etc. Here! or Boy More message choices with the Cheap Talk 8 by Enabling Devices, www.enablingdevices.com www.enablingdevices.com Single messages with the Big Mack by AbleNet, www.ablenetinc.com www.ablenetinc.com
Picture symbols for taking attendance, by E.M. Stack
EXAMPLES: Offering picture symbol choices– Choices format The next slides contain examples of object and picture symbol choice making displays. Select activities of interest to the student and when appropriate redesign them so that students are to express choices. Choices can even be embedded in picture symbol schedules. This format can be used to work on goals related to communicative intents to request or respond; to express actions, nouns, word combinations; to work on comprehension, and more. Symbols presented as choices can be motivating and can serve as a good and easy way to begin using AAC strategies.
Picture symbols of toys and other things, from Boardmaker, Mayer-Johnson Company at SpeakingofSpeech.com
EXAMPLES: Picture symbols that can be used in several activities Generic picture symbol displays See the next few slides for examples of multipurpose or generic picture and word symbol displays that can be used throughout the day. These picture symbols usually do not have as many motivating messages. They include messages that can be used in different activities.
Sample printed word display for an older student who was combining many words to express new sentences throughout the day
EXAMPLES: Picture symbols that depict steps in a sequence, activity, or schedule– Symbol sequences See the next few slides for examples of symbol sequences. Students can use this type of display to tell someone what they did, to preview or better understand what they are to do, how and when; to direct someone to complete the same task, to take home to know what to do for homework, to answer questions, etc. It is always more motivating for students to use these in activities of interest first.
Overview Picture symbols can be placed on voice output devices. Symbol displays that have voice output can become powerful tools or methods to address classroom goals and objectives. For example, adding voice output can: promote auditory processing and comprehension of key information increase receptive and expressive vocabulary model words for a student to use in an activity expand expressive language increase participation in classroom activities facilitate independent work, and more.
Overview – continued Other benefits of using voice output devices include the following: The voice more effectively calls attention to others and is not easily ignored. It can also facilitate learning of pragmatic skills of when to talk to whom and what makes sense in a given situation. When the student communicates, the message will not need to be interpreted by the listener. The student will be able to hear the result of his communicative attempt which should help him improve language and academic skills even more. Voice output can help students be more socially accepted by others
Overview – continued Adding voice output to symbols lends itself to messages used for a variety of communicative intents. Examples: As a means to get attention or initiate conversation– Come over here, Hi, is Tim here, Look what I did, I have a surprise in my bag. As a way to request or express a desire for more– Do it again, More cookie please, I want my toy car, Give me a push (on a swing). As a means to deliver a message– Mrs. Smith needs some glue, Here is the attendance. As a way to take part in activities– Can I have a turn, Here (during roll call), I need help, or to give a report on insects.
Overview – continued When considering AAC voice output devices, it is important to know that these can range from simple devices (that allow 1 or a few messages, are easy to record with your or another students voice) to more complex systems (that allow numerous messages, message combinations, symbols, and displays). are usually selected with the help of AAC or assistive technology teams or others designated to assist in this area, so that the demands and requirements of the device match the language abilities and preferences of students and classroom. Many settings also have allow trial use of equipment. The next few slides show examples of AAC voice output devices.
BIGmack These are a few of the companies and devices that are available. BIGmack communicator allows you to record your speech or another students voice for up to 2 minutes. The teacher places the picture symbol for the message on a single button (that can be any of 4 colors) and the student activates the message, report, information, etc., by touching the button. This device is good to use by beginning communicators, in activities that do not require many messages (such as roll call), or for one message that can be used in many activities throughout the day (such as my turn). From Ablenet http://www.ablenetinc.com/Default.aspx?tabid=36 http://www.ablenetinc.com/Default.aspx?tabid=36
The iTalk2 Dual-Message Communicator lets students express choice between 2 activities, in the same way as for the previous slide. This device is good to use by beginning communicators or in activities that are conducive to a choice of 2 messages. Examples: Students can select activities, such as listen to a story or go outside. Teachers can also record comments for social situations, and choice for response (e.g., where does a giraffe live-- at the zoo or in the ocean during a lesson on animals; the weather report can be recorded on one button and here on another, for roll call; turn the page please and Brown Bear, Brown Bear, What do you see? for story time). A toy or appliance can be added and activated at the same time as the message. From Ablenet http://www.ablenetinc.com/Default.aspx?tabid=36http://www.ablenetinc.com/Default.aspx?tabid=36 iTalk2 Dual-Message Communicator
Four Level Communicator that allows 4 symbol displays with 4 corresponding recorded messages, beginning with a display for one symbol, then two, four, and eight symbols at a time. This company also sells a Seven Level Communicator that takes a student up to 16 symbols at a time. The device is lightweight and portable. It can grow with students as they are able to use more messages or combine words into messages. Any of the types of displays shown in this lesson can be placed on this device. From Enabling Devices http://enablingdevices.com/catalog/assistive_techn ology_devices_used_in_education Four/Seven Level Communicator
Hip Talk Twelve with Levels is worn by a student around his waist. Messages can be recorded on up to 12 symbols at a time. You can save up to seven different displays (on seven levels). As for the previous slide, any of the types of displays shown in this lesson can be placed on this device. From Enabling Devices http://enablingdevices.com/catalog/assisti ve_technology_devices_used_in_educa tion Hip Talk Twelve with Levels
Cheap Talk 8– this device has up to 6 levels for 6 different displays. It is lightweight, portable, and can be used with any of the symbol displays in this lesson. From Enabling Devices http://enablingdevices.com/catalog/assi stive_technology_devices_used_in_ education Cheap Talk 8
The GoTalk 20+ allows up to 25 messages on a display, and has up to 5 levels (5 different displays). As in the previous slides, you record your voice or another students voice, and use any of the displays in this lesson. It is lightweight, portable, and allows you to sequence symbols for a message. From the Attainment Company http://www.attainmentcompany.com/xcart/hom e.php http://www.attainmentcompany.com/xcart/hom e.php GoTalk 20+
The Message Mate 20 and 40 allows 20 and 40 symbols, and also allow teachers to save different displays (levels). As in the previous slides, you record your or another students voice, and use any of the displays in this lesson. It is lightweight and portable. From Words+. Companies such as Key Technologies, Inc. sell several AAC devices from various companies, at http://www.gokeytech.com/Zygo http://www.gokeytech.com/Zygo Message Mate 20 and 40
The Macaw also has several levels, and allows different displays with varying numbers of symbols, from 1-32 symbol displays. As in the previous slides, you record your or another students voice, and use any of the displays in this lesson. This device allows you to sequence symbols for new messages. From Zygo http://www.zygo-usa.comhttp://www.zygo-usa.com Macaw
The Dynavox Vmax and Dynavox V reports synthesized natural voices, using a dynamic display to access many different displays and messages. It allows personal computer access as well. The V is the smaller one for students requiring a smaller or more portable device. This device is often used by students who need access to many messages, are learning to create and can remember many new messages, are motivated to communicate using this type of display, or are transitioning from digitized devices. Dynavox Vmax and Dynavox V By the Dynavox Mayer-Johnson Company, http://www.dynavoxtech.com/products/products_categories.aspx http://www.dynavoxtech.com/products/products_categories.aspx
Chatbox 40 by Saltillo, has similar features as the Macaw. However, it allows both digitized and synthesized speech, a text printout on an LCD screen, a spelling mode, and personal computer access. Companies such as Key Technologies, Inc. sell several AAC devices from various companies including this one, at http://www.gokeytech.com/Z ygo http://www.gokeytech.com/Z ygo Chatbox 40
How do I get started? Summary and More Recommendations Plan communication opportunities throughout the day. Offer a lot of choices in daily activities. Include symbols/messages in fun natural routines; once AAC is included in 1 activity, start using AAC in a 2nd activity. Consider different ways to use the pictures you already have, such as using picture schedules for communication purposes. Add picture symbols to social stories and use the symbols as the story is reviewed. Make picture symbols accessible everywhere: during circle time, snack, roll call, on the wall, door, cabinet, place mat, etc. Think of different and fun ways to display symbols, such as flannel boards, photo albums, scrapbooks, etc.
How do I get started? Summary and More Recommendations Use any pictures and objects you have as symbols for these displays (trial and error may be needed to select ones that students respond to best); and remember to use speech and gestures (or signs) too. Encourage everyone– teachers and students-- to use the system; think of AAC as props for an entire class/group. Teach students to use picture symbols. Use: modeling, hand- over-hand assistance to be faded, natural consequences (student gets an item each time he touches the symbol choice), motivating activities versus drills, many choices, motivating messages, speech and visual supports, sabotage (e.g., favorite items out of reach, violation of routines), and pauses. Make the objects, pictures, voice output devices, etc., part of the daily routine for every one to use.
How do I get started? Summary and More Recommendations Build on students interests; include motivating messages. Practice and repeat. Example: read the same book adapted with picture symbols many times. This gets students to: be more actively involved, communicate more (they can tell you whats next), ask more questions, or retell the story. Recognize and build from subtle communication signals; develop a signal dictionary so everyone knows what the student may be communicating. Then gradually expose the student to more effective ways to communicate.
How do I get started? More Recommendations As described in this lesson (and in Lessons 1 nd 2), naturalistic strategies are commonly used to facilitate students use of picture symbols. Other approaches can be considered as well, such as the Picture Exchange Communication System (PECS). PECS has been used with students with autism and other developmental disabilities to teach self-initiated requesting as the very first skill. It uses behavioral techniques such as shaping and reinforcement to teach vocabulary, sentence structures and use of language to interact with others. Students are systematically taught to exchange symbols for desired items or activities instead of pointing to symbols; the student then receives the desired object or activity (Beukelman and Mirenda, 2005).
Module 3 Lesson 3 Activity Using slide 13 and the examples that follow for topic boards, describe: one classroom activity in which you already have (or could have) pictures/printed words or props and how you might use these visuals for a student with communication objectives. Select one of your students who you feel might benefit from AAC strategies List the communication or language goal and objectives for that student Describe how visuals you already have (or could have) are used with the entire classroom Describe how you might use these visuals, or adaptations, as picture symbols with your selected student, to address his communication or language goal and objectives.
References Beukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children & adults with complex communication needs (3 rd ed.). Baltimore, MD: Brookes Publishing. Beukelman, D.R., & Mirenda, P. (1992). Augmentative and alternative communication: Management of severe communication disorders in children and adults. Baltimore, MD: Brookes Publishing. King-DeBaun, P. (1999). STORYTIME: Stories, symbols and emergent literacy activities for young, special needs children. Park City, Utah: Creative Communicating. Goossens, C., Crain, S., & Elder, P. (1997). Communication displays for engineered preschool environments. Solana Beach, CA: Mayer-Johnson Co. Goossens, C. (1997). Engineering Circle Time. Birminghan, AL: 18 th Annual Southeast Augmentative Communication Conference Proceedings. Johnson, R.M. (1997). The Picture Communication Symbols guide. Solana Beach, CA: Mayer-Johnson Co.
References Johnson, R.M. (1981). The picture communication symbols. Stillwater, MN: Mayer-Johnson Co. Musselwhite, C.R., &Burkhart, L.J. (2001). Can we chat? Co-Planned sequenced social scripts, A make it/Take it book of ideas and adaptations. Eldersburg, MD: Linda J. Burkhart Publications. Noonan, M.J., & McCormick, L. (2006). Young children with disabilities in natural environments. Baltimore, MD: Brookes Publishing. Reichle, J., Beukelman, D.R., & Light, J.C. (Eds.). (2002). Exemplary practices for beginning communicators: Implications for AAC. Baltimore, MD: Brookes Publishing. Wetherby, A.M., & Prizant, B.M. (Eds.). (2000). Autism spectrum disorders: A transactional developmental perspective (Vol. 9). Baltimore, MD: Brookes Publishing. Woods, J.J., & Wetherby, A.M. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, Speech, and Hearing Services in Schools, 34, 180-193.