4speech (e.g., vocalizations, spoken words and sentences). 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 student’s 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, andspeech (e.g., vocalizations, spoken words and sentences).from Beukelman and Mirenda, 1992, 2005; Reichle, Beukelman, and Light, 2002
5AAC can facilitate the development of speech (not hinder it). 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
6AAC 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
7More 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 Speechfrom Beukelman and Mirenda, 1992, 2005; Reichle, Beukelman, and Light, 2002AAC should include any of a number of symbols, in any combination, including gestures/sign, objects, pictures, photos, printed words, and speech.Eat“Let’s eat!”
8AAC is a teaching strategy that is used everyday with all students– i 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 environmentUnderstand directionsPredict future activitiesLearnHave independenceHave structureWaitBe motivatedDevelop receptive and expressive language and communication to take part in every day activities.
9This 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.
10Even 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 student’s 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.
11AAC OPTIONS FOR THE CLASSROOM: Important Considerations
12AAC can be designed for work on a variety of goals/objectives 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 asTo supplement speech or cue speechTo facilitate development of speechTo provide a way to communicateReceptive/Expressive Language Development Needs, such asTo improve vocabulary and conceptsTo improve syntax or grammar, including to expand sentence length and complexityInteraction and Participation Problems, such asTo improve/elicit interactive or pragmatic communicationTo expand communicative intentsTo improve task completion or active participation in activities
13This 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.Don’t 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 student’s 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 student’s language level and other needs. Work with your team members , including speech-language therapists, to individualize use of AAC.Important considerations-- Everyone is capable of communicating and has something to say – Students with severe disabilities including ASD may communicate using body language, echolalia, and other vocal, verbal, or nonverbal means. Recognize these communication signals, and expand them by using picture symbols.The key to communication is opportunity – Plan opportunities so that students want to take part. For example, offer as many opportunities for choices, begin with activities of interest to the student, and establish and use predictable routines.Don’t wait for prerequisite skills, such as certain cognitive skills or demonstration of comprehension – Begin including AAC symbols in activities-- to facilitate comprehension, teach steps in a task, expand expressive communication/language, etc. Use the strategies in Lessons One and Two to encourage the use of picture symbols for communication and participation; include picture symbols as you use the teaching strategies in Lessons 1 and 2.Include motivating messages – How we teach or use visual supports can be important. For example:Instead of the message, “I have to go to the toilet” with a picture of toilet, start with motivating messages such as “I want more” or “My turn.”Instead of having the student show you the ball, have him tell you what is next by pointing to the ball or picture of it.And consult your team members as needed to individualize the use of AAC.
14Document progress by measuring increased participation. 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.Begin with classroom activities that are most conducive to AAC. Use the AAC setups yourself and, where possible, with the entire classroom as “props” for the lesson. The student with ASD may use the “props” in different ways, such as to understand a concept better or answer questions.The use of AAC should be a team effort as much as possible. Everyone needs to agree ahead of time on the types of symbols and formats that will be used.Select types of symbols based on student abilities, preferences, and classroom activities (for example, does the student understand picture or object symbols best, and what messages and concepts are important in each activity). Use pictures from any source (e.g., informal sources such as packaging from toy boxes to represent the toy, and picture symbols from published programs).Determine who on the team will be responsible for selecting messages, providing symbols, programming a device when one is included, etc.Plan for back-ups (for example, plan what you will do if a device is not working, or if picture symbols are left at home). Begin with low technology options, such as picture symbols without voice output (however, using symbols that are placed on a simple voice output device can be motivating for students).Document progress by measuring increased participation.For example, note if the student is participating with more symbols or is using more complex symbols, if his communication is spontaneous or prompted, if he is communicating with more partners and in more settings, etc.
16Resources for AAC Displays (Fairfax County Schools)and
17EXAMPLES: 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.
24Picture symbols for puzzle work Students can use the symbols on the left to request a puzzle piece on the right. The symbols on the left were cut out of the puzzle box.
25“Props” or picture symbols for Five Little Ducks Went Swimming One Day From Carol Goosens’ “Engineering Circle Time,” Augmentative Communication Service, New York City SchoolsStudents can participate in this song activity by touching, getting, pointing to the number plus picture of duck, picture of swim, etc., for main parts of the song.
26Picture symbols for reading or story time - from Dr Picture symbols for reading or story time - from Dr. Caroline Musselwhite and Julie Maro’s site, by Michelle Huber and Sheryl Balcair,Software is available that shows the picture symbol as you type words; it’s called Writing with Symbols 2000 from the Mayer-Johnson Company. These picture symbols and words can be used in more reading or story activities.
27Picture symbols of people, from Boardmaker, Mayer-Johnson Company at SpeakingofSpeech.comThese symbols can be used when teaching or talking about people in the community.
28Single messages with the Big Mack by AbleNet, www.ablenetinc.com “Here!” or “Boy”Single messages with theBig Mack by AbleNet,More message choices with the Cheap Talk 8 by Enabling Devices,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 it’s hot or cold outside, answering yes-no questions, saying hello to classmates, etc.
29Picture symbols for taking attendance, by E.M. Stack
33EXAMPLES: 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.
34Object symbol choicesIn this example, students select what they want to do during free time– paint, have a snack, or play games (potato head is a favorite). The items in this example have been placed in a shoe organizer to prevent grabbing and to encourage touching/pointing to request. This display could also be used for an object schedule or activity sequence.
37Symbols for Center Time These are photo symbols for students to select the center they want. Once a center has been selected, there are more photo symbols so that they can request toys for that center. Picture symbols of messages they can say at each center can also be included (such as, “I want yellow bus”; “crash”; or “1-2-3”).
38Picture and word symbols to select songs Students express their choice of song to sing by placing the picture symbol on the board, and saying or pointing to “I want _____.” Goals or objectives for this routine could relate to expressing requests, combining words, or answering questions.
39Menu choices offered at McDonald’s. Students can use these symbols, to express choice of food to eat or to answer questions on a field trip to McDonald’s.
40Picture symbols of toys and other things, from Boardmaker, Mayer-Johnson Company at SpeakingofSpeech.comStudents can use these symbols to express choice of toys or items when finished with their work.
41EXAMPLES: 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.
46Sample printed word display for an older student who was combining many words to express new sentences throughout the day
47EXAMPLES: 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.
49This sequence can be used to remind students the steps to follow in the bathroom.
50Symbols depicting steps in a task have been placed on an apron for everyone to see.... This arrangement frees up the teacher’s hands to take part in an activity. On the pockets below are comments or choices that she and the students might need to use.
52Overview 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 informationincrease receptive and expressive vocabularymodel words for a student to use in an activityexpand expressive languageincrease participation in classroom activitiesfacilitate independent work, and more.
53Overview – continuedOther 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
54Overview – continuedAdding 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.
55Overview – continuedWhen considering AAC voice output devices, it is important to know that thesecan range from simple devices (that allow 1 or a few messages, are easy to record with your or another student’s 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.
56BIGmackThese are a few of the companies and devices that are available .BIGmack communicator allows you to record your speech or another student’s 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 AblenetThe next few devices are called Digitized AAC devices. They produce a fixed number of pre-recorded messages which can be changed to accommodate the student’s varying communication needs.
57iTalk2 Dual-Message Communicator 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
58Four/Seven Level 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 Devicesology_devices_used_in_education
59Hip Talk Twelve with Levels 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 Devicesve_technology_devices_used_in_educa tion
60Cheap Talk 8Cheap 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 Devicesstive_technology_devices_used_in_ education
61GoTalk 20+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 student’s 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 e.php
62Message Mate 20 and 40The 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 student’s 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
63MacawThe Macaw also has several levels, and allows different displays with varying numbers of symbols, from symbol displays. As in the previous slides, you record your or another student’s voice, and use any of the displays in this lesson. This device allows you to sequence symbols for new messages.From Zygo
64Dynavox Vmax and Dynavox V 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.By the Dynavox Mayer-Johnson Company,The previous slides included examples of digitized AAC devices. Synthesized AAC devices use a technology that is sometimes called “dynamic display” and operates much like a computer screen. The voice output on these devices is not a true recording, and teachers program or pre-store messages and symbols onto a touch screen. These types of devices are considered higher technology AAC devices and usually give students access to more features than do digitized AAC devices. The Dynavox is one example.
65Chatbox 40Chatbox 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 ygo
66Summary and More Recommendations How do I get started?Summary and More RecommendationsPlan 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.
67Summary and More Recommendations How do I get started?Summary and More RecommendationsUse 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.
68Summary and More Recommendations How do I get started?Summary and More RecommendationsBuild 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 what’s 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.
69How 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).
70Module 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 strategiesList the communication or language goal and objectives for that studentDescribe how visuals you already have (or could have) are used with the entire classroomDescribe how you might use these visuals, or adaptations, as picture symbols with your selected student, to address his communication or language goal and objectives.
71ReferencesBeukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children & adults with complex communication needs (3rd 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: 18th Annual Southeast Augmentative Communication Conference Proceedings. Johnson, R.M. (1997). The Picture Communication Symbols guide. Solana Beach, CA: Mayer-Johnson Co.
72ReferencesJohnson, 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,