Cheryl Livingston, M.S., CCC-SLP Augmentative Communication Facilitator Implementation Strategies for AAC: How to Get Kids Really Talking ss_materials.html Oct 10, 2014

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

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?

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

Natural Language Development Brown’s 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 - 6 – 3 year old vocabulary: over 1000 words – 5 year old: up to 3000 words

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”

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)

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

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

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 Flexibility (generativ e 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. Flexibility (generativ e power) Speed High Low High Low Pre Stored Sentences High Flexibility (generative power) Speed Low High Low Words

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

Word of the Week Purpose : To promote a fun emphasis on increasing the number of opportunities to show our students the power of communication. We want to observe what happens when we give our students the challenge of seeing how many times a day they can use the Word of the Week (WOW), The emphasis is on functional communication. in onofffast slow get push make turn go stopplayupdown do open close The idea is to find numerous ways each day to use the Word of the Week for expressive, receptive &/or written task via a symbols, voice output communication devices, signs, verbally and or written. Consider giving a reward for each time the WOW is used.

Language Therapy 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! Instead – Use images or symbols to go along with the story 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

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

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

Estories Wiki

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

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

s=1#.UxY3R2CYbIU Websites with Free therapy resources -

Fun with Free Apps Language Lab: Core Words

Games to Download – game templates, homemade powerpoint games tml tml – Jeopardy, Millionaire, Hollywood Squares, Weakest Link, Mark E. Damon Games s.htm s.htm – 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

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 Word of the Week - promote functional communication with core words – in, on, off, fast, slow, get, make, turn, go, stop, play, do, up, down, push, open & close.

Word of the Week Purpose : To promote a fun emphasis on increasing the number of opportunities to show our students the power of communication. We want to observe what happens when we give our students the challenge of seeing how many times a day they can use the Word of the Week (WOW), The emphasis is on functional communication. in onofffast slow get push make turn go stopplayupdown do open close The idea is to find numerous ways each day to use the Word of the Week for expressive, receptive &/or written task via a symbols, voice output communication devices, signs, verbally and or written. Consider giving a reward for each time the WOW is used.

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

Aug Comm Wiki / AAC Language Lab resources – Stage 2

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

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

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

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. 9. 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.

Tags 5 Things5 Things AAC aided language input aphasia Apps ASD assessment communication core vocabulary core words implementation ideas inclusion intervention language literacy resources schools semantics SGD video visual schedule visual supports vocabularyAACaided language inputaphasiaApps ASDassessmentcommunicationcore vocabulary core wordsimplementation ideasinclusionintervention languageliteracyresourcesschoolssemanticsSGD videovisual schedulevisual supportsvocabulary

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