0. AAC Intervention for Infants, Toddlers, and Preschoolers
Brittany Garay
Katie Kampen
Haley Schmitt

1. RESEARCH

2. Normal Language Acquisition: Birth
Receptive
Language learning begins
Awareness of sounds in the environment
Listen to speech familiar to them - may startle or cry if unexpected noise
Loud noises awaken them
“Still” in response to new sounds
Expressive
Produce sounds that let others know they are experiencing pleasure or pain

3. Normal Language Acquisition: 0-3 months
Expressive
Smile when familiar person comes in view
Repeats same sound frequently
“Coos” and “goos” when content
Differential cries
Receptive
Learn to turn to person speaking
Smile when hearing a familiar voice
If upset, will quiet at the sound of a familiar voice
Cease activity and closely attend to sound of unfamiliar voice
Respond to comforting tones - familiar voice or not

4. Normal Language Acquisition: 4-6 months
Expressive
Gurgling sounds
Vocal play
“Speech-like” babbling
Receptive
Respond to the word “no”
Respond to changes in tone of voice
Respond to sounds other than speech

5. Normal Language Acquisition: 7-12 months
Expressive
Sounds of babbling changes
Includes more consonants and long and short vowels
Uses speech or sounds to obtain attention and hold it
First words start to appear
Receptive
Listen when spoken to
Turn and look at face when called by name
Discovers the fun of games
Recognize names of familiar objects
Respond to requests and questions

6. Normal Language Acquisition: 1-2 years
Expressive
Accumulation of more words
Ask 2-word questions
Combine 2-words
Receptive
Points to pictures in book when reader names them
Points to some body parts
Follows simple commands
Understands simple questions
Enjoys simple stories, songs, and rhymes
Requests the same story, rhyme or games repeated many times

7. Normal Language Acquisition: 2-3 years
Expressive
Vocabulary explosion!
Word for almost everything
1, 2, or 3-word utterances
Understood by family members
Asks for or draws attention to an object by naming it or one of its characteristics
Comments
Receptive
Understands 2-step commands
Understands contrasting concepts and meanings
Notices familiar sounds like the telephone ringing

8. Normal Language Acquisition: 3-4 years
Expressive
Combining 4 or more words to form sentences
Talks about events that happen away from home
Clear and fluent speech
Understood by unfamiliar listeners most of the time
Receptive
Understands simple “who,” “what,” and “where” questions

9. Normal Language Acquisition: 4-5 years
Expressive
Constructs long, detailed sentences
Maintains topic
Uses “adult-like” grammar
Correct production of most sounds
Communicates with familiar adults and children
Receptive
Enjoy stories
Answer simple questions about themselves
Hears and understands nearly everything that is said at home or school

10. Emergent Language
“Individuals who currently have no reliable method of symbolic communication, no means of referring to the world around them through semantic references.”
Rely on non-symbolic communication means
sign/gestures
body language
some vocalizations
facial expressions
Pointing to objects or people

11. Does emergent communication mean cognitive deficits?
NO!!!!!!!!!!!
Again, it means they don’t have a reliable means of expressive communication.
it is impossible to test cognition of an individual with severe motor impairments who is a non-speaker.
Reasons could include:
Device doesn't match motor capabilities, so unreliable.
Hidden hearing impairment
Hidden vision impairment
Low expectations of other people, so no AAC trials.
Lack of opportunities to communicate
Lack of AAC services

12. Emergent Language Does not begin with equipment trials
Begins with identifying activities or objects that engage the individual and then using those to screen sensory and motor abilities.
Start simple and increase difficulty over time:
Begin with one touch (Big Mac or Step-By-Step)
Move to more complex (Base Trainer)
Continue to increase language devices with age:
Voice pal plus super talker, Chat Box, NovaChat, Accent, etc.

13. Now that you know how typical children acquire language...
What can we do for children who do not acquire language typically?

14. AAC Intervention and Young Children
Young children who can benefit from an AAC devices include but are not limited to the following:
Expressive Language Disorders
Autism Spectrum Disorders
Oral Motor Difficulties (i.e. Dysarthria)
Motor Planning Disorders or Apraxia
Physical Challenges (i.e. Cerebral Palsy)

15. AAC Intervention and Young Children
Start Early!
Intervene during familiar activities in the daily environment
Focus on sustaining interactions with familiar partners
To support comprehension and expression, use experiences and contexts they’re familiar with.

16. AAC Intervention and Young Children
Show parents how to provide appropriate support
Frequent opportunities for communication
Respond to child’s communicative attempts
Provide models of AAC and speech
When talking to child and also to expand on what the child’s message
Make sure AAC systems are dynamic
This supports language learning
Introduce and add new concepts as frequently as you can \

17. AAC Intervention and Young Children
Intervention must be FUN!
Integrate communication and play
Enhance motivation of child and family
Make sure AAC systems are appealing, fun, and easy to learn and use

18. Importance of Play Play is a universal language for all children
If an activity is fun and interesting to the child, the child will attend longer and get more out of the activity.
Play contributes to the cognitive, physical, social and emotional well-being of children
Children learn to engage and interact with the world around them

20. Effective AAC Intervention
1. Identify meaningful social contexts for communication
2. Develop appropriate AAC systems for child
3. Set up environment to support social interaction
4. Use appropriate strategies to support child’s communication

21. Develop Appropriate AAC systems
Communication is multimodal
utilize the individual’s full communication capabilities, including any residual speech or vocalizations, gestures, signs, and aided communication
Identify current modes used by the child
Vocalizations
Facial Expressions
Introduce additional modes to enhance communication
Signs
Light tech symbols
Speech Generating Device (SGD)
Ensure system is fun, easy for infants to use and understand, and dynamic

22. Light Tech Symbols
Meaningful and appealing representations of concepts
Digital photos, scanned images, color line drawings

23. Light Tech Symbols Support language and literacy
Support children who are:
Verbal without enriched vocabularies
Non-verbal without access to a high-tech communication device with sufficient vocabulary
Allow children to learn a vocabulary set
Expect to find vocabulary
Know where to look for needed words
Inexpensive
Readily available

24. AAC = FUN Make it appealing to infants Use bright, primary colors
Use familiar and motivating content
Incorporate interactive play activities
Alluring characters
Inviting speech output, songs, instruments, sound effects, & laughter
Use objects that the child prefers

25. AAC = Easy to Use Easy for infants to use and understand
Use touch screen for selection (if possible)
Provide support to assist with navigation
Use visual contextual scene displays to provide meaningful, interactive contexts to promote social interaction

26. Visual Scene Display Layout
Vocabulary is embedded under a “hotspot” in visual scene display (VSD) through digital photos of the child’s experiences or scanned images of a familiar book
Traditional Grid Layout: Vocabulary represented by separate AAC symbols in “boxes” - decontextualized
The vocabulary is presented in meaningful context and concepts are related visually and conceptually as in life
Traditional Grid Layout: Concepts presented separately

27. Select Appropriate Vocabulary
Identify appropriate “hotspots” in the VSD for vocabulary related to the context
Be sure hotspots are an appropriate size
Consider the child’s language and cognitive level when adding vocabulary
Make sure the child is interested in the VSD

28. AAC = Dynamic Begin with systems that are expandable
Do not let AAC systems limit language development - gradually build language
Young children experience qualitative and quantitative changes in development so AAC systems must reflect these changes
Introduce new activities regularly
Introduce new concepts regularly
Introduce more hotspots as motor skills develop ts

29. Supporting Environment for Social Interaction
Ensure appropriate positioning
Accommodate motor skills and cognitive skills
Minimize joint attention demands
Maximize the child’s attention to partner and AAC system

30. Strategies to Support Communication
Ensure meaningful opportunities for communication
Ensure appropriate supports to ensure successful communication

31. Model AAC + Speech When talking to child, always model AAC
You want to model AAC use to support the child’s comprehension, to show them how to communicate, and to provide opportunities for the child to learn new language concepts and structures.

32. Evaluation

33. KM Age: 6;5 Diagnosis: Sensory Processing Disorder
Seem on July 7, 2014 at LSUHSC Speech-Language-Hearing Clinic
Referred by: Laura Triscuit, MCD, CCC-SLP
To obtain an augmentative and alternative communication (AAC) device due to concerns regarding overall communication, speech intelligibility, and social communication needs

34. KM Presently receives therapy at his school, Cypress Cove Elementary
Speech Therapy
Occupational Therapy
Adapted Physical Education
He receives additional speech therapy services with Laura Triscuit at NorthShore Regional Hospital

35. Hearing Status No formal measures implemented to assess hearing
Most recent hearing screening in fall 2012
Results: Normal Hearing
Functional listening performance during AAC assessment revealed no modifications regarding auditory output to use an AAC device effectively
Attended and responded to auditory information at conversational loudness levels
Parental report revealed no concerns regarding his hearing

36. Vision Status Parental report revealed no visual problems
Most recent vision test was January 2013
Results: Perfect vision.
Did not demonstrate any visual impairments and no modifications were needed to the AAC devices during the evaluation to compensate for his vision.

37. Motor Functions
Gross and fine motor skills were observed throughout the evaluation
Gross Motor Skills:
Ambulated independently
Wheelchair mounting system not required
Able to carry device independently, but carrying case recommended for safe transportation
Fine Motor Skills
Accessed AAC devices with manual direct selection technique
Accessed locations of relatively small size without difficulty using right hand pointer finger

38. Formal Language Evaluation
The Receptive One-Word Picture Vocabulary Test 4th Edition (ROWPVT-4) was administered to determine KM’s language skills.
Norm-referenced assessment that helps to make accurate comparisons of a child’s receptive language skills
Evaluated KM’s ability to identify pictures of objects, concepts, and actions when given a field of 4 picture options

39. Formal Language Evaluation
Results indicated:
Raw score: 65
Standard score: 89
Percentile rank: 23%
Age equivalent: 5;1
He understood the concepts of shapes and transportations
He had difficulty with the concepts of complex feelings and nouns
Overall: KM’s receptive language skills were within normal limits

40. Informal Language Evaluation
Used icons on the AAC devices to communicate wants and needs during functional play activities and requested actions and objects
Followed simple instruction which demonstrated the linguistic capacity to generate simple requests on an AAC device while sequencing icons and symbols
Had necessary language skills to functionally communicate using an AAC device

41. Informal Language Evaluation
Used the Nova Chat 7, iPad with LAMP program, and Accent 1000 with UNITY program
Verbally produced the words: “puzzle,” “I want more,” “stop,” “go,” “on,” “I want drink” and “turn on” after selection of the icons
Produced primarily one-word utterances and gestures to communicate
KM’s speech was echolalic and scripted

42. Oral Mechanism Informal oral mechanism examination was completed
All oral structures appeared sufficient for communication purposes
Protruded and retracted lips
Protruded, lateralized, and elevated tongue
Cheek tonicity not assessed due to reluctance to let clinician touch his cheks
Velar mobility, uvula and tonsils not observed due to KM’s reluctance to open mouth adequately
Dental hygiene was good
Normal Occlusion (Class I)
Diadochokinetic rate unable to be assessed

43. Oral Mechanism
Functional use of oral structures was observed during snack (applesauce and Goldfish crackers) and drinking juice
Chewed crunchy food with normal rotary pattern
Cleared spoon using upper lip
Created proper seal when drinking from a cup
Drank from a straw
Bit straw while drinking

44. Cognitive Skills Evaluated informally during evaluation
Alert and active participant
Memory, attention, and problem solving skills appeared functional to learn AAC effectively and attain communication goals
Followed simple instruction and modeling
Accessed devices independently
Enjoyed exploring icons and symbols on the device to determine the vocabulary programmed

45. Specific Daily Communication Needs
Needs to functionally communicate with family members, classmates, teachers, and other communication partners
Demonstrated cognitive, linguistic, and physical abilities to use an AAC device
Critical for KM to:
Express wants and needs
Ask questions
Make requests
Respond during functional communication, especially emergencies and medical situations

46. Ability to Meet Communication Needs with Non-SGD Treatment
Primarily one-word utterances and gestures
Echolalic and scripted speech
Needs to participate in decision-making, stories, conversations, ask questions and respond to questions
Present communication status causes frustration and discouragement when he is not understood by others

47. Ability to Meet Communication Needs with Non-SGD Treatment
It was in KM’s best interest to obtain an AAC device to be able to communicate his wants and needs
KM was active so a durable and portable AAC device is recommended so it can be transported in all environments and meet functional communication goals during all daily activities.

48. General Features of Recommended AAC and Accessories
Based on comprehensive assessment, daily communication needs, and functional communication goal, KM requires an AAC device with the following features:
Input/Message Characteristic Features:
Visual word/picture communication symbol displays of a minimum of 45 symbols
Dynamic touchscreen/direct selection and generation of novel utterances using multi-meaning icons
Output Features:
High quality synthesized voice output
Auditory feedback from device to assist in message preparation/selection

49. General Features of Recommended AAC and Accessories
Other Features:
Lightweight, durable, and portable
Minimum battery time 5 hours
Unity program with multi-meaning symbols to display core and fringe vocabulary words
Accessories:
Carrying case so device can be transported safely and independently
45 location touchguide
60 location touchguide

50. Trials with AAC Devices
NOVA Chat 7
Not considered most appropriate due to communication needs in a variety of environments and developing communication needs over time
Accent 1000 with Unity program
Unity program can grow will KM’s communication needs as he becomes more capable using the device
Accent 800 recommended as device that would best meet KM’s communication needs
iPad with LAMP app
Determined not functional due to KM’s activeness and the iPad’s lack of durability for easy and safe transportation and use in a variety of enviornments .

51. ACCENT 800 Multiple access options: Multiple voice options
Direct selection
Single- or Dual-switch scanning
USB connectivity for other products
Multiple voice options
Available with an 8” screen and weighs less than 2lbs.
Sealed for protection from moisture and spills.
Dimensions: 9.8"w × 5.9"h × 1.4"d
Integrated Bluetooth
$6000

52. AAC Device and Accessories Recommendations
Unity program:
Accent 800 is preloaded with Unity.
Uses Minispeak to display core and fringe vocabulary.
Can grow with KM’s communication needs.
Allows spontaneous and specific messages.

53. AAC Device and Accessories Recommendations
45 location touchguide
To ease selection process.
60 location touchguide
For vocabulary expansion
Carrying case
To protect AAC device in transit.
Allow him to access system in different settings.
Color options!

54. Patient and Family Support
Mother, father, and sister
Sister also being recommended for a device
Highly motivated and accepting .

55. Treatment Plan
Goal 1: Use an AAC device to engage in functional communication within the next 6 months
Objective 1: KM will combine 3 multi-meaning icons to generate novel utterances to communicate functionally with familiar and unfamiliar communication partners

56. Treatment Plan
Goal 2: Use an AAC device to use age appropriate pragmatic skills
Objective 1: KM will use an AAC device to initiate an activity while communicating with a variety of communication partners within 6 months.
Objective 2: KM will use an AAC device to take turns interacting with a variety of communication partners by combining two symbols on his device within 6 months.
Objective 3: KM will use an AAC device to terminate an activity within 6 months.
Objective 4: KM will use an AAC device to comment during an activity within 6months.

57. Treatment Plan
Goal 3: Use an AAC device to express his needs during medical emergency situation or health related information to a variety of communication partners
Objective 1: Use AAC device to indicate wants and needs independently to an unfamiliar listener within 6 months
Objective 2: Use an AAC device to express emotions independently to familiar and unfamiliar listeners within the next 6 months

58. OVERLAY

59. Core versus Fringe Core Vocabulary Fringe Vocabulary
Frequently used words
Useful in a variety of situations
Small, commonly used words
Fringe Vocabulary
Situation specific words
Importance changes from context to context and from person to person
Determined by informants who know the child’s likes and dislikes and communicative situations well
Core: i, the, have, and, on, want
Fringe: museum, funny, evaporation

60. Core Vocabulary
Core vocabulary was studied in 50 typically developing toddlers (24-36 months) during two different activities in the preschool setting.
Results revealed the most frequently used words by toddlers: I No
Yes My
The
Want f

61. Core Vocabulary Common words included: Nouns were absent from the list
Pronouns
Verbs
Prepositions
Demonstratives
Words representing different pragmatic functions
Nouns were absent from the list

64. Activity: snack Teacher: It’s snack time! Student: Snack!
Teacher: Do you want Goldfish crackers or applesauce?
Student: I want applesauce.
Teacher: That’s yummy!
Student: Yummy!
Teacher: Do you want more?
Student: I want more.
Teacher: Do you want more applesauce or drink?
Student: I want drink.
Teacher: Are you all done or do you want more?
Student: All done!

65. Activity: snack Teacher: It’s snack time! Student: Snack!
Teacher: Do you want Goldfish crackers or applesauce?
Student: I want applesauce.
Teacher: That’s yummy!
Student: Yummy!
Teacher: Do you want more?
Student: I want more.
Teacher: Do you want more applesauce or drink?
Student: I want drink.
Teacher: Are you all done or do you want more?
Student: All done!

66. Vocabulary Used Core words used: Fringe words used: I Want More
All done
Fringe words used:
Snack
Applesauce
Yummy

67. Activity: play ball Teacher: Who wants to play ball?
Student: I want play ball.
Teacher: Yes, I want to play ball.
Student: Yes.
Teacher: Do you want the ball to go?
Student: I want go.
Teacher: What now? Up or down?
Student: Go up.
Teacher: Do you want more?
Student: I want more.
Teacher: We’re all done.
Student: All done.

68. Vocabulary Used Core words used: Fringe words used: I Want Yes Go Up
More
All done
Fringe words used:
Ball

69. References
Banajee, M., Dicarlo, C., & Stricklin, S. (2003). Core vocabulary determination for toddlers. Augmentative and Alternative Communication, 19,
Beukelman, D.R., & Mirenda, P. (2013). Message management: vocabulary, small talk, and narratives. Augmentative & alternative communication: supporting children & adults with complex communication needs (pp , 239). Baltimore, MD: Paul H. Brookes.
Beukelman, D.R., Light, J.C., & Reichle, J. (2002). Exemplary Practices for Beginning Communicators (pp ). Baltimore, MD: Paul H. Brookes.
Bowen, C. (2013, August 30).Typical Speech and Language Acquisition in Infants and Young Children. Retrieved from therapy.com/index.php?option=com_content&view=article&id=35:admin&catid= 2:uncategorised&Itemid=117.

70. References
Drager, K., & Light, J. (2007, November). Evidence-based AAC Interventions for Infants, Toddlers, and Preschoolers. Retrieved from
Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parent- child bonds. Pediatrics, doi: /peds
Musselwhite, C. , & Hanser, G. (2009). Write to Talk CD. Litchfield Park,
AZ: AAC Intervention
Musselwhite, C. , & Hanser, G. (2011). Lite Tech Display Sets. Litchfield Park,