1. AAC Augmentative Alternative Communication
Cindy Nankee
CESA #3
WATI Consultant

2. Agenda Share assessment experiences Showcase low, mid & high tech AAC
Communication Symbols
Ideas for Using AAC
Set Up Success
Educational Opportunities
Planning Communication Boards – the 80/20 rule
Boardmaker

3. Session Objective
Participants will increase knowledge of low to high tech AAC materials, devices and software.
Participants will increase knowledge of AAC implementation in therapy, in the classroom, in the home and in the community.
Participants will understand strategies for success in using a communication system
Participants will increase knowledge of AAC resources.
Participants will create materials using Boardmaker software

4. Name some ways we communicate
Communication boards
Picture exchange system
Voice output systems
Gestures/signing
Hair-pulling
Body position
Crying
Eye contact
Sounds
Words
Pointing
Falling asleep
Screaming
Silence
But for children who tend to communicate in “socially inappropriate” ways, we must find alternate (or augmentative!) ways to help them be effective communicators.

5. Augmentative/Alternative Communication AAC
*refers to the ways (other than speech) that are used to send a message from one person to another (ASHA, 2005)
Examples
Communication boards/books/picture symbols
Voice output communication devices (VOCAs) now referred to as (SGD) Speech Generating Device
Picture Exchange Communication System (PECS)
Morse Code
Eye Gaze

6. AAC is not…. “Giving up” on speech Only for those of a certain IQ
Only the job of the speech-language pathologist
Just “HIGH TECH” devices
A “one-time only” endeavor

7. AAC can be a vehicle for developing: expressive language receptive language literacy control over the environment communication initiation
Quote over next few slides comes from Linda Burkhart’s book referenced on the slide
Linda’s background is as a teacher
Express wants and needs, make choices
Receptive understand agenda, transitions,
Literacy boards with books
Environment
Initiation greetings

8. Which leads to… increased academic success
increased participation in social situations
increased self-esteem
increased job opportunities
And more…

9. Individuals Who Might Benefit from Visual Tools…
Pre-Readers
Communication Delays/Disorders
English Language Learners
Attention Deficit Disorder
Comprehension Problems
Learning Disabilities
Developmental Delays
Traumatic Brain Injury
Down Syndrome
Autism Spectrum Disorder
And many more…

10. Assessment ASNAT AT Checklist/AT Wheel STAGES ATLAS Evaluware
TASP Test of Aided-Communication Symbol Performance
Communication Matrix
Online Free/hard copy $8.00

11. Online Communication Matrix
The Communication Matrix is an assessment tool designed to pinpoint exactly how a child is currently communicating and to provide a framework for determining logical communication goals.
This online version was designed especially for parents
The parent version is designed to be "user friendly"
Results on a one page Profile

14. Showcasing Low to High Tech AAC The WATI Continuum
Communication board or book
Eye gaze frame
Simple voice output device
Voice output device with levels
Voice output device with icon sequencing
Voice output device with dynamic display
Devices with speech synthesis that use typing

15. Communication Boards Should Include...
Vocabulary that reflects all 4 categories
Wants & Needs
Exchanging Information
Social Interactions
Social Etiquette
Using the available symbols, could you communicate about an activity in all categories?
Social closeness-social banter, comments, creates conversation, develops relations “What did you do last night”

16. Communication Boards
                                                                 
Next on the WATI Communication continuum

17. Communication book

18. Placement of Communication Boards
Mount on Wheel Chair
On Desk/table
On locker
On Wall/ by bathroom/ sink
Play areas
Work area
Kitchen area

19. Eye Gaze Frame

20. Simple Voice Output Device
AbleNet
BIGmack Switch
(800)

21. Voice Output Device with Levels
                                        
Tech scan 32, multiple levels, scan, light prompt, real voice recording $
Go Talk, 4 levels,

22. Voice Output with Icon Sequencing
                                      
Pathfinder, Prentke-Romich Company

23. Voice Output with Dynamic Display
                                           .
Voice Output with Dynamic Display
Mercury
DV 4 and MT 4
E-Talk
Palmtop

24. Tango by Blink Twice www.blink-twice.com

25. Speaking Dynamically Pro
AAC Software with speech output
Windows and Mac
Create personalized dynamic, multilevel, talking boards
$649.00

26. Type and Talk speech Synthesis

27. Tablet PC Speech Assistant www.herbi.org

28. Terms/definitions VOCA – Voice Output Communication Device
SGD – Speech Generating Device

29. Companies handling dynamic display devices
DV4, MT4, MightyMo, DynaWrite
Pathfinder, Vantage, Vanguard, Springboard
Mercury, MiniMerc, Enkidu
Tango
E-talk

30. More on Communication Symbols

31. Like Again Show me Whole Past Fast Correct Short Tomorrow Word
Communication
That’s crazy!
Quiz, talk about boardmaker symbols

32. Communication Symbol Guideline
REAL OBJECTS
TANGIBLE SYMBOLS
TOBIs (true object-based icons)
COLOR PHOTOS
BLACK & WHITE PHOTOS
LINE DRAWINGS
PICTURE COMMUNICATION SYMBOLS
TEXT W/ PICTURES
TEXT & LETTERS
Tangible symbols are whole objects, parts of object, texture that represents object, photos.
Make sure the child can understand and use objects/photos, without a doubt BEFORE moving on to picture symbols. Failure of symbols due to mistake of not understanding objects. The point here is that many young children need to use actual objects PRIOR to being able to understand Boardmaker symbols. This session is focusing on what they can do with Boardmaker.
Sign language is a separate strategy. Requires fine motor more than pointing to picture and requires partner fluent in sign.

33. Object Communication System www.adaptivation.com
This product contains common objects along w/ picture symbols to assist in the transition between the two methods.

34. Tangible Symbols
Tangible symbols are objects or pictures that stand for or represent something about which we need to communicate.

35. A T. O. B. I. can be a line drawing, photograph etc
A T.O.B.I. can be a line drawing, photograph etc. which is cut out in the actual shape of the item it represents

36. When Billy gets home from school…
Who will be home when he gets home from school/daycare
Or who will be coming to pick him up.

37. Line Symbols

38. Picture Communication Symbols

39. Text with Pictures

40. Communication Board with words/letters/numbers

41. Ideas for Using AAC In Therapy In the Classroom In the Home
In the Community
Behavior Regulation

42. Why Use Visual Tools and Strategies…
Hodgdon, 2002
Give students information about their activities
Prepare students for what will or will not happen
Reduce the anxiety that comes from the unexpected, especially during transition times
Help students understand the concept of “finished”
Provide the structure for appropriate behavior and participation
Support communication and conversation

43. AAC in Therapy Schedules and Calendars Tools to Give Information
Tools to Make Choices and Requests
Tools for Protesting and Rejecting
Tools for Behavior Regulation

44. Picture Schedules
What is it? A visual representation of a span of time or of a specific activity.
When? They can be used to help cue a child as to what comes next (e.g., put on snow pants, put on boots, put on coat, put on mittens)
How? Mount picture symbols or labeled photos on magnetic board, tag board with Velcro, or tape and have the board with you during that activity. Model use of it so the child can eventually perform the task independently.

47. Tools to Give Information
“Behavior problems emerge because what the student is expecting and what is really happening are not the same.”
Linda Hodgdon, 2002
Calming down board
Rule Cards (“When I get to the gym, I sit on the red line.”)
International NO
Lightning Bolt
Activity Termination Symbols
Social stories w/ or without picture supports
Card to hold (WAIT)
Show calming down board, lightning bolts, activity termination symbols, social stories (made w/ Writing W/ Symbols), wait card, international NO, etc. from inside your Autism WATi KIT

48. Making Choices and Requests Hodgdon, 2002
*Student may need to LEARN what it means to make a choice
*Start with highly desirable choices
*Choices often motivate the student to communicate
*Offer immediate reinforcement for their choice
*Choice-making can be practiced multiple times per day
*Adults can structure the choices provided

49. What to choose, what to choose…
Which snack to eat
Which toy to play with
Which seat to sit in
Which person to walk with
Which cereal to buy
Which washcloth to use
Which job to do
Which CD to listen to
Which book to read

50. Tools for protesting or rejecting
                              
"All Done“ Card

51. Behavior Regulation
Tools

52.                                                
"Wait" Card

53. Teaching NO

54.                                  
"First-Then" Card

55. AAC in the Classroom Same as in Therapy Vocabulary Literacy Boards
Literacy Activities to expand language
Customize books
You don’t have to talk before you read
Reading comprehension increases if you are able to talk about it

56. Vocabulary

57. Literacy Boards
What is it? A single page containing pictures/words specifically relating to a particular story
Why? Used to identify key characters of the story, along with messages like “turn the page,” “more” or other story-specific comments
When? Use before, during, and/or after a story to help lead discussion and help the child fully understand the vocabulary and concepts within the story
How? Model use by pointing to characters, comments as you talk/read about them

59. Snack Time
Simple snack time
Boscobel ECH
Lily Rider, Louise Hebel

60. Snack Time Boscobel ECH Lily Rider, Louise Hebel
More complex snack Does it meet 4 categories?Wants and needs/Exchanging Information/Social closeness/social etiquette
Boscobel ECH
Lily Rider, Louise Hebel

61. School to home note
Boscobel ECH
Lily Rider, Louise Hebel

62. Software to expand language skills
Laurette
Stages choice
Pixwriter

63. AAC in the Home Same as Therapy and classroom
Create boards for playing games
Follow a recipe
AAC systems with infrared can be used to control anything that can be operated with a remote
Channel surf the TV
Purchase a infrared mini controller and automate small appliances (lights, fans, computer, robotic vacuum)
Control infrared toys & switch adapted toys

65. Playdough recipe with Pixwriter

66. AAC in the Community Same as Therapy/Classroom/Home
Make choices at the restaurant/library/
Make comments about: sporting events/movies/concerts/ plays/festivals/fashions
Create shopping lists

67. communication/the academic activity/language
?? Remember ??
The focus is not on the technology (low or high) rather, it is on communication, the academic activity and language.
Remember
the focus is not on
the technology rather,
it is on
communication/the academic activity/language ??
Remember

68. The following section from CCE Creating Communication Environments
Set Up Success
The following section from CCE Creating Communication Environments
Communication
Activity
Environment
Partner
Activities that focus on communication
Environment that’s conducive to communication by the child
Partner that knows how to prompt, model, elicit language, pause

69. Arrange the Environment to Increase the Likelihood of Communication
Common Strategies….
Use motivating materials and activities
Materials should be in view but not accessible
Student should need assistance with some materials
Provide small or inadequate amounts of materials
Sabotage
Provide something the student doesn’t like/want
Use communication boards/devices & visual tools

70. Increase Communication by being a good communication Partner
Accept and respond to ANY communication attempt
Provide descriptive feedback instead of praise
(“You wanted paint. Here’s more paint.”)
Be silent when appropriate
Be aware of use of figurative language (“take your seat” vs. “sit”)
Use a prompt hierarchy

71. Prompt Hierarchy Environmental Cue Open Question
PAUSE
Open Question
Prompt OR Request for Communication
Full Model
Incorporate descriptive feedback into each step

72. Prompt Hierarchy Step #1 Environmental Cue
Set up the environment to signal to the student that an activity is about to begin.
Ringing bell
Lining up at the door
Art materials prepared but out of reach
Desired items visible but inaccessible
Cutting the pizza, e.g.
After student responds, provide Descriptive Feedback

73. Prompt Hierarchy--Pausing Pause after every step
Focus your attention on the student (expect communication!) A N
PAUSE D
After student responds, provide Descriptive Feedback

74. Prompt Hierarchy Step #2 Open Question
If the student does not respond to the pause by making a response:
Ask a WHAT, WHY, WHO, WHEN, WHERE, OR HOW Question
“What do you want?”
“Whose turn is it?”
“Where does that go?”
AND then…...PAUSE
After student responds, provide Descriptive Feedback

75. Prompt Hierarchy Step #3 Prompt or Request Communication
Provide a prompt to students
Choices, carrier phrase, initial sound, visual cue OR
Request Communication
“Tell me what you need.”
“Tell me what goes next.”
AND then……PAUSE
After student responds, provide Descriptive Feedback

76. Prompt Hierarchy Step # 4 Full Model
Provide a full model for student
Use student’s AAC device
Use developmentally appropriate model
AND then…...PAUSE
After student responds, provide Descriptive Feedback

77. PAUSE In other words…PAUSE!
Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause!
In other words…PAUSE!

78. Prompt Hierarchy—WHY?
Gives student the necessary time to process information and to formulate a message to communicate
Provides a structure for adults that encourages communication
Can be customized for individual students
Organized least to most

79. CCE video

80. Educational Opportunities
Visual Strategies – Susan Stokes CESA /20 CESA 9 2/26/07
CCE (Creating Communication Environments) WATI Consultants
Get A Grip On Communication Cesa #2- 1/26 and 4/24
DynaVox –
PECS (Picture Exchange Communication System) Green Bay 1/4 & 5; Milwaukee 4/23 &24

81. Creating a Communication Environment (CCE)
Activity
Environment
Partner
CCE is for staff struggling with the implementation of AAC systems including language boards and low tech to high tech devices, across the school environment.

82. Creating a Communication Environment (CCE)
A four part sequential intervention
A team is required (teacher, SLP, Para, OT, PT, Parent)
CESA #2 Milton Wisconsin
$600. per 3 person team, $50. per additional team member
Jill Gierach, CESA #2 WATI consultant
Shelly Weingarten, CESA #1 WATI consultant
training link

83. Get A Grip on Communication
2 part training – assessment & programming
Severe and profound multiple disabilities
Special educators, SLP’s, OT’s, Paraprofessionals, Parents
$225
College credit
registration forms

84. DynaVox Trainings www.dynavoxsys.com
DynaVox Local Trainings
Introductory and Advanced Trainings
Online Programming Tutorials
Video and slide presentations
DynaVox Virtual Classroom
an online learning environment that features a live instructor

85. Picture Exchange Communication System (PECS):
PECS allow the child to spontaneously initiate a communicative interaction by actually exchanging, or giving a visual representation system to another person.
By making a physical exchange with another person, the child develops a concrete understanding that communication is an actual exchange of information between two or more people
The PECS program is composed of various phases or levels, starting with simple, concrete communicative exchanges and moving to more abstract communication.
Visual representation systems which can be used: miniature objects, T.O.B.I.s, photos, real drawings, line drawings, written words.

86. Visual Resources for Enhancing Communication from the Indiana Resource Center for Autism
*Attainment Company, Verona, WI
*Autism Resource Network
*Don Johnston Company, Volo, IL
*Imaginart Communication Products, Bisbee, AZ
*IntelliTools, Inc., Novato, CA
*Mayer-Johnson Company, Solana Beach, CA
*Pyramid Educational Consultants I nc., Newark, DE
*Silver Lining Multimedia, Inc., Poughkeepsie, NY
*Slater Software, Inc, Guffey, CO

87. Creating Communication Boards
Planning
Assessment & Design
Boardmaker
Speaking Dynamically Pro
PixWriter
Microsoft Word Table

88. 80/20 Rule
Augmentative Alternative Communication is 80% planning and 20% programming

89. Assessment Evaluware TASP Computerized assessment
Assesses size/spacing/visual preferences/auditory preferences
TASP
Hard copy assessment
An easy-to-use tool for assessing symbolic skills,
Design communication boards
Help select Aug Communication device
Set appropriate AAC goals
Serves as a tool to benchmark progress in aided communication performance.

90. Designing Communication Boards
Physical considerations:
Size of symbols
Spacing between symbols
Physical access to all locations of board
Landscape vs. Portrait orientation

91. Designing Communication Boards
Visual considerations:
Color vs. black/white
Color background
Size & spacing

92. Designing Communication Boards
Language/Cognitive Considerations:
Type of message (single word vs. phrase)
Type of symbol (Photos, line drawings)
Amount of vocabulary to be displayed at a time
Organization
Brandenburg, S., & Vanderheiden, g.C. (1988)
The Vocally Impaired: Clinical Practice and Research pp

93. Arrangements for Communication Displays
Activity-Based
Category-Based
Grammatically
Correct-Based
Alphabet and Word Based

94. Activity-Based Displays
For use with a specific activity (block play, cooking, office help)
May necessitate repeating of symbols across multiple displays
Should include comments and social etiquette messages
General left-to-right progression (person-action-attribute-object-location)
Should include problem-solving messages

95. Category-Based Displays
Groupings are based on categories with vocabulary items arranged according to familiar categories
May include a main board (e.g., I want to tell you a joke) with branching subtopic messages
Requires knowledge of categorization and the hierarchy of language
Difficult to express relational concepts, or complex thoughts, and difficult to use appropriate syntax

96. Grammatically-Correct Displays
Groupings are based upon some knowledge of grammar
Provide a way to generate more complex thoughts, to develop linguistic and literacy skills
Includes semantic arrangements, grammatical arrangements, or a modified Fitzgerald Key
Makes it possible for communication partners to model language (augmented input/aided language stimulation

97. Alphabet or Word- based Displays
Groupings are based on the alphabet
May include combination word-symbol messages
Effective use depends on the student’s prior knowledge, future goals, and the message selection techniques being used

98. Color Coding will allow user and facilitator to locate symbols more easily
Verbs/descriptors/nouns/prepositions
Tip of the month

99. Prepositions……….Green Nouns…………………..Yellow Miscellaneous……Orange
Goosens’ Crain & Elder Color Coding System Communication Displays for Engineered Preschool Environments (1994)
Verbs…………………..Pink
Descriptors………..Blue
Prepositions……….Green
Nouns…………………..Yellow
Miscellaneous……Orange
“WH” words, exclamations, negations, etc.

100. Planning is Ongoing Continue to Adjust Variables
Expand vocabulary
Increase size & array of symbols
Increase settings: home/community/other people/times in a day
Differ communication: requests/labeling/commenting/questions
Multi symbol utterances
Accessible/portable
Bridge up/down hierarchy

101. Summary of Ideas Picture supported story/newsletter Calendars
Literacy board
Weather Board
Snack placemats
Games (bingo)
Certificates
Greeting Cards
Calendars
Schedules
Vocabulary
Worksheets/Quizzes (matching/fill in)
Math/Reading/
Science/SS
Social Stories
Community

102. Category Worksheet Kristin Whitfield DynaVox educational specialist

103. Boardmaker Software
Picture communication symbols used to create communication boards, device overlays, worksheets, picture schedules
Teacher Tool
$299.00

104. Boardmaker Plus Software
This is Boardmaker plus voice
Create interactive Activities
Minus SDP bells and whistles
Student/classroom Tool
$399.00
Minus real speak, word prediction, abbreviation expansion

105. Boardmaker with Speaking Dynamically Pro Software
SDP is a speech output program
Use to create dynamic, talking, multilevel communication boards
Teacher Tool
Individual Student Tool
$649.00

106. Boardmaker Tutorial

107. Word Table with ClipArt

108.
4000 symbols include emotions, animals, verbs, nouns, computer technology, and many more. Imagine Symbols are available for download for non-commercial use.

109. Created in Word with Free Image Symbols

110.
This is a great site for non-readers.  Everything is in symbols.  Stories, news, recipes, personal care, and much more.   There is even a newsletter that is similar to News 2 You.....but it's free.   

111. www.widgit.com Resources on symbol use Symbols for literacy Products
Webwide – see websites with symbol support

112. References
American Speech-Language-Hearing Association website:
Burkhart, L. 1993, Total Augmentative Communication in the Early Childhood Classroom, p.38
Binger, C. & Kent-Walsh, J. (2005). Evidence-Based Language Supports for Children Using AAC: Increasing Expressive Communication. Closing the Gap conference, Oct. 2005, Minneapolis, MN.
Casey, K. & Kornfeld S. (2004). Developing language-rich light tech AAC systems for young children. Closing the Gap, October/November 2004, 23 (4).
CESA 4 & 5 Cumley, J. and Pallaske, M., CESA 1 & 2 Weingarten, M. and Gierach, J., Creating Communication Environments training, 2005
DynaVox educational specialist Whitfield, K., Planning for and supporting Meaningful Participation and Learning for children and Adults Using AAC

113. References
Hodgdon, L., Visual Strategies For Improving Communication: Solving Behavior Problems in Autism: Improving Communication with Visual Strategies, QuirkRoberts Publishing, P.O. Box 71 Troy, MI
Hodgdon, L., Solving Behavior Problems in Autism: Improving Communication with Visual Strategies, QuirkRoberts Publishing, P.O. Box 71 Troy, MI
Karlan, George. Environmental Communication Teaching Training. Field-Initiated Research Grant Award No. H023C9005 from the Office of Special Education, U.S. Department of Education. Lafayette, Indiana: Purdue University.
Quill, Kathleen, Do-Watch-Listen-Say, Paul H. Brookes Publishing, 2000
Raising a Reader, Raising a Writer: How Parents Can Help. Washington DC: National Association for the Education of Young Children (NAEYC) #530
Teaching Our Youngest: A Guide for Preschool Teachers, Child Care & Family Providers, U.S. Department of Education