Augmentative and Augmentative Alternative Communicatio Communication n (AAC): What is it and how can it help my child? Children’s Hospital Colorado Lisa Nobel Martin, MA, CCC-SLP Augmentative Communication Communication Program Coordinator Speech Language Pathologist
AAC – What is it? AAC involves involves using multiple multiple modalities modalities to help people people communicate: n
vocalizations, vocalizations, verbal approximations
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gestures, sign language
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facial expressions, eye-gaze
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postural change/tone tactile cue/tangible symbols, objects
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pictures (labels, photographs, Picture Communication Symbols, Unity)
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speech generating devices (SGDs)
We all use it AAC is a set of tools tools and strategies that that an individual uses to solve everyday communicative challenges.
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Everyone uses multiple forms of communication, based upon the context and our communication partner.
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The form is less important than the successful understanding of the message. Taken from: http://www.isaac-online.org/english/what-ishttp://www.isaac-online.org/english/what-is-aac aac
Communication n
Communication is the essence of human interaction and learning.
Communication is what makes us uniquely human, all individuals have the right to communicate to their fullest potential (American Speech-Language-Hearing Speech-Language-Hearing Association, 2005). 2005).
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“If all my possessions were taken from me, I would choose choose to keep keep the ability to communicate because with it I would win back all the rest.” n
Daniel Webster
Who could benefit from AAC? Anyone with unmet communication needs
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This can include children who are verbal, minimally verbal, or non-verbal, with a variety of diagnoses (e.g., cerebral palsy, autism, Down syndrome, apraxia, traumatic brain injury).
Common Myths Regarding AAC Taken from: YAACK website –www.mrtc.o –www.mrtc.org/`duffy/yaack/toc. rg/`duffy/yaack/toc.html html Supporting Language and Communication For Individuals with Austin, Dynavox Mayer-Johnson, 2010
“AAC should be introduced only after giving up all hope of natural speech” n
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It is virtually impossible to predict the future development of speech in a young child (Beukelman ( Beukelman & Mirenda, 1992). 1992 ). Children with severe communication deficits who receive only speech therapy often endure years of being without an effective means of communication. A child who is not able to communicate effectively is at great great risk for cognitive, social, emotional and behavioral problems ( Berry, 1987; 1987; Silverman, 1980). 1980).
Common Myths Regarding AAC “The introduction of AAC reduces motivation to work on speech” speech” n
The introduction of AAC correlates with the improvement of natural speech—-even in situations in which no speech therapy has been given (Berry, ( Berry, 1987; 1987; Daniels, 1994; 1994; Romski & Sevcik, 1993; 1993 ; Konstantareas, 1984; 1984 ; Silverman, 1980). 1980).
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Studies have shown that even normally developing children who are communicated with in both sign language and speech during infancy appear to begin to communicate (initially with signs) and develop spoken language at a much younger age than would otherwise have been expected ( Holmes & Holmes, 1980) 1980 )
Common Myths Regarding AAC “A young child is not ready for AAC” n
There are no known cognitive or other prerequisites that are necessary for a child to use AAC. ( Kangas & Lloyd, 1988). 1988 ).
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Even infants are known to engage in purposeful, communicative behavior well before the development of language. These early exchanges are very important in that they form the basis for later formal, symbolic communication ( Reichle, York, & Sigafoos, 1991). 1991 ).
Common Myths Regarding AAC “A child with severe cognitive deficits cannot learn to use an AAC system” or “ A A child must exhibit certain certain specific cognitive prerequisites before being able to learn to learn to use AAC ” AAC ” n
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Children with severe cognitive deficits are capable of learning and benefiting from AAC (Beukelman ( Beukelman & Mirenda, 1992; 1992 ; Romski & Sevcik, 1993; 1993 ; Kangas & Lloyd, 1988; 1988 ; Silverman, 1980). 1980 ). It is impossible to accurately predict a child’s ability to learn AAC
Least Dangerous Assumption n
“The criterion of least dangerous assumption holds that in the absence of conclusive data, educational decisions ought to be based on assumptions which, if incorrect, will have the least dangerous effect on the likelihood that students will be able to function independently as adults” (Donnellan, 1985)
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www.inclusive-solutions.com/leastdang www.inclusive-solutions.com/leastdangerousassumption.as erousassumption.asp p
Common Myths Regarding AAC As long as someone someone talks a communication communication device is not needed
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Whether speech is echolalic or just limited, while waiting for functional speech to develop we might see (Light, Collier, & Partners, 1985; National Research Council, 2001): n
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Difficulty building social relationships Difficulty Acquiring Language Difficulty Meeting Educational Goals Challenging Behaviors
Common Myths Regarding AAC As long as someone someone talks a communication communication device is not needed
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In reality there is room for f or both AAC and natural speech. When both are utilized: n
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Can see increases in the use of multiple modes of communication at the same time (Schepis, 1996) AAC can be a catalyst to verbal productions
Common Myths Regarding AAC n
Individuals who have challenging behaviors shouldn’t use high-tech AAC n
Challenging behavior is viewed as communicative (Mirenda, 2005) Why? Because it has a function (Durand, 1990) n
Escape § Attention § Tangible § Sensory §
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Use of AAC can decrease challenging behaviors (Durand, 1999; Sigafoos, O’Reilly, & Lancioni, 2008; Wilkinson & Reichle, 2008)
Participation Model n
Historically, guidelines for AAC intervention were based on “candidacy” (i.e., cognitive prerequisites)
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Communication Needs Model emerged
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Now candidacy is based on the individual’s unmet communication needs, rather than a profile of impairments
Why does AAC help? n
“Information is encoded and remembered better when it is delivered in multiple modes (verbal and pictorial), sensory modalities (auditory and visual), or media (computers and lecturers) than when delivered in only a single mode, modality, or medium. Dual codes provide richer and more varied representations that allow more memory retrieval routes (Graesser, 2008, p.2)
Why use AAC? n
Increase Expressive Language n n n n
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Increase Receptive Language n n
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To communicate To improve speech To improve grammar To demonstrate knowledge To learn To follow directions
Increase Social Skills n n
To participate To improve behavior
AAC Tools n
No tech - do not require anything beyond the user’s body (e.g., sign language)
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Low Tech - something external to the user that may be nonelectronic (e.g., PECS) or a simple electronic device
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High Tech – electronic devices similar to computers
Examples of levels of representations •Objects •Photographs •Labels •Picture Communication Symbols (PCS) •Unity •Orthography
Examples of Low Tech Speech Generating Devices (SGDs) Attainment Company
Examples of Low Tech Speech Generating Devices (SGDs) Ablenet
Examples of Low Tech SGDs
Example of High Tech SGDs
Is the iPad the Answer for everyone? n
No
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The limitless possibilities and ever advancing technology of PCTs creates a scientific lag behind empirically based treatments that target communicative communicative goals. (Alliano, Herriger, Koutsoftas, & Bartolotta, 2012).
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Recommendations about the use of an AAC hightech device should flow from the evaluation and feature matching process.(McBride, 2011 )
Where Do I start? n
Communicative Intent
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What is the child’s understanding of visual representations – objects, photographs, pictures?
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WARNING!!! There is a difference between teaching the meaning behind visual representation in a “show me” style versus as a means of communication. Teach visual representations as a means of communication in order to provide context.
Feature Matching: The Purpose of an AAC Evaluation n n n
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Portability
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Access Speech (digitized vs. synthesized) Means of encoding language n
Objects
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Photos
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PCS/Symbol Stix
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Unity
Ability to navigate n Categorical n
Icon sequencing
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Visual scenes
Learning Style: Visual n Auditory n
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Motor
Language Needs (e.g. Spanish) Additional Needs/ Considerations: n
Computer access
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Email
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Phone
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Text messaging
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ECUs
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There is no one best AAC intervention
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key is matching your child’s individual strengths and needs with the most appropriate type(s) of AAC
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Some children may respond best to a combination of different types of AAC
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A child communication “system” refers to multiple modes of communication (e.g., SGD, sign language, pictures, etc.).
Mobile Devices n
Pros n
Mainstream technology/ Societal norm
Attractive price point
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Accessible to people people quickly
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Other apps: educational, entertainment, schedules, rewards Reduced fear factor
Mobile Devices n
Cons n
Durability
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Sound
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Technical Support
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Distraction of other apps **
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Language system **
Access**
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Assessment Process Process n
Use same clinical approach pre and post mobile device era
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If iDevice is deemed to be the right platform, feature matching needs to be continued to select the appropriate application
Key to Success: Ongoing Support n
Programming
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Language Development
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Communication Partner Strategies
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Device Maintenance/upgrades Maintenance/upgrades
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Support with integration of device across environments
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Family buy-in
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Consistent expectations/support across environments
Teaching AAC Strategies n
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Why? n “Technology alone does not make a competent communicator any more than a piano makes a musician or a basketball and a hoop make an athlete.” (Beukelman & Mirenda,1998) n The goal of AAC should be “the most effective interactive communication possible” (Hill, 2005; On-line: www.asha.org www.asha.org)) How? n Need to know in order to teach (i.e., take a hands-on, exploratory approach to learn systems) n Just use good language therapy; in normal language development, children begin using individual words and word combinations; AAC uses the same basic rules (Hill, 2005)
Communication Partner Strategies: The Communication Tricks of the Trade! Provide increased opportunities for communication (Light, Dattilo, English, Gutierrez & Hartz, 1992) n Wait time/Expectant Delay (Angelo & Goldstein, 1990; Light & Binger, 1998) Stimulation (Goosens’, Crain Crain & Elder, 1992) n Aided Language Stimulation n Re-casting (Lund & Light, 2003) n Support with navigation (Light, 2005) Sabotage/Communication Temptations (Wetherby & Prizant, n Sabotage/Communication 1989) n Peer Partners/Modeling (Buzolich & Lunger, 1995) n Open-ended Questions (Basil, 1992; Bruno & Dribbon, 1998) n Natural Conversation, Pragmatic Cues, Topic Cues n
Parent Perspective n
“Always building towards something. It’s all about foundation. The talker taught him receptive language, the concept of social exchange, and academics. Using the talker jump started his language language and ability to to engage in conversation” §
Steve Hemelstrand, father
Questions & Discussion
References n
American Speech-Language-Hearing Association. (2005). Roles and responsibilities of speech-language pathologists with respect to Augmentative and Alternative Communication: Position statement. Available from www.asha.org/policy
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Ashley Alliano, Kimberly Herriger, Anthony D. Koutsoftas, and Theresa E. Bartolotta (2012). A Review of 21 iPad Applications for Augmentative and Alternative Communication Purposes. Perspectives on Augmentative and Alternative Communication 2012;21 60-71
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Beukelman, D.R. & Mirenda, P. (2005). Augmentative (2005). Augmentative & Alternative Communication: Supporting children and adults with complex communication needs (3rd ed.). Baltimore, MD: Paul H. Brookes.
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Blischak, D.M., Lombardino, L.J., & Dyson, A.T. (2003). Use of speech-generating devices: In support of natural speech. Augmentative and Alternative Communication, 19, 29-35. Bodine, C. & Beukelman, D. R. (1991). Prediction of future speech performance among potential users of AAC systems: A survey. Augmentative survey. Augmentative and Alternative Communication, 7, 100-111 Does AAC impede natural speech?—and other fears (1999-2004). (On-line.) Ruth Ballinger - YAACK: AAC Connecting Young Kids. Available: http://aac.unl.edu/yaack/b2.html
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Dowden, P.A. (1997). Augmentative and alternative communication decision making for children with severely unintelligible speech. Augmentative speech. Augmentative and Alternative Communication, 13, 48-58.
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Gorenflo, C.W., & Gorenflo, D.W. (1991). The effects of information and augmentative communication technique on attitudes toward nonspeaking individuals. Journal of Speech and Hearing Research, 34, 19-26.
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Gosnell, J., Costello, J., & Shane, H. (2011, September). Using a clinical approach to answer “what communication Apps should we use?”. Perspectives on Augmentative and Alternative Communication, 20, 87–96.
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Hustad, K.C., & Shapely, K.L. (2003). AAC and natural speech in individuals with developmental disabilities. In Janice C.Light, David R. Beukelman, & Joe Reichle (Eds.), Communicative Competence for individuals who use AAC: From research to effective practice. Baltimore, MD: Paul H. Brookes.
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Improving Natural Speech: AAC Speech: AAC devices increase word production in children with developmental delays (2004). (On-line.) Available: http://speech-language-pathology-audiology.advanceweb.com/common/editorial/editorial.aspx?CC=12409
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Introduction to Augmentative and Alt ernative Communication (1997-2004). (On-line.) American Speech-Language-Hearing Association. Available: http://www.asha.org/public/speech/disorders/Augmentative-and-Alternative.htm
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Lilienfeld, M. & Alant, E. (2002). Attitudes of children toward an unfamiliar peer using an AAC device with and without voice output. Augmentative and Alternative Communication, 18, 91-101. McBride (2011). AAC Evaluations and New Mobile Technologies: Asking and Answering the Right Questions. Perspectives on Augmentative and Alternative Communication, 20, 9-16
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Millar, D., Light, J., & Schlosser, R. (2000, August). The impact of AAC on natural speech development: A Meta-Analysis. Paper presented at the Biennial Conference of the International Society for Augmentative and Alternative Communication, Washington, D.C.
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Romski, M.A., & Sevcik, R. (1996). Breaking the speech barrier: Language development t hrough augmented means. Baltimore: Paul H. Brookes Publishing Co.
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What is AAC (2012). (On-line.) International Society for Augmentative and Alternative Communication. Available: http://www.isaac-online.org/english/what-is-aac
