Using AAC all day and every day

Using AAC all day and every day

Charlene CullenSpeech PathologistSpeech Language and AAC [email protected]: @chacullen

Today’s Outline

9 – 1pm• Good practice in AAC• Apps for AAC• Additional supports to good practice in

AAC

30 minutes morning tea

What is AAC?

• Augmentative and Alternative Communication (AAC): An area of specialised clinical and educational practice that provides communication options and interventions for people with complex communication needs. The term augmentative in this context means supplemental or additional to speech. Augmentative techniques (e.g. gestures, and facial expressions) are commonly used when communicating and interacting with others.

• The use of the term alternative acknowledges that there are some individuals whose speech is sufficiently impaired that they must rely completely on standard and special augmentative techniques, which do not augment speech but are alternatives to speech (Vanderheiden & Yoder, 1996).

(Speech Pathology Australia AAC Position Paper 2004)

AAC System

• AAC system: An integrated group of components, including the symbols, aids, strategies and techniques used by individuals to enhance communication. The system serves to supplement any gestural, spoken, and/or written communication abilities

(American Speech and Hearing Association, 1991).

AAC System

Unaided and Aided AAC

• Unaided AAC: All techniques that do not require any physical aids (e.g. gesture, sign, facial expression).

• Aided AAC: Techniques where some type of physical object or device is used (e.g. object symbols, communication boards, books, wallets). Aided AAC is often divided into high technology or low/light technology systems.

(Speech Pathology Australia AAC Position Paper 2004)

AAC Myths and Legends

• Introducing AAC will stop someone from developing speech

• Low tech before High tech• Has a little speech so doesn’t need AAC• Too cognitively impaired for AAC• AAC will fix all communication difficulties• Too young for AAC• Doesn’t need AAC as they can express

basic needs

AAC Myths and Legends - Resources• Romski, M.A. & Sevcik, R.A. (2005).

Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18:3, 174-185.

• YAACK http://aac.unl.edu/yaack/ • DynaVox Implementation Toolkit

http://www.dynavoxtech.com/implementation-toolkit/learning-paths/list/?id=7

AAC Myths and Legends - Resources

AAC Myths and Legends - Resources

So how do we introduce AAC?

Good Practice Approaches to AAC• Aided Language Displays (ALDs)• Engineering the Environment• Chat Now• PODD• Core Vocabulary

Additional AAC options to support good practice• Small Talk• About Me Books• Yes/No ++++• Social Scripts• Partner Focused Questions• Storytelling

High Tech AAC

• Custom Speech Generating Devices• Mainstream Technology

• iPod touch/iPad• Android Phones/Tablets• Laptops

Communicative Competence

• Light (1989) • Linguistic Competence (mastery of the

linguistic code)• Operational Competence (access methods,

on/off)• Social Competence• Strategic Competence (make the most of the

vocab they have)

Aided Language Displays

Aided Language Displays

• Prospective users must be provided with frequent examples of interactive, generative use to acquire any semblance of proficiency.

• No one would dispute the fact that it would be very difficult to become a fluent speaker of French, if your instructor seldom used French in your presence.

Goossens’, Crain and Elder (1988); Goossens’ (1989)

Aided Language Displays

• Likewise, it is difficult for a nonspeaker to become a proficient AAC user if other people never model interactive use of their system during all aspects of the day.

Aided Language Displays

• Aided Language Displays are NOT choice making boards.

• Choice making boards supplement ALDs.• E.g. in music time a choice board of songs

is followed by boards for singing the songs.

It is critical for an individual to not only have symbols, but also to have experience with those symbols in a symbol rich environment / print rich environment. The typically developing child will have been exposed to oral language for approximately 4,380 waking hours by the time he begins speaking at about 18 months of age.

If someone is using a different symbol set and only has exposure to it two times a week, for 20-30 minutes each, it will take the alternate symbol user 84 years to have the same experience with his symbols that the typically developing child has with the spoken word in 18 months!!!

The typically developing child will demonstrate language competency around 9-12 years of age having been immersed in and practicing oral language for approximately 36,500 waking hours. For 9-12 years that child has been using and receiving corrective feedback while practicing with the spoken word.

At twice a week, 20-30 minutes each time, it will take the alternate symbol user 701 years to have the same experience

Jane Korsten (2011) QIAT Listserv 4th April

Aided Language Displays

• If children are to gain proficiency in using their aided AAC systems, others must begin to use the children's AAC system to communicate with them.

From “Being a Model Communicator,” ComTEC, 2010

Aided Language Displays

• By modelling how to use a display to initiate and maintain communication, you show a student how to initiate and maintain – not just respond!

Aided Language Stimulation

Aided Language Display Design

Aided Language Display Design

Aided Language Display Design

Aided Language Display Design

Aided Language Display Design

• If you (as a person proficient in language) cannot use a communication system or display throughout an interaction then how can you provide Aided Language Stimulation?

• If you cannot use it, is it designed well?

Exercise

• In pairs: Design an Aided Language Display for making things from pipecleaners.

• Remember to include vocabulary such as names, actions, positions, requests, commands....

Boardmaker Software Family

• Boardmaker• Boardmaker Plus• Boardmaker with SD Pro• Boardmaker Studio

www.boardmakershare.com

Engineering the Environment

Engineering the Environment

Engineering the Environment

Storing displays

• Must be stored in close proximity to where they are needed

• Must be stored in a way that helps with quick access and set-up

• E.g. in dress-up box, on back of bookshelf, on walls, in plastic bucket, inside game box, with props, in eye gaze arrangement

Engineering the Environment

Week 1

• Figure out how to make the display(s) available everywhere.

CHAT-Now

CHAT-Now

• Developed by Gayle Porter (Cerebral Palsy Education Centre) and Marnie Cameron (Communication Resource Centre)

• Children’s Aided Language Tools• Consists of aided language displays for

early childhood settings and general interactive board(s)

CHAT-Now – Book

CHAT-Now – Music play

CHAT-Now – Music play

CHAT-Now General Interactive

CHAT-Now

• A series of ALDs for different activities.• Designed for early childhood but suits

many special education settings• Also includes a general interactive board

for use throughout the whole day

Special School Project

• Approx 80% of students in school with CCN

• A few have individual systems – generally not being used

• Lots of visual supports in place – all staff carry key caddies and all classrooms use visual schedules, first then boards etc

• Commonly used AAC is all adult focused language

Key Caddies

Special School Project

• Baseline observations and videos end of 2010

• No spontaneous AAC use by students

Term 1 2011

• Every student establish yes/no• Begin using CHAT-Now• Introducing general interactive board• Then aided language displays

Week 1

• Problem solve how to make general interactive display available in every situation

Week 2

• Model more and finished all week

Week 3

• Add I like this

Week 4

• Add I don’t like this

Week 5

• Use whole board

• Made up in Tap Speak Choice, AAC App

Weeks 6 - 10

• Consolidate use of whole board• Ensure all students have yes/no

Special School Project

• Repeat observations and videos end of term one

• 10 spontaneous uses of AAC by students observed

• Next term introducing ALDs for a range of activities

• Term 3 introducing multi-page generic displays

CHAT-Now

• General interactive multi-level

Yes/No

• Need to watch the number of yes/no questions we ask AAC users

• BUT• Every AAC user needs to develop a good,

clear Yes/No response

Yes/No

Yes/No

Pragmatics

Pragmatics

• Pragmatics – social use of language• Using language for different purposes,

such as greeting, informing, demanding, promising, requesting

• Changing language according to the needs of the listener

• Following conversational rules

www.asha.org

Pragmatics

• Need to ensure AAC users have access to and know how to use a range of pragmatic skills

• Dewart and Summers “Pragmatics Profile” (1998)

• http://wwwedit.wmin.ac.uk/psychology/pp/

Pragmatically Organised Dynamic Displays (PODD)

PODD

• PODD is a way of organising whole word and symbol vocabulary in a communication book or speech generating device to provide immersion and modelling for learning. 

PODD

• The aim of a PODD is to provide vocabulary:• for continuous communication all the time• for a range of messages• across a range of topics • in multiple environments.

PODD

• PODDs can have different formats, depending on the individual physical, sensory and communication needs of the person who will use it.

PODD

• PODDs have been developed over the past 15 years by Gayle Porter, a speech pathologist with the Cerebral Palsy Education Centre (CPEC) in Victoria. Each PODD format has been shaped by the experiences of both children with Complex Communication Needs (CCN), and their communication partners.

Let’s have a look....

Core Vocabulary

• Using common English words on an AAC display to enable a user to construct their own sentences.

• Approach used in lots of high tech systems but not used as much in low tech due to difficulty of arranging vocabulary for access.

Core Vocabulary

• CORE VOCAB• High frequency

words• Can be combined

to get your message across in lots of different situations

• FRINGE VOCAB• Low frequency

words• Only useful in one

or two situations• Often related to a

specific topic

Core Vocabulary

Core Vocabulary

• WordPower 24 in TouchChat, AAC App

Pixon

• http://www.vantatenhove.com/showfolder.php?id=57

Core Vocab to supplement ALDS• From the Disability Services Commission

WA

http://www.boardmakershare.com/Activity/969086/Core-Vocabulary-Display

The Language Stealers

Technology

High Tech and Light Tech

• Both are just tools• Both need good vocabulary design and

good modelling to ensure success• High Tech can be less forgiving but can

offer more access options• Some students more motivated by high

tech and some don’t like it!!• Most people need both – for different

situations

Speech Generating Devices

• STATIC DISPLAY • DYNAMIC DISPLAY

Static Display

• May be more durable• Generally cheaper• Often run off AA or AAA batteries• Overlay based - require Boardmaker or

other tool• Need to work out system for storing and

changing overlays• Need to ensure vocabulary is updated• Harder to maintain in many ways

Dynamic Display

• May be more durable• Usually rechargeable• Tools for generating pages in device – and

sometimes in free software too• Can change vocabulary on the spot• Can change pages and levels easily• Generally offer a wider range of access

options

Access Options

• For a user who need alternative access, SGDs can offer:• Large range of access options• Flexibility• Complete control over device and other

software

Scanning and Eye Gaze

High Tech Scanning

Scanning

Low Tech Scanning & Eye Gaze

• Add movie file here

Eye Gaze

Eye Gaze

Mainstream Mobile Devices for AAC

There’s an App for that!

Over 100 AAC Apps

www.spectronicsinoz.com/article/iphoneipad-apps-for-aac

It started with Proloquo2Go...

• How do I choose?• Are they worth the

cost?• What do they offer

that traditional speech generating devices don’t?

• What don’t they offer that traditional SGDs do?

iPad

Media, Stories, Opinion

Media, Stories, Opinion

http://socialtimes.com/iphoneipad-app-helps-autistic-children-communicate_b10778

Media, Stories, Opinion

www.spectronicsinoz.com/blog/resources/2011/04/aac-apps-speaking-appropriately/

Media, Stories, Opinion• Apple iPad2 launch

Media, Stories, Opinion• http://www.wired.com/geekdad/2011/03/ipads-are-not-a-miracle-for-

autism-geekdad-opinion/

Apps with Symbols/Pictures

Apps with Symbols and Text-to-speech

My Voice

Apps with text only

Traditional SGDs

Research

http://aac-rerc.psu.edu/index.php/pages/show/id/46

Accessories

Access

Other mobile devices

Resources

• www.spectronicsinoz.com/blog/apple • http://a4cwsn.com/• iTeach Special Education – iDevices in

Special Education (Facebook group)• Assistive Technology (Facebook Group)

Expertise

Case Study

Additional AAC options to support good practice• Yes/No ++++• Small Talk• About Me Books• Storytelling• Social Scripts• Partner Focused Questions• Introducing yourself• Taking non-obligatory turns

Social Communication

• Social communication is a BIG part of our day.

• We use different forms of social communication – small talk, storytelling, greetings, wrap ups and farewells.

Social Communication

• Social communication is more than 50% of our daily conversation.

• Light (1998) found that reasons for communication between adults were (in ranked order)• Social closeness• Social etiquette• Information transfer• Wants and Needs

Small Talk• A type of conversational exchange used for initiating and maintaining

conversational interaction.• Some conversation never progresses beyond small talk e.g. at a cocktail

party.

So…. Let’s get more social!

Small Talk

Small Talk

• Small talk is used as a transition between the greeting and information sharing stage, especially when people don’t know each other well or don’t possess a lot of shared information.

• Small talk is often the first step towards social closeness.• A quick check at Amazon showed 16 books aimed at

helping people improve their small talk skills. Including “How to get people to like you in 90 seconds”.

• There are even websites to teach you how to small talk! e.g. www.ehow.com, www.englishclub.com, www.ivillage.co.uk and many more!

AAC Users and Small Talk

• Many AAC users use little or no small talk• This can be because

• They don’t have access to small talk in their communication system

• They don’t see the need for it• They think it is a waste of time.

• Light and Binger (1998) found that AAC users were seen as more intelligent, valued and competent communication partners if they used small talk.

Generic Small Talk• Generic small talk is small talk that people can use with a variety

of different conversational partners because it doesn’t refer to specific shared information.

• Particularly effective for many AAC users as it has many different uses.

Generic Small Talk

Specific Small Talk

How is your family?

How is your wife?

What’s happening?

What are you doing?

Don’t you look nice!

Nice haircut.

She’s great. She’s a great teacher.

Generic Small Talk

• Several groups of researchers at the University of Nebraska-Lincoln looked at the frequency and types of generic small talk used by speakers of various ages without disabilities.

• 3 – 5 year olds - 48% of all utterances at both home and pre-school/school were generic small talk

• 20 – 30 year olds - 39% of all utterances were generic small talk

• 65 – 74 year olds – 31% of all utterances were generic small talk

• 75 – 85 year olds – 26% of all utterances were generic small talk

Generic Small Talk

• Most of the age groups used continuers as the most common form of small talk.

• Really? Yeah? Great! Cool!• Go to aac.unl.edu for more detailed

information.

Differences in Small Talk Vocabulary• The small talk vocabulary lists showed that

some words were used more frequently than others e.g. OK

• Some words were common across all age groups e.g. great

• Some words were specific to certain age groups e.g. “bummer” was used by the 25 – 35 year age group but not by the others.

• Small talk also differs based on your friendship groups, your geographical location, your interests and life experiences.

Small Talk and Mealtimes

• Balandin and Iacono (2000) found that it was nearly impossible to script the content-specific vocabulary needed for mealtimes for an adult in the workplace (although there was a good chance on Mondays and Fridays that footie would be the topic during the footie season).

• In this situation, the only predictable thing was small talk.

Pre-school Generic Small Talk

Adult Generic Small Talk

George’s Small Talk

George’s Small Talk

• 21 year old male with athetoid cerebral palsy

• Attends a day centre for young adults• Uses a Dynavox 3100 but only uses the

spelling page• Controls communication device with a

head switch

George’s Small Talk

• Over 20 other people with disabilities and 6 staff attended George’s centre, most of whom talked.

• George rarely used his device during the day.• Staff requested a review of his device because

he didn’t “ever” use it.• George had previously had a setup with core

vocabulary on his device but found it frustrating to find words he wanted when he could just spell them.

George’s Small Talk

• A speech pathology student observed him in two sessions. He “used” his device constantly but only spoke with it twice.

• George was accessing his device with a head switch and block/row/column scanning. She observed that by the time he had formulated a message the conversation had moved on and he erased and moved onto a new message.

• A two pronged approach was used. Firstly, a conversational topic was established before each group e.g. “What are your favourite films?”. This allowed George to compose messages in advance.

• A small talk page was programmed and George practiced using this in one-to-one and then small group conversation.

George’s Small Talk

• At the end of 8 weeks the same speech pathology student observed George in the same two sessions.

• George used his device 46 times. Five of these were topic setters, 41 were small talk continuers.

• Several other people in the centre commented spontaneously that “George was much cleverer than they thought” or that “They enjoyed talking to George much more”.

• And….he’s still using it!

Sequenced Social Scripts

Sequenced Social Scripts

• Sequenced social scripts can really help a user to• Get a 'feel' for the anatomy of a conversation• Develop turntaking skills• Learn to interact with a variety of partners.

What are Social Scripts?

• They support students in learning to claim, start, and maintain turns in a conversation.

• Much of the information in this section is taken from “Can We Chat? Co-Planned Sequenced Social Scripts: A Make It / Take It Book of Ideas and Adaptations” by Caroline Musselwhite and Linda Burkhart

• Also called Participation Scripts

What are Social Scripts?

• Social Scripts are interactions such as joke-telling, sharing life stories and general conversations.

• They help persons using augmentative and alternative communication (AAC) move beyond wants and needs to using 'real' communication for conversational purposes.

• Often give developing communicators a sense of the power of communication.

Anatomy of a social script

• Attention getters• Starters• Maintainers, holders and interjections• Turn transfers• Closings

Attention Getters

• These are the phrases that start an interaction and make sure that someone is ready to listen.

• Creative attention getters can motivate a listener to be interested in hearing more. They can also change perceptions of others about the child who is using the script, by conveying, humor, age appropriateness, and initiative.

• AND they can be very motivating to use!

Hey, you guysWaz upDudeYoHellooCome hereLet’s talk

Starters

• Starters are used once attention is gained. They set the stage for what the child will be talking about.

• Setting the context further prepares the listener and allows the child to take charge of the conversation.

• Like attention getters, creative starters pique the interest of the listener and often get a natural response that encourages the child to go on and tell the story, complete the joke, etc.

Guess what I did?I have a secret!Wait till you hear what I heard!You won’t believe thisDid you see the game?I’ve got something to show youWanna hear a joke?

Maintainers, Holders and Interjections• These are phrases such as "Shall I give you a

hint?", "You know what happened next", "You will never believe what she said after that", "It was so awesome", It was really scary", etc.

• They allow the child to add interest to the basic story line while maintaining control of the conversation.

• They also prompt the listener to make comments and naturally encourage the child to tell the rest of the story.

And thenIt was so funnyGuess what happened next?Wanna hint?I hate that!Can you guess?I’ll give you a clueIt was so embarrassingAnd then it got even worse

Turn Transfers

• After the child has communicated his story, or sometimes in the middle of a longer story, turn transfers invite the listener to comment or give their opinion.

• They give the child the power of turning the conversation over to a partner, without ending the conversation.

What do you think?Isn’t it amazing?Can you believe it?You won’t tell anyone will you?How about you?Is that amazing or what?What did you see?

Closings

• Closings allow the child to take the initiative of ending the conversation. This helps the listener and also avoids that awkward feeling of “well is that all?”

• Again the child’s personality and humor comes through in the choice of closings used.

• Often several closings in sequence are appropriate, because people typically take several turns when finishing a conversion.

Nice chatting with youEnough about thatWhat have you been up to?Catch you laterCan you find someone else for me to tell about this?Hasta la vista baby

Exercise

• In pairs pick a topic e.g. Joke, prank, gossip, message

• Generate a sequenced social script• Find another pair and try your script out

Anatomy of a social script

• Attention getters• Starters• Maintainers, holders and interjections• Turn transfers• Closings

About Me Books

• Communication Passports• Personal Photo Stories

Communication Passports

• Template available from CALL Centre Scotland

• www.communicationpassports.org.uk• iPhone App coming soon• Also from SCOPE UK at

http://www.scope.org.uk/help-and-information/publications/scope-communication-passport

Communication Passports

• Useful for exchanging information about an AAC User between others

• Often not a tool used by the AAC user directly

Personal Storytelling

• As we get older the percentage of small talk decreases and the percentage of storytelling increases.

• Older adults, in particular, use stories to entertain, teach and establish social closeness with their peers.

• As individuals lose their spouses and move to retirement and care facilities the need to socially connect with individuals their own age becomes important and storytelling becomes a vehicle for this.

Personal Storytelling

• Schank (1990) discussed story formulation, refinement and storage in detail. He found a few different “types” of stories in common use:• First person stories• Second person stories• Official stories• Fantasy stories

• Marven et al (1994) found that for preschoolers, 9% of their communication at home and 11% at preschool involves fantasy of some sort.

AAC and Storytelling

• Storytelling with AAC systems has become practical and possible with improved technology.

• However, we must be careful that the stories are ones which the person would choose to tell.

• Storytelling is very personal and must be individualised.

John’s storytelling

John’s “chat” cards

• John is an 11 year old with autism spectrum disorder.• John uses words (which are mostly intelligible to familiar

people), signs and a multi-page communication book.• John also has some challenging behaviour. • Five years ago, John had challenging behaviour every

night when he got home from school.• His mum felt that this was due to his frustration over

trying to tell her about his day.• His team decided that “chat” cards about his day would

help.• They setup a process to write a sentence about each

day.

John’s “chat” cards

John’s “chat” cards

John’s “chat” cards

John’s storytelling

• Many of John’s old chat cards are in a milk crate in his room.

• John began spontaneously using them with new people a couple of years ago.

• He selects a few cards and then brings them to the new person. They read them with him and if they show particular interest in one topic e.g. playing basketball he will go and get more things around this topic.

• He brings out fewer chat cards as people become more familiar with him and understand more of his speech.

Ted’s Storytelling

Ted’s Storytelling

• Ted is a 78 year old who had a CVA when he was 72.• Following the CVA he regained some spontaneous

speech, mostly small talk. He can understand everything that is said and can read the paper and magazines. He cannot speak (apart from small talk) and he cannot write.

• Prior to the stroke he was president of his local RSL Club. His wife and his friends miss his storytelling.

• His wife was able to work with him and write out many of his stories. These have now been stored in a Macaw, with one of his friends doing the recording.

• He and his wife are delighted as he is once again able to tell stories and delight his family and friends.

Personal Photo Stories

• A series of photos about a person to give the “listener” a sense of who the person is

• Can be used to let them have a “conversation” with their “listener”

Sarah’s Storytelling

Sarah’s Storytelling

• Sarah is a woman in her sixties who lives in her own house.

• In her forties she was in a motor vehicle accident and is now a quadriplegic.

• She has a good understanding of spoken English but very limited expressive communication, including very little facial expression.

• She has control of a single switch with her left thumb, but tends to fatigue quickly, although her stamina is increasing.

• She has a multi-level communication book which she accesses with eye pointing.

Sarah’s Storytelling

• She has a range of in-house care staff who tend to stay around for between 5 months and 3 years.

• Many of these staff assume she doesn’t understand what is said to her because she doesn’t give body language feedback.

Sarah’s Chat BookInside this book are some of my photos. The writing tells

you about them. The questions are things I am interested in about you. Please read out the writing and the questions and we can find out about each other together - but be

warned - it might take more than one visit!

Sarah

• I was born in 1943, but this is the first decent photo of me - sitting at the piano when I was 11 like a good girl!

You won’t see that often.

• Did you learn an instrument? If so, what was it?

• Me and my cat in 1955. I’m the one on the right.

• Did you have a pet as a child. If so, what was it?

• What was its name?

• This is me in 1957 with my family. My brother and I are up the back, my mother and sister are in the middle

and my father is at the front.

• Who is in your family?

• And here starts the party girl era….

• 20 years old and ready for anything

• Party, party, party.

• Are you a party person?

• Recognise me? I’m one of the goddesses at this toga party.

• Have you ever been to a toga party?

• There’s me (left), Bob, Delilah, Juno, someone’s back and Helen.

• And here we are - Peter and I in late 1978 just after we’d met.

• And here’s the wedding invite. It all happened very quickly - we were married less than a year after we’d

met, in October 1979. It was a wonderful time.

• The wedding day - myself and Pete.

• Peter loved sailing. This was a fantastic day. It would have been sometime in 1984.

• Have you ever been sailing? Do you like it?

• On the 12th of July 1985, Pete and I were hit by a car as we were walking to a restaurant for dinner.

• My life completely changed after that. Pete died as a result of the accident and I am now severely

physically disabled.

• Pete and I had over six wonderful years together. I still miss him very much as you can imagine.

• Luckily, I have many great friends and they, and my own determination, have helped me to keep going.

• And in 1991, getting familiar with the options in communication technology at the time.

• And on to 2002 - some things never change. Recovering from a party and Melbourne Cup day.

• Do you enjoy a flutter on the cup?

Sarah’s Chat Book

• Sarah’s chat book has completely changed the way staff see her.

• Each new staff member sits down and goes through the book with her over a few different sessions.

• They realise how interested Sarah is in them and they gossip with her more.

• It also gives them topics to talk about that they think will interest her.

Maggie’s Storytelling

• A series of photos about a person to give the “listener” a sense of who the person is

• Can be used to let them have a “conversation” with their “listener”

http://sheldonhickey.com/maggie/All%20about%20me/index.html

Just how important is social communication?• In Building Communicative Competence

with individuals who use Augmentative and Alternative Communication Light and Binger (1998) looked at just three different social communication skills.• 1. Use of an introductory strategy when

meeting new people• 2. Use of nonobligatory turns to increase

participation in social interactions• 3. Use of partner-focused questions to

demonstrate an interest in the partner.

Use of an introductory strategy when meeting new people• Teaching a 35 year old with a closed head injury to use

an introductory strategy to explain his use of AAC and his communication resulted in much more positive interactions with unfamiliar people, with fewer breakdowns and made the new partners more at ease.

• Teaching a 44 year old with cerebral palsy to use an introductory strategy allowed her to be more confident and assertive with new people. Twenty adults with no previous experience of AAC viewed tapes of Maureen meeting new people pre and post. 100% of them reported she was a more competent communicator when she used an introductory strategy.

Use of nonobligatory turn taking

• Teaching a young (4½ year old) child with cerebral palsy to use non-obligatory turn taking via AAC meant that the child was initiating more frequently and was more eager to participate in group activities. One of her peers said she was more fun to play with. Her speech improved and she acquired 30 new words.

• Teaching a 14 year old with autism to take non-obligatory turns also resulted in a increase in initiating and turn taking. There was a decrease in his inappropriate behaviours and he was less disruptive in class. 20 adults who were not familiar with AAC rated his pre and post videotapes and rated him as a much more competent communicator in the post tapes (although they didn’t know which were pre or post).

Use of partner focused questions• Teaching a 13 year old child with developmental

disability to use partner focused questions produced a change in the focus of his interactions. His partners began to see his communication as more appropriate.

• Teaching a 24 year old with athetoid cerebral palsy to use partner focused questions meant that he became a more valued communication partner with those he regularly communicated with.

So how do I decide what’s important in an AAC system?• Beukelman (2004) wrote that

“vocabulary selection in AAC can be viewed as the process of choosing a small list of words or items from a pool of all possibilities”

Choosing vocabulary for pre-literate individuals• For people who are pre-literate those designing

an AAC system face a hard task. Generally we consider there are two forms of vocabulary for this group – vocabulary that is needed to communicate essential messages and vocabulary to develop language (which includes small talk and narratives).

• Many people like to make this decision around core vocabulary ie words and messages which are commonly used and occur frequently. Small talk vocabulary fits well within these criteria.

Choosing vocabulary for non-literate individuals• Aim to meet their daily, ongoing

communication needs in a variety of environments.

Choosing vocabulary for literate individuals

• For literate individuals, they may need some phrases or words which need to be pre-stored for quick access either so they can participate in the conversation in a timely way or so they can reduce fatigue.

What do we know about aided AAC use?

Many people who use AAC

• (Kraat, 1985; Light, 1989; Muller and Soto, 2002)

• Play a passive role• Rarely initiate interaction• Express a limited number of speech acts• Use restricted linguistic forms• Limited opportunities to interact with

other people

Communication board use is frequently less than one might expect.

When the communication board is used, it is often used primarily to provide information requested by the facilitator.

The range of communicative functions produced is typically restricted.

Functionally non-speaking partners tend to assume a respondent role using primarily yes/no answers and other short provisions of information.

Patterns of turntaking, initiation and conversational control tend to be asymmetrical in nature ie the speaking partner dominates the conversational exchange.

Speaking partners are frequently observed a) to ask closed-ended questions and specific Wh-questions and b) to repeat and rephrase previous turns, often initiating topics without expecting a response from the child.

In the classroom setting, AAC users tend to communicate predominantly with the adults in the class, not their classmates.

AAC should be…

Used frequently, interactively and generatively to express a wide

range of communicative intents;

Occurring during at least 80% of ongoing classroom programming

(as speech or manual sign use is);

Being used to mediate communication with classmates as

well as personnel (ie teachers, aides, therapists, clinicians);

Being designed and implemented in as time and cost effective a

manner as possible.

What we know

• Communication displays and devices are often not used

• AAC users are typically responders not initiators

• Interaction patterns focus on “closed” questions such as “What do you want?”

• Conversational partners control interactions (turn taking is unequal)

• Peer interaction is minimal

(Kraat, 1985)

Four main issues

• Lack of Modelling• Lack of Access to Vocabulary• Communicative Competence• Passivity/Learned Helplessness

We know how to fix this...

• We just need to do it!

• And model, model, model