More AAC Solutions for People with Severe Disabilities: Part I
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1 More AAC Solutions for People with Severe Disabilities: Part I Cathy Binger, Ph.D., CCC-SLP June 11-12, 2009 WATR workshop Binger
2 Overview What is AAC? What is Low Tech AAC? Who needs AAC? Who needs low tech AAC? How do I know a client is ready for AAC? What kinds of low tech AAC solutions are available? Where do I start? What can go wrong, and what can I do? How do I create opportunities for using AAC? Case Studies Preschooler w/ autism Partner Instruction WATR workshop Binger
3 What is AAC? AAC = Augmentative and Alternative Communication Augment = to supplement Alternative = to replace AAC = Using ANYTHING other than speech to communicate Facial expressions Gestures Manual signs Objects (whole or partial) Miniature objects Remnants Graphic symbols (line drawings, photos) Electronic devices (high end and low end) WATR workshop Binger
4 AAC as a Tool AAC is about COMMUNICATION Using AAC is never an outcome in and of itself Only helpful if it improves FUNCTIONAL COMMUNICATION Devices cannot accomplish anything in and of themselves Nothing magical about using AAC Think of devices as a TOOL to get the client to exactly the same places as clients who rely on speech; for ex, Increase/improve Participation Academic/employment outcomes Social skills Language skills WATR workshop Binger
5 MUST know what the purpose of using that tool is to be successful Goals/objectives are not, for the most part, much different for clients who use AAC Examples of communication goals for your clients? Therefore, we will discuss AAC devices within the context of communication NOT the features of each device in isolation INSTEAD How do those features fit your client within a context for improved functional outcomes? WATR workshop Binger
6 What is Low Tech AAC? We will focus on low tech AAC Appropriate for people with very severe disabilities It s a type of aided AAC Using something other than the body to communicate May be electronic or non-electronic If electronic, use digitized (recorded) speech No speech synthesizer Static displays Symbols are placed on paper Do not have electronic screens where you can change the screen at the press of a button/mouse (i.e., dynamic displays, like your computer) WATR workshop Binger
7 Typically used for clients who: Cannot put more than 1 or 2 words together But they may understand more than that (simple full sentences) Use symbols to support comprehension/ organization Visual schedules Supplementary devices for people with higher cognitive functioning Emergency messages (ALS client in ABQ) Alphabet boards WATR workshop Binger
8 Features of Low Tech AAC Non-electronic or electronic Types of symbols Photos, line drawings, objects, partial objects, miniature objects Number of symbols per page Some devices allow you to change this Size of symbols Spacing between symbols Number of levels Length of recording time WATR workshop Binger
9 Low Tech Systems: Non-Electronic Individual Graphic Symbols WATR workshop Binger
10 WATR workshop Binger
11 WATR workshop Binger
12 Remnants WATR workshop Binger
13 Visual Scene Displays WATR workshop Binger
14 Visual Scene Displays WATR workshop Binger
15 Eye-Com Board WATR workshop Binger
16 Communication Book & Wallet WATR workshop Binger
17 Simple grids WATR workshop Binger
18 WATR workshop Binger
19 More complex grids (Available at WATR workshop Binger
20 More Complex Grids WATR workshop Binger
21 Word Power Communication Board WATR workshop Binger
22 WATR workshop Binger
23 WATR workshop Binger
24 Social Scripts WATR workshop Binger
25 Low Tech Systems: Electronic Object Symbol Electronic Devices WATR workshop Binger
26 Take/Place N Talk WATR workshop Binger
27 Single/Dual Message Electronic Devices WATR workshop Binger
28 Multi-Message Devices WATR workshop Binger
29 Go Board WATR workshop Binger
30 Go-Talks WATR workshop Binger
31 Other Multi-Level Static Displays WATR workshop Binger
32 SuperTalker & BlueBird WATR workshop Binger
33 Talking Frames/Photo Albums Stories Scripts Travels Show & Tell Etc. WATR workshop Binger
34 Visual Scene Displays WATR workshop Binger
35 WATR workshop Binger
36 Simple grids WATR workshop Binger
37 More complex grids (Available at WATR workshop Binger
38 Who Needs AAC? Anyone whose communication needs are not met with their speech WATR workshop Binger
39 Who Needs Low Tech AAC? Demonstrate intentional communication; e.g., Lead person around to show/tell them something Vocalize to request/comment Point/reach/gesture toward people/objects Reach to grab desired item Request/comment with gaze Ask for help in any way (not just general crying/whining) Other examples? Clients on your caseloads? May be READY to start using symbolic communication WATR workshop Binger
40 Demonstrate (emerging) symbolic communication Indicate yes or no (head nod/shake, thumbs up/down, facial expression of pleasure/displeasure, etc.) Use any manual signs Use any words (even if not pronounced precisely) Use any photographs or line drawings to communicate in any way Use objects to communicate in a non-literal way E.g., plastic apple to request real apple, empty cup to indicate thirst (Engage in symbolic play Cradling a baby, pretending to be a pirate, stirring an empty bowl with a spoon) WATR workshop Binger
41 Are ALREADY using symbolic communication Have a receptive vocabulary/language age of 1 year or higher May not be using symbols EXPRESSIVELY, but are ready to start Often see individuals with receptive vocabulary/language scores of 2, 3, or even 4 or 5 years who simply lack ACCESS to good ways to communicate Note: MUST give tests that require NO verbal output!!! PPVT, TACL, subtests of CELF; NOT the PLS!!! WATR workshop Binger
42 If the client is using ~50 symbols or more, he/she is probably ready for, at a minimum, higher level low tech May be ready for mid-to-high tech solutions WATR workshop Binger
43 How do I know a client is ready for If someone is AAC? Demonstrating intentional communication, or Demonstrating emerging symbolism, or Demonstrating consistent use of symbols He/she is ready to begin working with AAC solutions WATR workshop Binger
44 If someone is NOT communicating intentionally We can discuss at some length tomorrow Framework for working with people who are presymbolic Goal areas for 7 early levels of communication How many of you want to do that? Also: see Pre-symbolic Communication section on AAC Resources handout WATR workshop Binger
45 What kinds of low tech AAC solutions are available? For list of device that you can borrow from WATR (for free!), go to: With AT4ALL, you can now borrow devices from other partner states (2 nd website above) Also free! WATR workshop Binger
46 Where do I start? Key Question #1 In what ways is this client currently communicating? We need to have some idea of where they are so we know where to go next Vocalizing Gestures Pointing, reaching, pushing items away, etc. Gaze Challenging behaviors Yelling, kicking, screaming, biting, throwing, etc. Other idiosyncratic behaviors Dropping head to indicate boredom WATR workshop Binger
47 Key Question #2 What is the client trying to communicate? It s easiest to start by shaping current communicative behaviors (rather than teaching brand new ones) For ex: Rejecting undesired objects/events/transitions Requesting desired objects/people/activities Commenting on events» E.g., something surprising happens and the student looks at you to see if you noticed it too Make a list of how these things match up See next slide & handout WATR workshop Binger
48 Commu. Act Modes of Communication Vocalization/ speech Facial expression Gesture Manual sign Graphic Symbol AAC device WATR workshop Binger
49 Commu. Act Modes of Communication Vocalization/ speech Facial expression Gesture Manual sign Graphic Symbol AAC device Request food item for snack X X (reaches) Request drink for snack X X (reaches) X (hand over hand) X (hand over hand) Rejects food X (grimaces) X (throws) Requests participation with peers for floor play time X (whines) X X (reaches toward peers) Comments on sound of school bell indicating it s time to change classes X (looks expectantly at teacher) Etc. WATR workshop Binger
50 Key Question #3 Are these methods of communication Appropriate? Efficient? Effective? Any communicative attempts that do not meet these 3 criteria are an excellent place to start For ex, hitting a button that says, I don t want that instead of throwing things Let s discuss examples of your clients WATR workshop Binger
51 What Can Go Wrong, and What Can I Do? (aka Troubleshooting) The client Isn t interested in communicating Isn t making progress Is inconsistent With each communication partner Within each situation From one day to the next Is still demonstrating challenging behaviors Other challenges you ve faced? WATR workshop Binger
52 Lack of Interest in Communication Possible reasons Lack of access to via communication modes Not provided with communication opportunities Boredom Active dislike for activity Opportunity to work on teaching socially appropriate ways to reject! Not taught a variety of interests (Meds may interfere) Your clients & some possible solutions WATR workshop Binger
53 Lack of Progress May be aiming too high How can I make this task easier? May be aiming too low Bored to death Vocabulary is inappropriate/uninteresting May not be appropriate for this client For ex, motorically unable to access device Should NOT have the same goals/objectives year after year Must write attainable goals, however minor the progress may seem Much better to document SOME progress on a modest goal than no progress on a more ambitious goal Your clients & some possible solutions WATR workshop Binger
54 Inconsistent Performance Look for PATTERNS of when client does and does not perform behavior Are there differences in Location of device? Other issues with device Programming/symbol changes Nature of the task? Varies depending on communication context E.g., rejecting object vs. person Any of these possible for your clients? Also: Change can vary with partner, setting, day, time of day See next slide WATR workshop Binger
55 Variable Performance across Partners, Settings, & Days Partners Clients may simply like some partners better than others Settings/Tasks May vary because of like/dislike for certain settings/tasks Even one set of books to another Demands may be different across settings/tasks Days We all have good days and bad days! WATR workshop Binger
56 If client has variable performance with the same partner in the same setting on the same day May be bored E.g., doesn t WANT to request that you play music again May be tired May need to offer more choices for communication May need to offer fewer choices Your clients and some possible solutions WATR workshop Binger
57 Ongoing Challenging Behaviors ABC approach Antecedent Behavior Consequence May have mis-identified the antecedent May not have a valued consequence Must provide a way to express the intent of the challenging behavior that is equally EFFECTIVE & EFFICIENT Your clients and some possible solutions WATR workshop Binger
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