Sara Robinson, M.A., CCC-SLP Speech-Language Pathologist Questions? For any questions during this broadcast, please send an email to: teresa.mcevoy@boystown.org Questions will be answered at the end of the presentation. 1
Augmentative & Alternative Communication: Sara Robinson, M.A., CCC-SLP Speech-Language Pathologist The Hundred Languages Of Children The child is made of one hundred. The child has a hundred languages a hundred hands a hundred thoughts a hundred ways of thinking of playing, of speaking. A hundred. - Loris Malaguzzi Outline AAC & Common Myths Assessment Child Profiles Intervention Techniques 2
What Is AAC? Augmentative and Alternative Communication (AAC) encompasses all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. American Speech-Language-Hearing Association http://www.asha.org/public/speech/disorders/aac/ Types Of AAC Unaided: use of body only Gestures Sign language Eye gaze Vocalizations Aided: use of external equipment No-tech Low-tech High-tech Common AAC Myths AAC means giving up on vocal communication If a child has some speech, AAC is not necessary A child can be too young for AAC 3
When Do We Start? When a child s earliest communication behaviors are difficult to interpret, their need for AAC intervention begins. (Cress & Marvin, 2003) Early access to multiple forms of AAC is essential for early communication development in young children at risk for expressive communication impairments. (Cress & Marvin, 2003) Assessment Basics Multi-disciplinary assessment Case History S C A L E S Vision, Hearing status Access considerations Current communication mode Observation Formal assessments Device trials Two Categories Of AAC Users Bridge Users Those for whom AAC is a temporary bridge to spoken or signed communication Long-Term Users Those for whom AAC is a long-term means of expressive communication 4
Two Categories Of AAC users Bridge Users Children who speak but have difficulty being understood AAC temporarily facilitates both understanding and expression of language Long-Term Users Children who understand spoken language but who have difficulty expressing it AAC facilitates both receptive and expressive communication A Journey Of Exploration Explore a variety of options to allow the child to show us their most effective mode of communication Continue the exploration as the child s skills will change and shift over time Multi-Modal Communication Consider multiple modes of communication (both aided and unaided) Different environments may call for different modes of communication 5
How Does AAC Fit In The World Of Hearing? A Bilateral CI s: Comprehension Continuums A Receptive Communication: Understanding of Language 1 Auditory - - - A V - - - AV - - - V A - - - Visual Adaptation of McConkey Robbins, 2001; Nussbaum, Scott, Waddy-Smith, Koch, 2004) Expressive Communication: Use of Language 2 Oral - - -O S - - - OS - - - S O - - - Sign/AAC (Adaptation of Waddy-Smith, Clerc Center, 2004) Expressive Speech: Use of Words and/or Vocalizations 2a Words - - - W V - - - VW - - - V W - - - Vocalizations (ACRN, 2011) Expressive Communication: Use of Pictures and/or Gestures 2b Pictures/Sign - - - Pictures/S g - - - P/S/G - - - G P/S - - - Gestures (ACRN, 2011) 6
Social S(2) Emotional C(1) Cognitive L(2) Language E(3) Extra A Balanced Approach A(2) Auditory S(3) Speech Home SCALES Weight 1 DAP Soc-Emotional Behavior Cognitive Auditory Language -Receptive -Expressive Extra: Executive Function, Motor, Vision, Sensory, Attention Speech 2 DAS R- E- 3 DAC DAP = Developmentally Appropriate Progress DAS = Delayed Acquisition of Skills DAC = Different and Additional Challenges (ACRN, 2011) Why AAC For A? Diagnosis of childhood apraxia of speech Difference between receptive and expressive language abilities Temperament High sensitivity High rhythmicity Low adaptability High-tech: ipad Bridge AAC user Multi-Modal Communication 7
Classroom Integration Of AAC E Bilateral CI s: Detection Primarily neutral vowels Continuums E Receptive Communication: Understanding of Language 1 Auditory - - - A V - - - AV - - - V A - - - Visual (Adaptation of McConkey Robbins, 2001; Nussbaum, Scott, Waddy-Smith, Koch, 2004) Expressive Communication: Use of Language 2 Oral - - -O S - - - OS - - - S O - - - Sign/AAC (Adaptation of Waddy-Smith, Clerc Center, 2004) Expressive Speech: Use of Words and/or vocalizations 2a Words - - - W V - - - VW - - - V W - - - Vocalizations (ACRN, 2011) Expressive Communication: Use of Pictures and/or Gestures 2b Pictures/Sign - - - Pictures/S g - - - P/S/G - - - G P/S - - - Gestures (ACRN, 2011) 8
C(3) L(3) Language S(3) Speech Cognitive S(3) A(3) E(3) Extra Social- Emotional Auditory A Balanced Approach Home SCALES Weight 1 DAP Soc-Emotional Behavior Cognitive Auditory Language -Receptive -Expressive 2 DAS 3 DAC Extra: Executive Function, Motor, Vision, Sensory, Attention Speech (ACRN, 2011) Why AAC For E? Limited spontaneous signing Temperament High sensitivity High intensity Low adaptability Difficulty maintaining eye contact & joint attention No-tech: PECS system Bridge or Long-Term User? PECS Use In Therapy Session 9
PECS Use In The Classroom L Hearing aid + BAHA: Comprehension Continuums L Receptive Communication: Understanding of Language 1 Auditory - - - A V - - - AV - - - V A - - - Visual (Adaptation of McConkey Robbins, 2001; Nussbaum, Scott, Waddy-Smith, Koch, 2004) Expressive Communication: Use of Language 2 Oral - - -O S - - - OS - - - S O - - - Sign/AAC (Adaptation of Waddy-Smith, Clerc Center, 2004) Expressive Speech: Use of Words and/or Vocalizations 2a Words - - - W V - - - VW - - - V W - - - Vocalizations (ACRN, 2011) Expressive Communication: Use of Pictures and/or Gestures 2b Pictures/Sign - - - Pictures/S g - - - P/S/G - - - G P/S - - - Gestures (ACRN, 2011) 10
S Social- Emotional C Cognitive A E Auditory Extra L S Language Speech A Balanced Approach Home SCALES Weight 1 DAP Soc-Emotional Behavior Cognitive Auditory 2 DAS 3 DAC Language -Receptive -Expressive R- E- Extra: Executive Function, Motor, Vision, Sensory, Attention Speech (ACRN, 2011) Why AAC For L? Speech production not a realistic goal at this time Bilingual home environment, sign language challenging for family Difference between receptive and expressive language High-tech: Dynavox system Potential long-term AAC user? Multi-Modal Communication 11
AAC & Sign In The Classroom Intervention Intervention Basic Principles It takes commitment! In order to develop AAC competence, there must be a reasonable number of people in the environment who are more competent than the child in understanding and using the child s language form. Von Tetzchner, et. al. (2005) Communicative autonomy 12
Intervention Basic Principles It takes a team! Parents Speech-language pathologist Classroom teacher Teaching assistants Anyone with whom the child interacts during the day Specials teachers (art, music, etc) Audiologist Other therapists Intervention Main goal of AAC to provide users with the ability to formulate novel utterances Model and use a variety of communication functions Provide access to a rich vocabulary Easy access to common phrases for efficient communication Ability to combine words Use of grammatical morphemes Vocabulary from a variety of parts of speech Intervention Techniques Auditory techniques Linking auditory and visual cues Developing multi-modal communication Partner augmented input Supporting social interaction S C A L E S A Balanced Approach Home 13
Auditory Techniques Auditory sandwich Acoustic highlighting Auditory imprinting Optimizing the auditory environment Linking Auditory & Visual Cues What is it? A tool for varying the level of support given to a child during a communication exchange Why use this technique? Provides scaffolding to encourage the child to gain independence in navigating and using their communication skills Natural Cues Linking A & V Cues Direct Visual Language Cues Routine Repeat Phrase Say With Speech Reading What do you want for snack? Indirect Cues Say With An Eye Gaze Say With Natural Gesture Let s find your snack words Direct Visual/Verbal Cues Say Phrase Or Word With Sign Help child activate appropriate button Say With A Point To Object Show location of word/phrase on device without activating it Adapted from DynaVox Systems LLC 14
Linking Cues: Indirect Cue Linking Cues: Direct Visual Cue Multi-Modal Communication What is multi-modal communication? Use of more than one mode of communication (ex. sign, speech, AAC, gestures, etc.) Why target this area in intervention? Allows the child to develop understanding of their communication modes and develop the ability to code-switch when needed 15
Multi-Modal Communication Partner Augmented Input What is it? Pointing to pictures while you are talking Why use this technique? Provides a model of the language the child is expected to produce (i.e. pictures) Facilitates the child s symbol association, memory/recall, and selection of response options Partner Augmented Input 16
Partner Augmented Input In The Classroom Social Interaction A shared means of communication is a necessary pre-requisite for interactions between children using alternative means of communication and speaking peers. Von Tetzchner, et. al. (2005) Supporting Social Interaction 17
Classroom Integration Of AAC Ingredients for successful classroom AAC use: Competency of staff Teacher assistant Classroom environment Expectations for use Classroom Integration Of AAC Classroom Integration Of AAC During A Listening Task 18
Conclusion Always a hundred ways of listening of marveling, of loving a hundred joys for singing and understanding a hundred worlds to discover a hundred worlds to invent a hundred worlds to dream - Loris Malaguzzi AAC Resources http://www.dynavoxtech.com http://www.aactechconnect.com/ http://www.aacinstitute.org/ http://aac.unl.edu/ http://www.ussaac.org/index.htm http://www.aaclanguagelab.com/ References Binger, C. & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23 (1), 30-43. Branson, D. & Demchak, M. (2009). The use of augmentative and alternative communication methods with infants and toddlers with disabilities: A research review. Augmentative and Alternative Communication, 25(4), 274-286. Cress, C. J. & Marvin, C. A. (2003). Common questions about AAC services in early intervention. Augmentative and Alternative Communication, 19(4), 254-272. Kristal, J. (2005). The temperament perspective: Working with children s behavior styles. New York: Brookes Publishing. Millar, D., Light, J., & Schlosser, R. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language and Hearing Research. 49, 248-264. 19
References Schlosser, R. & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology. 17, 212-230. Schuit, M., Segers, E., Balkom, H., Stoep, J., & Verhoeven, L. (2010). Immersive communication intervention for speaking and non-speaking children with intellectual disabilities. Augmentative and Alternative Communication, 26(3), 203-220. Van Der Schuit, M., Segers, E., Van Balkom, H., Stoep, J., & Verhoeven, L. (2010). Immersive communication intervention for speaking and non-speaking children with intellectual disabilities. Augmentative and Alternative Communication, 26(3), 203-220. von Tetzchner, S., & Martinsen, H. (1992). Introduction to symbolic and augmentative communication. San Diego: Singular Von Tetzchner, S., Brekke, K. M., Sjothun, B., & Grindheim, E. (2005). Constructing preschool communities of learners that afford alternative language development. Augmentative and Alternative Communication, 21(2), 82-100. Sara Robinson, M.A., CCC-SLP Boys Town National Research Hospital 555 North 30 th Street Omaha, Nebraska 68131 sara.robinson@boystown.org Sara Robinson, M.A., CCC-SLP Speech-Language Pathologist 20
A production of the Lied Learning & Technology Center at Boys Town National Research Hospital 555 North 30 th Street Omaha, NE 68131 21