1 Debby McBride Ligon, MS, CCC-SLP AAC for Persons With Complex Communication Needs Part I: Emerging Communicators/ Developing Communication Intent

Goals: Discuss Continuum of Communication towards Independence Describe Emerging Communicators Learn about AAC resources for your use that will be included on the PPHC website. Review AAC Communicator Profile for referrals/evaluations (website). Review University of Washington Resources and Communication Matrix - online resources Examples of AAC recommendations from patient referrals 2

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Communication is not "independent" if.. utterances can only be understood by some people, or... other people have to preprogram all vocabulary in a device, or... he cannot spell well enough to compose novel utterances, or... she is given no opportunity to communicate what she wants to say, or... his communication system doesn't match his motor skills making it difficult to control, or... her communication system doesn't match her communication needs, or... there are partners who influence communication through cueing, or... he has hidden vision impairments making it hard to see the symbols, or... she has a hidden hearing impairment making it difficult to hear what is said, or... he has been given insufficient training and time to learn to use his AAC system, or... she has no access to a communication system at times, or... he cannot see the display on his system in some light conditions, or... no one believes she has anything worth listening to....etc. 5

 Have some functional non-verbal communication (gestures, vocalizations, other nonsymbolic communication).nonsymbolic Increase attention and/or desire to interact with environment/others. Able to attend, even briefly, to individuals, conversations, pictures, or symbols. Yes/no (acceptance/rejection) depicted with body language; i.e. no reliable yes/no for more complex communication. 6 Emerging Communicator: No RELIABLE means of EXPRESSIVE communication through SYMBOLIC languageSYMBOLIC

Other Emerging Communicators Have interest / motivation Limited by motor Limited by vision / hearing (may be unknown Have to rely on non-symbolic (facial, body language, intonation, etc.) Given AAC tools/strategies – have lots to say 7

AAC Glossary- on website 8

Build skills for communication 9

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Current communication skills 12

Vision Skills/Modifications 13

Hearing Abilities/Modifications 14

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AAC Communicator Profile for Evaluations & Referrals On PPHC website In referral packet Can be used by itself for your own evaluations 16

Determining the FUN in FUNctional Likes / Dislikes checklist - Available on website - More info online

Popular AAC Apps (pictures) 18

Analysis of Inappropriate Behaviors Some individuals have problem behaviors, such as tantrums, kicking, scratching, damaging property or self-injurious behaviors. There is considerable evidence that some of this behavior can be replaced with functionally equivalent alternative communication. Studies have identified specific communicative functions that are crucial for many individuals with problem behaviors. According to Lloyd et al (1997), these are: · getting attention · getting or keeping objects or actions · getting pleasant sensory input (e.g. sounds, etc.) · escaping from an unpleasant task, sensation, demand 19

The communication matrix is an assessment tool designed to pinpoint exactly how an individual is communicating and to provide a framework for determining logical communication goals. 20

Communication Matrix - start 21

Communication Matrix – re eval 22

Example of summary of communication content 23

Free online profile for therapists & parents 24

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Pictures / video examples 26

Communication Matrix Questions & Answers (on PPHC website) 27

Design and Organization of the Communication Matrix 4 Reasons to communicate 24 specific message examples to communicate developmentally 7 Levels of communication 9 categories of communication behaviors 28

4 Reasons to communicate & 24 specific messages 29

30 9 categories of communicative behavior * Body Movements* Simple Gestures * Early Sounds* Conventional Gestures & Vocalizations * Facial Expressions* Concrete Symbols (includes AAC Tools) * Visual (Look at) * Abstract Symbols ( “ ) * Simple Gestures* Language ( “ )

7 Levels of Communication Level I: Pre-intentional Behavior Level II: Intentional Behavior Intentional Behavior Begins Here Level III: Unconventional Behavior Level IV: Conventional Communication Symbolic Communication Starts Here Level V: Concrete Symbols Level VI: Abstract Symbols Level Vii: Language Handout on website: Design and Organization of the Communication Matrix 31

YouTube 2pW3CzfY 2pW3CzfY 32

Case examples BCH Decide on preferred item(s) Touch/reach for preferred item (s) Move around; change sides; up/down Use food labels – put on eyegaze board Add non-preferred item (by itself – in a choice) – watch for PROTEST – turn away/push away. Ask for help – put item in box- hand over to person for assistance 33

EG Physically challenged Vision questionable Non-symbolic (facial, body language, Therapist introduce symbolic Use single message communicator for YES/NO Offer choices with partner assisted auditory scanning Observed to follow direction (blow kisses), follow conversation 34

JG – appear to be emerging non-symbolic to symbolic Severe physical challenges Body position – new wheelchair – holding head up still a challenge (tilt chair) Limited hand/arm movement – preference direct select – develop compensatory strategies on own Vision – functional – recognizes pictures Yes/no responses – thumbs up – pictures/eyegaze – laptray – iPad (direct select) 35

Communication goals – guided by AAC Communicator Profile (PPHC website) Look at Functions Look at Behaviors Decide which functions to expand Decide what Non-symbolic ways to do that (listed above) Introduce symbolic as appropriate Include AAC tools/strategies as appropriate 36

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Hope you: > > >> Learned about some new resources... Have some fresh ideas... And New / different perspectives.... On Developing Skills for Emerging Communicators

41 Including:  Other AAC Training Sessions  AAC Referral Packet  Interest in participatin on an AAC Team (if available). Debby McBride Ligon See PPHC website – under Employee Login for these and other AAC forms & resources