AAC for OTs Vicki L. Haddix, M.S., CCC-SLP Clinical Assistant Professor University of Memphis

Agenda Definitions Visual Supports and Visual Communication AAC for Children AAC for Adults Being a Good Communication Partner Partner Assisted Scanning Practice Communication Partner for Adults

What Is AAC? Augmentative and Alternative Communication AAC or AugComm, on Twitter look for #AugComm SGD: Speech Generating Device Aided or Unaided Voice Output or Picture Display Voice can be digitized or synthesized Static Display or Dynamic Display Varied Level of Representation Objects, photographs, picture symbols, words Access Methods direct select, typing, scanning, partner-assisted, eye-gaze, etc

Most Frequently Asked AAC Question Will using AAC mean that we’ve given up on natural speech? Does this mean you don’t expect speech to develop? ANSWER: NO! Many research studies have demonstrated the exact opposite. Most children actually show an increase in spoken language after starting to use AAC. A few show no change. No documented cases show a decrease in spoken language after AAC introduction. NOTE: Think efficiency!

What Is NOT AAC? You will see many well-done visuals like calendars, schedules, classroom rules, memory books, behavior supports, choice boards, etc. These are all great and very helpful. They can introduce a vocabulary of picture symbols. They are not communication systems.

AAC is a (Often Visual) Communication System Communication is connection with others for a variety of reasons: requesting commenting gaining attention social closeness denying/negating changing topics asking questions negotiating starting a conversation sharing personal information....

AAC for Children When you are working with children who are not verbally communicating, you are working towards building language AAC systems for this population need to include ways for children to learn new vocabulary, combine words/symbols in new combinations Well-designed AAC systems also include some pre-programmed phrases for faster social communication, especially if the child has motor control issues But even for children with motoric challenges, they need access to single words to build language

AAC for Adults Most adult AAC users had an established language system and, at one point, were sophisticated communicators. Adults are looking for communication options to maintain relationships and have some control over their environment by indicating their choices Adult AAC systems can look quite different, are ideally unique to the user- and are often more dependent on the communication partner to create shared meaning. This co-creation of messages helps maintain relationships with caregivers and loved ones.

Very important to show you value non-speaking communication methods

Being a Good Communication Partner Wait Time/ Expectant Delay Might be uncomfortable for you, but the more you reiterate- the more the AAC user restarts message formulation Some adult AAC users are comfortable with you filling in when they’ve started and some are definitely not- ASK if you’re not sure Model, Model, Model Use the system yourself while communicating with the AAC user Don’t be afraid to make mistakes- model how to repair the mistake Don’t be afraid to search for words- model how to look for the word you want or to say it in a different way with the words available

Why Model? Many AAC users rarely see/hear anyone else communicating like them Providing aided language modeling “restores symmetry” (Binger & Light, 2007) Can be considered promising evidence-based practice according to standards published by Reichow et al. (2008 & 2011) Sennott, Light & McNaughton (2016) published an AAC Modeling Intervention Research Review and found AAC modeling led to meaningful linguistic gains across pragmatics, semantics, syntax, and morphology Think about the importance placed on modeling and imitation in typical language learners

Jane Korsten’s Math on Opportunities Typical Child Experience AAC User Experience 2x30/week By 18 months when they start speaking: 4,380 hours of exposure to language models would need 84 years to catch up By 9-12 years of age, when they are considered to have language mastery: 36,500 hours of exposure to language models would need 701 years to catch up

Core Vocabulary Core Vocabulary refers to a subset of basic words (in any language) that are used frequently and across contexts (Cross, Baker, Klotz & Badman, 2006) Research shows that 80% of what we say is communicated with only 200 words in the language (Baker & Hill, 2000) Core vocabulary words chosen based on early language development research (Beukelman, 1989; Banajee et al., 2003) Optimized for language development (vocabulary and syntax) Organized by grammatical part of speech S-V-O Usually color coded Links to fringe vocabulary organized semantically

Why Core Vocabulary? Core vocabulary is flexible enough to be used across situations, allowing for topic changes and a range of communicative functions Core vocabulary helps develop language use in AAC users For students with significant disabilities, who may learn a small amount of new vocabulary each year- focus on the words that have the most impact Communication partners usually need some time to learn how to use these displays to model Can slow down the social interaction if fringe words are required (i.e. during a game)

Recipes for Success Developed by the SLPs and OTs on the AT/AAC team at the Children’s Hospital of Richmond at Virginia Commonwealth University Parent-friendly handouts intended to help families facilitate core vocabulary learning with their children Provide Step-by-Step scripts at a variety of language levels and some generalization ideas (May not be same core vocab- what can you do?)

PODD: Pragmatically Oriented Dynamic Display Organized by REASON to communicate Based on “branch starters”- the WHY is first, then the WHAT Emphasizes efficiency at first Developed by Gayle Porter in Australia and slowly coming to America Intended as Partner Assisted Communication Books Only recently have dynamic displays been developed

Who Should Use PODD? Particularly useful for those AAC users who have significant motoric limitations but have a reliable indication of yes/no Maintains the social interaction of communication Organization is also helpful to teach the functions of communication Well-suited to the co-creation of messages

Adults and AAC Communication Partners Hard to generalize as the reason for using AAC as an adult may change the strategies utilized (i.e: ALS or aphasia) Keep in mind modeling (aka partner augmented input) can be used as much for comprehension as for supporting expressive language

Modeling with Core Vocabulary

Helping Your Loved One Communicate BY: JONATHAN ROGERS, CALEY REEVES, & KATIE SHOULTA

Key Principles Presume Competence: The patient has things that are worth saying You are not re-teaching language, you are helping him communicate You are his partner, communication is a dance (meet people halfway) AAC is a holistic system, (i.e. gestures, facial expressions, pictures, pointing, iPad, etc.) Keep in mind that each person is different some strategies may be more/less appropriate.

Environment Be mindful of noise Distractions Fatigue Medications

Strategies to Guide Communication Be Patient and use appropriate pause time (45-60 seconds) Be aware of what they can and cannot do Capitalize on their strengths Use open ended questions, and avoid yes/no questions that limit their responses Use concrete sentences Use augmented input You are BOTH sharing a system of communication, it’s a two-way street Allow for multiple communication strategies

Responsive to Communicative Attempts Don't interrupt the flow Eye Contact Encourage them to continue Use nonverbal communication to maintain your partner’s engagement Be aware of their difficulties and show sensitivity to their feelings

SMoRES Slow, Clearly, Articulated Speech Model Respect and Reflect (remember to treat them as adults) Expand (Co-Construct Meaning, Communication is a team effort) Mackie and Kagan (1999): focus on a collaborative interaction, in which partners work to acknowledge the essential competence of the communicator rather than focusing primarily on the disability. Stop