1. Vocab Selection, Symbols, Layout Organization

2. Unaided and Aided Symbols

3. No-tech Systems

4. Low-Tech Systems

5. Mid-Tech Systems (Voice Output Communication Aides)

6. High-Tech Systems

7. Do I need to follow this symbol hierarchy?
Should I start with no tech, then progress to low tech, then mid tech, then high tech as my client becomes more “competent”???
NO! This is a MYTH. There is NO evidence that we need to use a symbol hierarchy! (Romski and Sevcik, 2005)
We should not be “testing” our clients before providing them access to a robust system of communication!
We need to IMPLEMENT AAC in order to TEACH AAC (AND language, communication, social skills, etc)!

8. More “Myths” of AAC…
But doesn’t my client need to demonstrate pre-requisite skills to use AAC?!
NO!!! This is a myth! (Romski and Sevcik, 2005)
But what if my client has low cognition, negative behaviors, no “desire” to communicate, poor motor control, is too young?!
Your client is a candidate for AAC! With AAC your client can express cognition, replace behaviors with communication, and initiate conversations about self-selected topics. There is NO age requirement!
Communication is a basic HUMAN RIGHT. There are NO prerequisites that justify withholding or delaying access to that right.
You are the GATEKEEPER of the language your client has access to!

9. Mobile Technology - Pros
iOS and Android platforms have changed the way people communicate, including those with communication disorders.
These devices/platforms offer many affordances that traditional AAC devices lack:
Less expensive
Less stigmatizing
Can be implemented for two distinct uses:
Therapeutic tool to teach new skills
As an AAC device
Clinicians can use a similar framework for determining appropriateness of a traditional AAC device when making a determination on a piece of mobile technology for a client.

10. Mobile Technology - Cons
Clinicians should be well-informed consumers of technology.
Need to be aware of the benefits and downfalls of new technology
Unlike traditional AAC devices, mobile technology is not covered by Medicare or Medicaid.
Durability of these devices is not well known when using them with individuals with CCNs.
Limited tech support available, especially when using third party “apps.”
Issues with service delivery (e.g., a caregiver purchases an iPad and wants the clinician to use it with their family member)

11. What Do You Think?
If you could pick a few people to select your messages for you, who would they be – people who know a lot about language or people who a lot about YOU?

12. Vocab selection

13. “WE USED TO THINK: Start with just a few (4-6) picture symbols and add a few more at a time, as the (student with ASD) shows that he or she can communicate appropriately with them usually by requesting.
Now we think: REALLY?!? Where is the research that defends this practice?
This is certainly not how other kids learn new words and acquire language.”
-Pat Mirenda, 2014 at the ISAAC Conference

14. Teaching Vocabulary Teach vocabulary that is powerful to your client
Motivating and meaningful to your client
Age appropriate
Vocabulary your client needs to be successful
Appropriate to use across environments
Enables him/her to communicate for a variety of communicative functions (i.e., comment, provide information, express opinions)

15. Pre-stored phrases & sentences
We must always consider the client’s understanding and his/her language level
I think most people need a combination
Focus on functional communication—what is efficient and effective for the individual
Some kids need a big bang for their buck

16. Pre-stored phrases & sentences
Emergency situations
Partner instructions and communication transaction messages
Discourse Functions
Questions
Predictable Routines

17. Core vs Fringe
Core vocabulary includes high frequency words that can be used in a variety of situations.
Fringe vocabulary is more situation specific. Importance depends on the context and the individual

18. Vocabulary Organization
“Professionals often spend a great deal of time concerning themselves with which box they should get their AAC user.  Should I pick a Prentke Romich or a Tobii Dynavox?  But what about the iPad?  And what about the money?  Should I pick a CheapTalk or a GoTalk instead? The box is not the issue…Let’s forget the communication box for a few minutes and focus on what’s inside to help us make our decision.”
Vicki Clarke, 2016

19. Organizing Vocab Simple Pragmatic Organization (Functional Language)
Grammatical and Noun Categorical Organization
Context Based Messaging (Visual Scenes or Grids)
Single Message Core Vocabulary
Multi-Meaning Core Vocabulary
“All have research supporting their efficacy as tools to assist non-verbal communicators in developing and using language.” Clarke, 2016

20. Organizing Vocab
Many SGDs and AAC apps lean towards a specific type of organization
Most GOOD systems have some of all of these.
The challenge is matching the patient’s specific skills and needs to the vocabulary system that best supports him.
Clarke, 2016

21. Intact Language/Need for AAC to compensate for a MSD
Can use almost anything (spelling)
Don’t typically need support for language development/social interactions
Focus on what will increase their RATE of communication, what is PHYSICALLY accessible, and what APPEALS to client
Clarke, 2016

22. For individuals WITHOUT intact language/communication…
Consider social skills, attention, language skills, visual and auditory processing, and memory
Is client “object focused” or “socially motivated”?
Clarke, 2016

23. Object Focused Client
May be a great requester, but cannot comment, respond, greet
Sequential memory is better than language comprehension (“I…Want…Alvin and the Chipmunks”)
Must teach social skills in addition to communication
Needs simplification of messages
Clarke, 2016

24. Object Focused Clients
Require minimal modification to core-based systems
Consider:
LAMP or UNITY on Accent systems
WordPower on a NovaChat
Core First on a T-series systems
Speak for Yourself app
AVAZ app

25. Socially Motivated Client
Good social skills but struggles with symbolic representation and STM for sentence construction
Need for language that is complex, specific, and easy to access
Phrase-based vocab allows for communication of variety of functions without taxing STM or attention skills
Clarke, 2016

26. Socially Motivated Client
Need heavy emphasis on context based communication
Consider:
Compass (Masterpage or NavBar) on T-series
SonoPrimo on I-series
Autismate App
GoTalk Now

27. Managing Context-Based Concerns
Lack of core
-Provide access and instruction to core in addition to context- based instruction
Lack of consistent placement of words
-Use placement of words on core vocab page to drive location of semantically similar messages in context-based pages
Need for extensive modifications
-Use systematic collection of messaging needs in environment
-Train caregivers to make modifications
Clarke, 2015

28. Remember…
There is no one or “best” vocabulary system that works for everyone. 
One size does NOT fit all!
NEED to consider individual strengths and needs and match our tools and teaching to individual differences.
“Most high quality apps and devices have a little of all of these types of vocabulary organization, so as long as you choose a high quality, comprehensive system, you can adapt it to meet the needs of most of your clients” Clarke, 2016

29. Lessons learned
The client’s personality and preferences must be considered AT ALL TIMES!!!
Have quick ‘on the fly’ strategies to use when things don’t work
Training, follow up, and ongoing support are essential for success
Communication is about people. Technology is only a tool.

30. References
Augmentative Communication News newsletter, Augmentative Communication Inc,
Augmentative and Alternative Communication: Knowledge and Skills for Service Delivery, ASHA 2001
Roles and Responsibilities of Speech-Language Pathologists with Respect to AAC: Technical Report, ASHA, 2004
Beukelman, D., & Mirenda, P. (2005). Supporting Children & Adults with Complex Communication Needs (3rd ed.). Baltimore: Paul H. Brookes Publishing Co.
Light, J. & Binger, C. Building Communicative Competence with Individuals Who Use Augmentative and Alternative Communication. Baltimore: Paul H. Brookes Publishing Co.
VanTatenhove, Gail. (2005). Personal Communication.
Content shared with permission from Children’s CO, AAC Team
Romski, M. and Sevcik, R. (2005) Augmentative communication and early intervention: Myths and realities. Infants and Young Children, 18(3), 174‐185.
Clarke, Vicki (2016). “AAC Assessment Corner: Thinking Inside the Box”
Clarke, Vicki (2015). “Context Based Communication: Using High-Tech Solutions to Increase Communication”