1. Getting Started with AAC: Parent and Clinician Perspectives
Vicki L. Haddix, M.S., CCC-SLP JoClaire Merrill, M.A., CCC-SLP
Clinical Assistant Professor Clinical Assistant Professor
University of Memphis University of Memphis

2. Agenda Introductions Research: AAC does not hinder speech development
Visual Supports and Visual Communication
Words to start with
Core Vocabulary: what is it?
AAC Implementation Resources
Being a Good Communication Partner

3. Who we are
SLPs and Clinical Assistant Professors at the University of Memphis
Teaching and supervising graduate students
Vicki- specializes in AAC, would prefer not to delve into the details of articulation and phonology, thinks a lot about how to teach and supervise SLP grad students
JoClaire- loves delving into articulation and phonology, has an adult son who uses AAC, thinks a lot about how to teach and supervise SLP grad students
This presentation came from our conversations and we hope to continue the discussion today

4. William history 23 years old Down Syndrome
History of chronic otitis media
Moderate to severe mixed bilateral hearing loss
Bilateral hearing aids from age 7 until age 20
Communication methods- pictures, signs, gestures, vocalizations
At age 20, began to protest wearing the hearing aids
Began to show preferred communication method-writing, typing on iPad

5. AAC attempts Began PECS and other picture symbols at age 2 ½ Ages 3-4
Colored pics of favorite videos and foods laminated and placed throughout the home
Ages 3-4
Continued to use PECs primarily for choice making: ”I want ____”
Age 5- enrolled in PK special education class. Family requested AAC evaluation from the school system
Evaluation was conducted with another student
Results: AAC device not recommended due to lack of pictures symbols in the classroom
PECs notebook behind the teacher’s desk and not accessible by anyone in class
Age 6- enrolled in another school, continued to use low tech picture symbol systems

6. AAC Attempts
Age 10- was evaluated again, this time by a DynaVox sales representative
Sales representative attempted to demonstrate core vocabulary, but could not explain language benefits
Navigation was cumbersome, difficult
Neither parents nor child found any benefit during trial period. Did not purchase
From ages 10-17, William relied on signs and writing for the majority of his communication needs
Age 17- School purchased iPads and Proloquo2Go
Bulk purchase, not individualized
Staff spent administrative time programming devices for specific activities
Emphasis on core vocabulary and modeling was reduced

7. What could have helped? Discussion about the importance of modeling
As an SLP, mother knew about and used modeling for receptive and expressive language therapies, but underestimated the power of modeling and its importance to AAC
SLP training for parents, SLPs, and teachers regarding the importance of teaching core vocabulary
3-5 hours of instruction about how to model core vocabulary from an AAC specialist would have solved an entire host of difficulties

8. AAC does NOT hinder speech development

9. 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!

10. Research Compilations
Millar, Light & Schlosser (2006)
The impact of AAC intervention on the speech production of individuals with developmental disabilities: A research review JSLHR 49(2)
NONE demonstrated a decrease in speech
89% had increased speech with AAC
Range of intervention approaches with those aged years
Majority used low-tech AAC
Schlosser & Wendt (2008)
Effects of AAC intervention on speech production in children with autism: A systematic review AJSLP 17(3)
NONE demonstrated a decrease in speech
Majority reported some gains (modest effect size)

11. Visual Supports; Visual Communication

12. 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.

13. 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....

14. 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

15. Where to Start- Vocabulary Choices?

16. Getting Started- Vocabulary Choices
Think about reasons for communication from the child’s point of view
Go beyond requesting- many kids get a lot of needs met already
Commenting and being social with peers may be more motivating
Rejecting- saying no in a more socially appropriate manner may be more motivating

17. Getting Started- Vocabulary Choices
“We want to start simple” leads to displays of a handful of preferred objects
These are more like visual prompts/choice boards (which are awesome) than communication systems
Also hard to do much modeling with only objects to request
First vocabulary boards are usually core vocabulary mixed with some highly motivated “fringe” words

18. 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

30. 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
May still need some fringe words, particularly in specific social situations like playing a game

33. Where to Start- Modeling?

34. 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)
Think about the importance placed on modeling and imitation in typical language learners

35. 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

37. Barriers to Aided Language Modeling
A lot of speech therapy focuses on elicitation (think about articulation)-
SLPs may feel like they’re not doing anything if “all” they’re doing is modeling
Naturalistic nature of modeling may deceive clinicians into thinking they are not producing results
Modeling may be perceived as being “too easy”
Results may not be immediate and therefore not reinforcing to the modelers
Keep in mind typical children don’t immediately start speaking after they’ve been exposed to spoken language a couple times- it takes time
Strategy to appease chronic data collectors- count number of models presented

38. Barriers to Aided Language Modeling
Parents may not realize they are modeling and/or the value of modeling
Parents model all day, every day, perhaps without realizing
Educating parents/communication partners about modeling and how “planned” modeling leads to communication gains

39. AAC Implementation Resources

40. 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?)

42. Core Word Classroom from AssistiveWare
Do need to sign up/register but content is freely available
Has sections with
core words of the week
core words within specific activities
5-minute fillers
While organized around Proloquo, can use these words with and strategies with any system, including low tech

44. Center for Literacy & Disability Studies UNC
36 location core board, 9 page book with 4 symbols per page, classroom poster…
Articles and presentations explaining the word choices and research basis
Is the launching site for their professional development modules which include fantastic videos and can be done in a group or self-paced

45. Angelman Foundation https://www.angelman.org/
Go to “Communication Training Series”
More than 40 webinars, including handouts in some cases, that walk through the basics of AAC and using/modeling core vocabulary
Tend to focus on low tech, PODD and Proloquo but lessons are applicable across systems and there's even a webinar to see if your app “measures up” to the qualities of a good language system

46. POWER AAC initiative from PaTTAN
From the Pennsylvania Department of Education, a series of videos by Gail vanTatenhove
Practice powerful communication PARTNER skills,
Create powerful communication OPPORTUNITIES,
Implement power WORDS in social and instructional contexts,
Continually utilize EVIDENCE in decision making about AAC systems and supports,
Create, implement, and share powerful RESOURCES.
PaTTAN- Pennsylvania Training and Technical Assistance Network, founded to help Bureau of Special Education build capacity of local education agencies

47. Carole Zangari
This website is one stop shopping for any AAC resources you could think of- use the search function
Core Vocabulary of the month resources available in a range of systems
TELL ME: AAC in the Preschool Classroom available from Attainment Company

48. AAC Role Models
Videos of people who use AAC are powerful motivators for both students and their communication partners
Find examples on Gail vanTatenhove’s youtube channel, WeSpeakPODD youtube channel, Facebook & Twitter
USSAAC SpeakUp blog/Facebook page/Twitter handle has frequent examples- device

49. AAC in the Cloud conference
Took place in June 2017, videos all archived:
Rachael Langley’s session on Prompt Awareness very useful
Karen Owens of WeSpeakPODD
Carole Zangari talks about going beyond the basics
(Full disclosure- we presented, too!)
Sept 2017 online conference- was free but now have to pay to watch the replays

50. Tips for Communication Partners

51. Very important to show you value non-speaking communication methods

52. 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 more advanced 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

53. SMoRRES (Senner & Baud, 2016)
S: Slow rate- speak in a slow, clearly articulated manner
Mo: Model- Point to the symbol on the child’s device while talking
R: Respect & Reflect- When the child communicates something through gesture or word approximation, model a word or phrase to communicate the same thought or feeling
R: Repeat- Frequently repeat utterances
E: Expand- Build up utterances by adding elements to provide a more complete expression of intended meaning
S: Stop- Pause to allow the child time to respond