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

2. 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

3. 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

4. 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!

5. 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.

6. 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....

7. 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

8. 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.

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

10. 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

11. 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

12. 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

14. 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

17. 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)

18. 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?)

19. 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

23. 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

25. 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

26. Modeling with Core Vocabulary

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

28. 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.

29. Environment
Be mindful of noise
Distractions
Fatigue
Medications

30. 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

31. 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

32. 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