Sunday, December 31, 2017

3 Little Words That Mean a Lot

I find a lot of professionals and parents alike who don’t really understand what AAC means.
So, first, to break it down, let’s look:

A= Alternative
A = Augmentative
C = Communication 



Alternative is typically what we’re talking about in AAC.  These students need an alternative to speech because they are completely non-speaking, or because they have so few words that they cannot meet their communication needs at all.

Augmentative is the one part people tend to forget.  To augment is to add to.  And that’s what we do with AAC for individuals who have some speech, but not enough to meet all of their communication needs. It’s also what we do for individuals who have speech, but their speech is unintelligible so much of the time that  they need a functional repair strategy, so that they can fix the breakdowns in communication when others don’t understand them.

One of the biggest groups I see with this difficulty is those individuals with cerebral palsy whose speech is so dysarthric that it is unclear to most of their listeners much of the time.
Another group I see with this need is children with apraxia of speech who may have some speech, but it does not function for their all of their needs.



AAC as a repair strategy is a novel idea for some, and is a “hard sell” sometimes.  We speech-language pathologists take the ‘speech’ part very seriously. But when we’re not meeting the needs of our students, we need to step back and remember that our goal, really, is communication; that last pesky letter in AAC.

AAC as a way to augment what speech the user has is often delayed while teams work on speech to the point where students themselves are frustrated with their inability to communicate.

One of the most persistent myths about AAC is that it shouldn’t be used for students who have some speech.  That it will delay their speech further or become a “crutch.”
However, research now tells us that far from delaying speech, AAC used consistently can actually help students develop their speech skills more.
And, far from being a crutch, it is a tool that helps students develop their language and communication skills.

So, what, exactly, is communication?   According to the National Joint Committee for the Communication Needs of Persons with Severe Disability, it is:

  • “any act by which one person gives to or receives from another person information about that person’s needs, desires, perceptions, knowledge or affective states.  Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or nonlinguistic forms, and may occur through spoken or other modes”

This definition puts the focus on the extent to which there is shared meaning between the communicator and his partners - NOT on whether the interaction is spoken.
AAC refers to all modes that make communication easier; and can include gestures, facial expressions, alphabet or pictures, computers, and signs.
So, before you say, "He's note ready for AAC,” remember - even babies communicate. No one is too impaired to learn some communication skills.
I’m pretty sure that if you look at your students who “aren’t communicating,” that you will find that they truly are.

Ascribe meaning to what they do do, and……… keep on modeling.




Sunday, December 24, 2017

What 3 Kinds of Books Should You be Reading?

This is my last gift-giving post, and today I want to talk abut books.  I have always been a big fan of giving books to children as gifts.  They may not be quite as welcome as the latest video game or electronic toy, but I love instilling a love of reading - or being read to. 

The fact is that while we provide lots and lots of opportunities to interact with books to neurotypical students, we’re slower to provide those to students with complex communication needs.



We recognize 3 types of text; enrichment, transitional, and conventional.
Enrichment texts are books you read to students that are rich is both text and graphics. They develop background knowledge; which  can be crucial for these students who do not get the same richness of experiences as neurotypical students.  These books support learning concepts and are full of rich vocabulary and variety of sentence types.

These books should be used at home to build rich experiences and at school to build vocabulary and language form.  These readings should be interactive and the students should be engaged in learning about book structure, story structure, and specific contexts or topics.

We build language skills when we provide mediation and scaffolding during reading, and when we provide structured Before-During- and After language activities.

A Before activity activates background knowledge, preteaches concepts, and learn both how to use words and how to find them in the AAC system.

A During activity involves the same type of activity - with the same specific language target - while reading the book.  A purpose for reading should be set; i.e. let’s listen for the different types of animals the children see, or listen for the words the author uses to describe the place where the story takes place.

An After activity is the follow-up activity the students have now been primed for, where they practice the language skill being targeted.

It is crucial to build into this practice the ability to retell the story.  We can prime students for this by starting with simple sequences from routines - the steps of a daily living task, the order of events in a day.  Use visual cues to show first - next - last, or a numbered sequence, or symbols for story elements.

By providing students with practice opportunities to build retelling skills they gain confidence in telling stories to their friends, parents, dolls, stuffed animals, and pets.  This is the kind of opportunity that our students with CCN don’t normally get.  They don’t get practice with vocabulary and syntax, with sequencing events and describing.

If we can give them symbol supports for telling stories, we can increase their engagement in story reading and increase their opportunities to practice language skills.








Have a fun and safe holiday season and Winter break from school.  And remember, keep on talking …. and reading!

Musselwhite,C.R., Erickson,K., Zoilkowski,R. (2002 ). The Beginning Literacy Framework. Don Johnston Inc.

Smith, M. (2009). Vocabulary Instruction and Aided Communication. AAC by the Bay Conference. San Francisco


Kent-Walsh,J. & Binger,C. (2009) Addressing the communication demands of the classroom for beginning communicators and early language users. Practically Speaking: Language, Literacy, and Academic Development for Students with AAC Needs. Brookes Publishing.




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Sunday, December 17, 2017

Three Keys to AAC Implementation Success

If you've been reading this blog for a while, I'll bet you can tell before you even begin what my 3 top tips might be.  They're the 3 basic steps to start with when teaching a child/student to use an AAC system.
And if you don't know them, didn't learn them in graduate school, haven't run into them yet in your career, or are a parent who's never been told, then please, keep on reading.
And even if you think you know what they are, please keep reading. We can all use some reminders, refreshers, and  a bit of reinforcement that what we're doing is right.



Tip #1: Knowing how to balance core and fringe vocabulary
Core words are important.  But you can’t forget the important fringe words, either.  Don’t exclude them.
Why is this important?  We focus on core words because they are crucial for generating the majority of utterances.  But every speaker has words that are important to him or her to which we should not leave them without access.
This tip is important because the user’s earliest communication often centers around those things that are uniquely important to him.
How is this important to get better AAC implementation results?  Early interactions with the AAC user will focus on daily routines, routine activities that are important and motivating to the user.  While core words, function words, are important in all of these interactions, the users will also want to specify those items that are important to him within this routines.  To maximize the user’s comfort and engagement, make sure to in crude these words, too.

Tip #2: Knowing how to create a descriptive language environment so students can use core words
One of the keys to maximizing the functionality of core words in the classroom - and minimizing time spent programing minimally useful vocabulary into an AAC system - is training teachers to use descriptive, rather than referential, language.
Why is it important? Again, we want to give the AAC user the most communication impact for his system “real estate.”  With a limit to the number of words on a page, we want those words to count - and be useful over and over again.
This tip is priceless to those of us who used to spend hours and hours adding vocabulary into each student’s AAC system, only to have it be useless the next year - or month!
How ca you implement this tip to get better AAC implementation results?
Here's how: Train teachers to think about Bloom’s Taxonomy.  They’ll already be doing this if they’re thinking about the Common Core Standards.  Rather than having a student recall or identify (What is the name of the place where this story took place?) have them think more descriptively, summarily, or analytically.  For many students, the best way is to ask; “Can you describe where this story takes place?”  It might be “green,” “trees,” “dark,” “cold,” if the story happens in a forest, for instance.  Three out of those 4 words are core words that the user will find in his AAC system and use over and over again.  No need to program in the name of the particular words or forest.  That’s much less important.
My favorite example is one Gail Van Tatenhove uses, explaining why programing the names of the layers of the Rainforest into an AAC system is significantly less useful than asking the student to describe, for example, the Emergent Layer.


Tip #3: Knowing how to teach more vocabulary regularly
Introduce new vocabulary in as many ways as you can.  Providing a context for the vocabulary is crucial; particularly for students with special needs who may not have the same life experiences as their neurotypical peers.
If you can’t provide the context in real-life, then bring life into the classroom or therapy room.  If you’re teaching the story of the 3 Pigs, bring in pieces of straw and sticks and brick for students to feel.  Make a pile of each.  How easy is it to blow each of them over?
If even that is not possible, try creating role play and simulations.  I don’t think I know a speech-language pathologist who has never held a mock-birthday party in her room.  Gather plastic figurines, laminate pictures of objects to manipulate.
And, of course, read.  Reading text provides a context for which a student may have no experience.  It’s a little circular, I know.  We provide experiences to teach the vocabulary in books, and use the context in the book to teach the vocabulary.  But it is the very nature of providing these multi-faceted experiences that help the student learn what the word is, what it means, where and when to use it, and then…… how to find it in the AAC system.

Now that you've got the advanced tips for AAC implementation success down, I'd like to invite you to get even MORE advanced help with your (free) instant access to "Top Tips and Strategies for Teaching AAC"








Sunday, December 10, 2017

Making Puppets Talk: 3 Ways to Use Puppets to Build Communication

One of the agencies I consult to has group homes for adolescents with Autism Spectrum Disorder.  One of the boys had been there for more than a year before I could talk to him enough to do a cursory assessment of his communication skills.

How did I finally connect with him?  A marionette. While he wasn’t willing to talk to me - or most people - he had a grand time conversing with the dog marionette I had brought.  

That was a few years ago, and, as far as I know, the marionette is still there.


While most of the students I work with are school aged, I have been seeing more and more 2-3 year olds for AAC evaluations; which makes me a very happy SLP. I love seeing children early; before they lose more ground in the language development arena.

While some children have a fear of puppets - and clowns and Disney characters in costume - many love them.  I have an assortment of animal puppets, and a few “people” puppets from an old Peabody Development Kit (which was new in 1971, but still has some uses).

Puppets can have conversations.  Teach the parts of a conversation, taking turns, asking and answering questions while your puppets are engaged in conversation.

Puppets can tell stories.  Teach the elements of stories, starting with the characters themselves.  Where will they go? What will they do? What will happen to them? How does it end?

Puppets can re-tell a story they’ve heard.  Carol Westby discusses how typical children learn elements of narratives when they “read” or tell stories they’ve heard to their dolls and stuffed animals.  Students who are nonverbal don’t get that practice unless we provide them with the tools for expression and the scaffolding they need. 

This oral-literate continuum helps to move children from early, emerging language skills where children talk about what they can see and feel and hear to language skills needed for literacy, where they understand a shared context between themselves and a story, and can use this knowledge for written language..

Academic success is dependent on students developing these literacy skills.
Find these great puppets - and some others - at the SpeechScience Shop.


 Carol Westby (1985) Learning to Talk—Talking to Learn: Oral literate language 

differences, in Simon, CS (Ed) Communication skills and classroom success: Therapy methodologies for language learning disabled students. College Hill , San Diego, pp 182-213 




Sunday, December 3, 2017

How Many Ways Can I Use This Toy? 3 More Tips for Building Language Through Play

Fishing games are used a lot in speech-language therapy.  Many SLPs I know use a version of this game for practicing articulation sounds with their students. Kids seem to enjoy the challenge of getting a fish to stick to their magnetic pole.



Since I don’t do articulation therapy (and have pretty much never done it) I’ve used a game like this for building language skills in a couple of different ways.

First, simply use the game as is, and have students provide description of the sea creature they catch.  If giving descriptions is too difficult, you can use it for building receptive language by having them “Catch the pink seahorse,” or “Catch the orange fish with yellow polka dots.”

Second, practice comparing and contrasting.  Have the student catch two sea creatures, or you catch one and the student catches another.  If you’ve got more than 1 student, work in pairs.  Students compare and contrast the sea animals caught.  
“Both of the animals are fish, and both are orange.  But my fish has yellow polka dots, and your fish has blue fins and tail.”  

Use the Venn diagram below to lay the animals out so students can see the similarities and difference.  Laminate the sheet and use wipe-off markers for repeated use.
I’ve also included some descriptive images to use.





Third, work on narrative skills.  Create an ocean scene on your computer, or tear one out of a calendar or travel magazine.  This will set the “Where” of the story.  The sea creatures caught by the student are the characters, telling the “Who” of the story.  The student creates the action, moving the fish around the picture and telling the action, or “What doing” of the story.
Use the story map below the provide visual cues for what elements are needed.



While the catalogue says this game is for children under 3 and babies, I’ve used it with elementary school-aged students with these higher level language targets and we’ve had tons of fun while building crucial language skills.

For younger students, or those with more language difficulties, you might start just by having them label the animal, then gradually add colors and other descriptors; from “crab” to “orange crab.”


If you’re looking for further resources to practice these skills, try my Describe it to Me, Describe-Compare-Contrast, Describing Things Book, and Describing Snow Globes resources.  







Sunday, November 26, 2017

Making Puppets Talk: 3 Ways to Use Puppets to Build Communication

One of the agencies I consult to has group homes for adolescents with Autism Spectrum Disorder.  One of the boys had been there for more than a year before I could talk to him enough to do a cursory assessment of his communication skills.
How did I finally connect with him?  A marionette. While he wasn’t willing to talk to me - or most people - he had a grand time conversing with the dog marionette I had brought.  
That was a few years ago, and, as far as I know, the marionette is still there.
While most of the students I work with are school aged, I have been seeing more and more 2-3 year olds for AAC evaluations; which makes me a very happy SLP. I love seeing children early; before they lose more ground in the language development arena.

While some children have a fear of puppets - and clowns and Disney characters in costume - many love them.  I have an assortment of animal puppets, and a few “people” puppets from an old Peabody Development Kit (which was new in 1971, but still has some uses).



Puppets can have conversations.  Teach the parts of a conversation, taking turns, asking and answering questions while your puppets are engaged in conversation.

Puppets can tell stories.  Teach the elements of stories, starting with the characters themselves.  Where will they go? What will they do? What will happen to them? How does it end?

Puppets can re-tell a story they’ve heard.  Carol Westby discusses how typical children learn elements of narratives when they “read” or tell stories they’ve heard to their dolls and stuffed animals.  Students who are nonverbal don’t get that practice unless we provide them with the tools for expression and the scaffolding they need. 


This oral-literate continuum helps to move children from early, emerging language skills where children talk about what they can see and feel and hear to language skills needed for literacy, where they understand a shared context between themselves and a story, and can use this knowledge for written language.

Academic success is dependent on students developing these literacy skills.



 Carol Westby (1985) Learning to Talk—Talking to Learn: Oral literate language 

differences, in Simon, CS (Ed) Communication skills and classroom success: Therapy methodologies for language learning disabled students. College Hill , San Diego, pp 182-213 



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Sunday, November 19, 2017

Building Language is Child’s Play

I’ve written before on the importance of using play for building children’s language.  Carol Westby has written a lot about the oral-literacy continuum, and the importance of children building scripts and schemas in play.  
Toys that target language skills and motor skills, and build engagement are important for developing both cognitive and language skills.  Westby (1980) wrote about the development of representational thought in children 18 months to 5-7 years.  While symbolic skills alone weren’t felt to be sufficient for language development, they were considered essential prerequisites for developing communication skills.
Westby developed a Symbolic Play Scale, based on research with “severely and trainable retarded children” and typically developing children; using 5 groups of toys.  These included infant toys (pull and wind-up toys, busy boxes, etc), a household play area (with dolls and play-sized versions of household appliances and furnishings), a store area with relevant toys, a creative play area (with sandbox, trucks, puppets, and similar toys), and a gross motor area (with slide, riding toys, bowling set, etc).
Interpreting a child’s performance on a symbolic play assessment helped to drive goals for communication functions, semantic concepts, and syntactic structures. A cognitively based approach to language acquisition implied that language intervention only assisted a child in expressing what was already understood (Leonard, 1978).  
When I was training in graduate school in the 1970’s Westby and Leonard, among others, were the go-to sources for child language development.  And in 2006, Preissler concluded that for children with autism, “Play is an effective modality to teach children the precursors to symbolic thinking and the dynamics of social interaction” 
In 2006, Berk et all also concluded “rich opportunities for make-believe….are among the best ways to ensure that young children acquire the self-regulatory skills essential for succeeding in school, academically and socially.”


More recently, however, research with children with complex communication needs and significant language disorders has shown that there are no prerequisites for communication development.  Rather than waiting for a child to develop specific cognitive and symbolic skills, we now provide more consistent modeling of communication and language skills while playing with children to help build those symbolic skills and interaction skills.
Pat Ourand wrote “A belief by many is that since AAC is not always so simple, it must require significant cognitive and linguistic skills, which become imposed prerequisites that must be met before a child or adult can benefit from AAC. The National Joint Committee for the Communication Needs for Persons with Severe Disabilities (2003) published the Position statement on access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. This paper states that, "eligibility for communication services and supports should be based on individual communication needs". 
As well, research (see below) has dispelled the notion that communicators must somehow qualify for AAC interventions by showing certain precursor language or cognitive abilities, and this view is now extending into policy. In 2001, ASHA, with the work of Special Interest Division 12, AAC, adopted a statement on "No Prerequisites" for communication.”
She continues,  “Lloyd and Kangas (1988), and others, have long countered this prerequisites-for-communication position with fact and rationales." These authors analyzed AAC research and concluded that cognitive prerequisites for communication were not required. "Specifically, they noted that withholding communication intervention until an individual develops specific presupposed cognitive or other prerequisites was unwise and not the best practice for then or now.”
Now, we support the participation-based model of communication rather than the cognitive-based model; and put an emphasis on building communication skills in AAC implementation, rather than focusing on areas of deficit. 

The work of young children is play!  Playing is how young children interact with and learn from the world.  Building language skills in children does, indeed,  involve a lot of play. 

But building language through play involves more planning and thought than you might think.  Play therapy involves creating an episode that unfolds; proceeds along a sequence, follows a set of actions that produces memorable experiences in the child's mind.  These memories are what help to cement in the child's mind the language attached to them.  
When using toys and games in therapy, we're always modeling the language we want to build, providing new vocabulary, expanding the child's responses to that next step up, and wearing that ever-popular "expectant look" that tells the child we're waiting for them to do/say something.

But play therapy does not only happen with young children.  Many students with more complex needs - such as those with autism - often haven't had the same kinds of play experiences as their typical peers.  They may not know how to play, and often have difficulty with the interactions involved in playing with another.

Over the next month - right up to those gift-giving holidays - I am going to focus on using toys to build language, and I will focus on open-ended play to build language; like this one in the Speech Science shop, which can be used to play barrier games, to talk about shapes and colors, to build conversations around building designs and making pictures.
And if you have a 4-5 year old you want to be ready for kindergarten, try this resource, too.






Ourand, P. (2010). Cognitive Prerequisites Not Required for AAC
Use. SpeechPathology.com 
Westby, C.E. (1980). Assessment of Cognitive and Language Abilities through Play. Language, Speech, and Hearing Services in Schools, 11, 154-168.
Why is play important? http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/early_learning_for_every_child_t
oday.aspx






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