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AAC (Augmentative and Alternative Communication) 2018-19

 

Alison Pentland
Speech-Language Pathologist
/AAC Specialist

Alison received her master’s degree in Speech-Language Pathology from San Jose State University after participating in the Augmentative and Alternative Communication in Educational Settings grant. Since then she has focused her career on Augmentative and Alternative Communication (AAC) assessment and treatment and has worked with individuals from age two through adulthood. She is a firm believer that students can meet, and most likely exceed, expectations when they are given the opportunity to do so and provided the appropriate supports. She promotes evidence-based techniques and strategies to increase communication and participation in social interactions and academic instruction.  Alison describes herself as an AAC enthusiast and has a deep passion for the students with whom she works.

 

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Click a topic below to expand the full question and answer.

  • new!AAC, symbols, iconicity

Question:

Is there a hierarchy to symbols in AAC? Is there a symbol set that is best for students with a certain diagnosis?


Answer:

What a great question, and one that I hear often! It’s true that symbols fall on a spectrum of iconicity, which is how similar a symbol is to its meaning. Transparent symbols have high iconicity and are very concrete (like the actual item itself) and opaque symbols on other end of the spectrum are abstract (like orthographic text or braille). Photos and picture icons, which are frequently used in AAC, are translucent symbols somewhere in the middle. That being said, this spectrum is not a hierarchy that corresponds with typical language development nor is it a hierarchy that needs to be followed during AAC intervention.

A recent study* looked at this exact topic and concluded that the “iconicity of a symbol may not be a critical factor in learning a symbol-referent relationship for a child who does not yet have the target referent in comprehension” (Sevcik et al, 2018). The research shows that there is a very small advantage for iconic symbols only if children already know the vocabulary. So, if a student already knows a word then they may be more successful with a concrete symbol that is similar to that word. For example, if a student knows that “when” indicates a question about time and has been taught to tell time on an analog clock, this symbol (see Tobii Dynavox’s Picture Communication Symbol for “when” below) may be meaningful to them because it is a question mark superimposed over a clock face.

Image result for boardmaker symbols

However, if that student does not already know the word “when” or understand the concept of telling time, then that symbol is not meaningful to the student and must be taught. Evidence from the research indicates that if a student does not know the word/concept already, they are just as likely to learn an arbitrary symbol as a concrete symbol. Therefore, if a student is linguistically developmentally young and learning new words and concepts, the iconicity of the symbol probably won’t impact their ability to learn it and it is not crucial that we use one symbol set over another.

The major exception is if a student has a sensory impairment. For example, a student with cortical vision impairment may benefit from adapted symbols with simplified icons and high-contrast colors. Below is an example from Linda Burkhart of adapted Tobii Dynavox’s Picture Communication Symbol with high contrast.

Image result for boardmaker cvi

In general, though, as we teach new vocabulary, we shouldn’t get caught up worrying about the iconicity of the symbols. The most important thing is that, whatever symbol set is available, we teach our students the symbols in a meaningful way so they can learn to understand and use them!

*Sevcik, R. A., Barton-Hulsey, A., Romski, M., & Hyatt Fonseca, A. (2018). Visual-graphic symbol acquisition in school age children with developmental and language delays. Augmentative and Alternative Communication, 34(4), 265–275.


  • AAC and Emergency/Safety Drills at School

Question:

I saw the resources for weather emergencies but what about regular school drills?


Answer:

It is important for our students to understand how to behave and stay safe during school drills and in case of an emergency situation. There are a variety of regular drills, such as fire drill, earthquake drill, lockdown drill, etc., that we can prepare them for. We should introduce our students to the drill procedures BEFORE they actually happen. Some of the ways we can support our students and prepare them for an emergency include visual schedules and social stories. We can also talk about the drills before, during (if appropriate), and after, as a way to teach our students the procedures. Make sure certain vocabulary is in your student’s AAC system and model the words in the drill, such as “stop, drop, and cover.”

Here are some resources and samples of visual supports:

  • The Kansas Technical Assistance System Network (TASN) has developed visual schedules for emergency drills, which they have shared on Boardmaker Online (free account required to view) here.
  • More materials are available within the Boardmaker Online, just search for what you need here.
  • Teachers Pay Teachers also has free downloads available. Two examples: here and here.
  • Noblesville Schools has an example of a visual for lockdown drills here.

I highly recommend you check out this website with information and materials for school safety drills and students who have disabilities. Carole Zangari also has a PrAACtical AAC post about this topic and links to more resources.

Thanks for your question!

Alison


  • Communication Systems and Natural Disasters

Question:

How can we prepare communication tools for natural disasters? I’ve read about people in Florida who lost their speech devices and I bet that has happened in California with the fires. Do you have any ideas?


Answer:

I’m glad you’re thinking about this - it’s so true that we should consider how to support our students and their families in times of disasters. Here are some suggestions for how to best prepare and respond.

ALWAYS have a backup of your communication system.

  • An electronic copy of the student’s high-tech system! Most dedicated AAC devices allow you to save a user area to an external USB, and the majority of AAC apps let you save the vocabulary online (to Dropbox, Google Drive, etc.). No matter how you obtain it, I recommend saving an electronic copy of the file so you don’t have to worry about losing a USB or hard drive.
  • A lite-tech version of the student’s system! You can print and laminate a paper copy to use when the student’s AAC device is unavailable. That way, if their high-tech device breaks or can’t be charged due to a power outage, you’ll have a lite-tech version to use. This tool can also be helpful in non-disaster situations when a student’s device is dead or not the most appropriate communication tool.

Give your students access to words and phrases they may need/want to use in case of a disaster. Program any disaster-specific vocabulary on their AAC system and model it for them. You can practice using the words as you read social stories about disasters and discuss the current events. That way the student will be familiar with the words and their locations if they want to use them later.

Additional Resources:

  • In the case of a federally-declared disaster, USSAAC helps people with severe communication disabilities regain access to lost AAC tools and technologies (https://aacdisasterrelief.recovers.org/).

 


  • AAC, myth, speech development, language development

Question:

The SLP at my son’s school wants to start using AAC with him but I’m worried that it will make him stop talking. He can say a few words and I understand what he’s trying to say at home, but the school thinks AAC will help him say more and be understood at school. I want my son to be able to communicate with everybody and I’m open to AAC. But at the same time I don’t want him to stop talking! Any advice?


Answer:

This is a great question and you are not alone when it comes to these concerns. The common myth that introducing AAC (Augmentative/Alternative Communication) will decrease or impede speech development is just that – a myth. Research has shown (see references below) that the use of AAC does NOT deter speech. In fact, more often than not it actually increases verbal output!

Also, just because AAC is introduced as an intervention strategy or communication tool does not mean that a child is limited to using only that tool. We are all multimodal communicators and use different means of communication for different purposes across various contexts. Adding AAC as a communication method offers one more tool in a person’s communication toolbox, along with gestures, facial expressions, body language, speech, etc.

The first letter of the AAC acronym stands for augmentative, meaning supplementary. AAC is often used in addition to speech and both can be worked on at the same time. Some communicators may use AAC in lieu of speech, and others enhance their verbal skills with aided means. Our ultimate goal is the ability to communicate independently, which may include the use of AAC. If a child has access to effective speech, however, that will always be the easiest, most efficient and accessible means of communication!

Thanks for your great question!

Alison

REFERENCES:

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The Impact of Augmentative and Alternative Communication Intervention on the Speech Production of Individuals With Developmental Disabilities: A Research Review. Journal of Speech, Language and Hearing Research, 49(2), 248–264.

Schlosser, R. W., & Wendt, O. (2008). Effects of Augmentative and Alternative Communication Intervention on Speech Production in Children With Autism: A Systematic Review. American Journal of Speech-Language Pathology, 17(3), 212-230.


  • AAC, app, communication board, low-tech, lite-tech

Question:

I want to give the students in my special day class more ways to communicate. Most of my kids can talk but some of them do better with visual supports and some need low tech AAC. I’ve seen other teachers use screenshots of students’ AAC devices and print them to use around the classroom, but I don’t have any students with devices. Do you have any of those AAC apps and can you send me a screenshot to print and use?


Answer:

Kudos to you for trying to bring more communication to your classroom! If you don’t have access to high-tech devices, or even if you do, communication boards are a great way to give your students access to more vocabulary. Many of the AAC device companies or app creators have downloadable boards available on their website. Here are links to FREE, PRINTABLE boards for some of the more common AAC apps:

Go ahead and download the pages you are looking for, print and laminate them, then MODEL MODEL MODEL and have fun chatting!


  • Assistive Technology, AT, Assistive Technology Assessment

Question:

Who is qualified to conduct an Assistive Technology assessment?  Is an SLP or OT qualified to conduct the assessment? If not what are the qualifications that a specialist should possess to be qualified to do an AT assessment?

-Gwen


Answer:

Hi Gwen,

I think your question is a common one, especially when there is not an official Assistive Technology (AT) team for a district or school. The short answer is, “it depends”. Keep reading! J As you probably know, IDEA mandates that we must consider Assistive Technology at the IEP and provide AT devices and/or services to students as necessary for a free appropriate public education (FAPE). When we consider AT, it could be a quick fix addressed during the IEP meeting (student needs a new pencil grip or a copy of an e-textbook for home). Sometimes the team may invite another professional to gain additional information (asking the OT which pencil grip would be best or contacting a publisher about audiobook options). Other times, the team may conclude that they don’t have the necessary knowledge and skills to meet the student’s needs and that further investigation is needed. At this point, the team would initiate an AT evaluation.

IDEA defines an AT device as: “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability." Assistive Technology is an umbrella term including wheelchairs, walkers, pencil grips, slant boards, screen readers, adaptive keyboards, text-to-speech software, hearing aids, aided communication tools, and more. This wide range of AT tools encompasses far more than any SLP or OT would have learned about in their SLP or OT program. Most SLPs enter the field with little knowledge of wheelchairs and walkers, and OTs probably know little about hearing aids and screen readers.

The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) offers a certification program to become an Assistive Technology Professional (ATP) and learn about the wide array of AT. An ATP has skills to assess and recommend appropriate AT, including knowledge of: augmentative and alternative communication (AAC), accessible transportation, activities of daily living, environmental aids, learning and study aids, recreation and leisure, sensory aids and accommodations, vocational aids and accommodations, seating, positioning and mobility. Certified AT professionals may or may not have additional training in a specific area. Some SLPs and OTs are certified ATPs and have received education in their field as well as AT. Others choose to specialize in a specific area under the AT umbrella, with or without RESNA certification, such as an SLP practicing as an AAC specialist or a PT focusing on orientation and mobility.

So, the answer to your original question – who should do the AT assessment? – It depends. The California Department of Education offers a list of examples of assistive technology from academic supports, to communication aids, to hearing and vision tools. If a student needs AT due to a vision impairment, an SLP may not be the most appropriate specialist to determine what size print the student requires. Similarly, if a student requires AT due to challenges with expressive language, a vision specialist would probably not have the knowledge or skills to complete a quality AT assessment. An Assistive Technology Professional will have received training in the range of AT tools, but may not have the expertise in language development like an SLP, or fine motor development like an OT.

The specific individuals who participate in an AT assessment may vary, but any AT assessment must be conducted by a team. In order to determine who that should include, the Wisconsin Assistive Technology Initiative (WATI) has documented five constituents that must be on every team making decisions about AT:

  • A person knowledgeable about the student (usually the student, their family)
  • A person knowledgeable in the area of curriculum (usually the teacher)
  • A person knowledgeable in the area of language (usually SLP)
  • A person knowledgeable in the area of motor (usually OT, PT)
  • A person who can commit the district’s resources, not only for purchase of devices, but to authorize staff training and guarantee implementation in various educational settings (usually an administrator)

For more information about AT assessment, the Quality Indicators for Assistive Technology (QIAT) outlines 8 areas of AT and what the Quality Indicators are for each: http://www.qiat.org/indicators.html. The second Quality Indicator for AT Assessment is that “AT assessments are conducted by a team with the collective knowledge and skills needed to determine possible AT solutions that address the needs and abilities of the student, demands of the customary environments, educational goals, and related activities.” So, the quality of an AT assessment team is not dependent upon the educational background of its members, instead it is most important that the team include individuals who know the student, the curriculum or task that is being addressed, and possible AT solutions. Perhaps the SLP knows the most about the student’s language challenges or AT tools for communication, and in another case the OT will take the lead because she is familiar with the student’s fine motor abilities and available AT supports. Every team will be a little different based on the student’s unique needs.

ADDITIONAL RESOURCES:

  • WATI has created invaluable resources about AT consideration and assessment. You can access their publications here: http://www.wati.org/free-publications/ (Check out the Assistive Technology Consideration to Assessment page, and specifically the Consideration Guide and Student Info Guide, which inform target AT areas and what specialists will be needed for the assessment.)
  • QIAT offers additional resources for AT consideration and implementation: http://www.qiat.org/resources.html
  • A common AT assessment procedure is the SETT Framework, which stands for Student, Environments, Tasks, and Tools. Joy Zabala has made documents about this AT assessment model on her website: http://www.joyzabala.com/Documents.html.
  • The PACER Center has a program called TIKES – Technology to Improve Kids’ Educational Success, and offers AT resources on their website. There is a whole page about AT in schools, with handouts such as the AT Consideration Flow Chart: http://www.pacer.org/stc/tikes/including-at-in-school.asp