Building Successful AAC Outcomes: Language Goals and Communication

Partner Instruction

Cathy Binger, Ph.D., CCC-SLP

University of New Mexico

ArSHA 2013

Overview

ArSHA Binger 2013

Role of AAC in Communication

ArSHA Binger 2013

Role of AAC in Communication

AAC is a TOOL◦GOAL = Improved daily life

communication◦TOOL = AAC

◦GOAL ≠≠ Using Using AAC

AAC is about COMMUNICATION

ArSHA Binger 2013

Role of AAC in Communication

AAC use is never an outcome in and of itself

Devices cannot accomplish anything in and of themselves◦ Nothing magical about using AAC

Devices are TOOLS to reach the same goals as clients who rely on speech ◦ Increase/improve

Participation Academic/employment outcomes Social skills Language skills ArSHA Binger 2013

Role of AAC in Communication

ArSHA Binger 2013

AAC is much less intimidating when viewed this way!

Language Goals for Children who use AAC

ArSHA Binger 2013

Language Goals for Children who use AAC

ArSHA Binger 2013

Our research has focused on:

Receptive-Expressive Gaps

• Test receptive language formally May need to make adaptations for physical limitations

• Use standardized, normed tests that require NO verbal output from child; e.g.,

ArSHA Binger 2013

Do NOT use the PLS: Requires verbal output

Receptive-Expressive Gaps

• Determine age-equivalent score on test

• This is the age to aim for expressively. E.g.,

– Child’s age = 5;0– Receptive age = 3;0– Expressive expectations = ???

• What are your expectations for language for a child who is 3 years old?

ArSHA Binger 2013

Receptive-Expressive Gaps

• Even if there is a big gap between chronological age and receptive ageYou may be underestimating expressive capability

• Many children simply lack:

ArSHA Binger 2013

There are (many) exceptions, of course Low level symbolism; pre-symbolic communicators

Vocabulary Selection Techniques (Beukelman & Mirenda, 2005)

• Environmental inventory– Observe and document what peers are saying

during that activity– Analyze and document vocabulary needed for

activities• Books, other curricular materials• Recipes • Etc.

ArSHA Binger 2013

Environmental Inventory Example

• Provide the person using AAC with this same vocabulary

ArSHA Binger 2013

Additional Techniques

• Aided AAC ModelingWhen you model using AAC, you will quickly

figure out what vocabulary is missing• Core vocabulary lists

http://aac.unl.edu/vocabulary.html

• Fringe vocabulary questionnaires• Fallon & Light, 2001; http://ajslp.asha.org/cgi/content/abstract/10/1/81

• Analysis of materials & activitiesIEP goals, curriculum, daily/classroom activities

ArSHA Binger 2013

Example Goals: Pragmatics

ArSHA Binger 2013

Increase turn-taking

Pragmatic Goals, con’t

ArSHA Binger 2013

Ask partner-focused questions

Example Goals: Semantics

ArSHA Binger 2013

Increase expressive vocabulary

Example Goals: Syntax

ArSHA Binger 2013

Increase sentence length

Examples of Page-Based Communication Boards

Facilitating Syntax

ArSHA Binger 2013

Simple Grids• Use grids as soon as the

client can!

• Enables the client to build simple sentences

• Can color code by morphemes or concepts In English: by words

ArSHA Binger 2013

More Complex Grid

• This one is for a storybook

ArSHA Binger 2013

Another Moderately Complex Grid

• This one is for a 4 year old who loves to play with dolls

ArSHA Binger 2013

Picture WordPowerTM Grid

• A more complex grid for someone learning to spell

ArSHA Binger 2013

Providing Communication Opportunities

Case Studies

ArSHA Binger 2013

Providing Communication Opportunities

• Let’s start by looking at two videos

• Notice differences with – What the teacher is doing– What the child is doing

ArSHA Binger 2013

What’s Different in the 2nd Video?

ArSHA Binger 2013

Necessary but not Sufficient Conditions

• Even in the first video, we hadIdentified motivating contexts for communicationDeveloped appropriate communication boards

Selected appropriate vocabularyOrganized vocabulary appropriately

These steps are necessary but not sufficient for communicative success Communication partners must change how they

interact with AAC clients

ArSHA Binger 2013

What is “Timmy” Doing and Not Doing, Communication-Wise?

Timmy is doing a lot pragmaticallyTaking communicative turnsPointing to what he wantsUsing gestures to communicateAnswering questionsVocalizing

Timmy is notUsing words to communicate

ArSHA Binger 2013

False Assumptions

• Many clinicians would assume that we should start with very basic goals

• Using single symbols to communicate

• However, his receptive language abilities are strong

• 3 year old range He understands many linguistic structures If his speech were not impaired, he would be using full

sentences Don’t aim too low!

ArSHA Binger 2013

Differences between the 1st and Last 2 Videos

ArSHA Binger 2013

Lessons from Timmy

• Don’t hold your clients back

ArSHA Binger 2013

Ray’s Choice Book & Schedule Board

ArSHA Binger 2013

Lessons from Ray

ArSHA Binger 2013

Providing Communication Opportunities: Summary

ArSHA Binger 2013

Multiple steps are involved in creating meaningful communication opportunities