practical language-based solutions for children who need aac · practical language-based solutions...

Practical Language-Based

Solutions for Children who Need

AAC Fostering Expressive Language & Communication Skills

Cathy Binger, Ph.D., CCC-SLP

University of New Mexico

Utah State University 2012 Summer Seminars

in Speech-Language Pathology

ASHA’s SIG 12 Conference

First ever online SIG 12 Conference Co-chairs: ◦ Cathy Binger & Jennifer Kent-Walsh

Focus: ◦ Partner Instruction in AAC

Speakers: ◦ David Beukelman, Laura Ball, Cathy Binger, Nancy Brady,

Lynn Fox, Ann Kaiser, Jennifer Kent-Walsh, Joanne Lasker, David McNaughton, Billy Ogletree, MaryAnn Romski, Rose Sevcik, Gloria Soto, Kathy Thiemann-Bourque, and more!

Dates: ◦ June 13-25

More info http://www.asha.org/Events/aac-conf/default

USU Seminars Binger 2012

http://www.asha.org/Events/aac-conf/default



Overview

This morning:

• Role of AAC in Communication

• Language Goals for Children who use AAC

• Developing Communication Boards

• Providing Communication Opportunities: Case Studies

This afternoon:

• Selecting Skills to Teach Communication Partners

• Exploration of the ImPAACT Program: Communication Partner Instruction


My Background

Clinical SLP for 8 years ◦ Worked in many settings Birth-3/preschools, elementary & middle school Group homes/ sheltered workshops Hospital out-patient, private practice

◦ With lots of folks who needed AAC

Professor specializing in AAC for 8 years ◦ Research foci: Building language skills with children who need AAC Teaching communication partners how to facilitate communication

with these children New NIH grant: Teaching linguistic rules to preschoolers using graphic

symbols


How I Like to Conduct Presentations

• Interactive, even in big groups like this one

• Please ask for clarification

• Please ask questions


ROLE OF AAC IN COMMUNICATION


Role of AAC in Communication

AAC is a TOOL

◦ GOAL = Improved daily life communication

◦ TOOL = AAC

◦ GOAL ≠ Using AAC

AAC is about 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



• Improving daily life communication

Focus

• Very similar to non-AAC clients; e.g.,

• Improve spoken syntax

• Expand expressive vocabulary, etc. Goals

• Therefore, we will discuss AAC devices within the context of communication

• NOT the features of each device in isolation Context


AAC is much less intimidating when viewed this way!

LANGUAGE GOALS FOR CHILDREN WHO USE AAC


Language Goals for Children who use AAC

Pragmatics

• Turn-taking

• Commenting

• Asking questions

• NOT just requesting!!!

Semantics

• Vocabulary size

• Vocabulary diversity

Morphology

• Grammatical morphemes

Syntax

• Message length and complexity

• Early language rules


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.,


PPVT

TACL (Test of Auditory Language Comprehension)

CASL (Comprehensive Ax of Spoken Lang)

CELF-P (some sections)

TOLD-P (Test of Language Devp – Primary)

Do NOT use

the PLS:

Requires

verbal

output


• 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?



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

• Many children simply lack:


Tools The tools to do more

expressively

Expectations The expectation that they can do more expressively

There are (many) exceptions, of course

Low level symbolism; pre-symbolic communicators

DEVELOPING COMMUNICATION BOARDS


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.


Environmental Inventory Example

• Provide the person using AAC with this same vocabulary


List of ingredients

List of cooking utensils

“This looks delicious!”

“We need some spices.”

Etc.

Additional Techniques

• Aided AAC Modeling When 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 & activities IEP goals, curriculum, daily/classroom activities


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

http://ajslp.asha.org/cgi/content/abstract/10/1/81

Example Goals: Pragmatics

Whole phrases

• Take quick communication turns

• That sounds great!

• Tell me more!

• Can you ask me that again?

• That’s not my favorite.

Single words/ concepts

• Can use for different communicative functions

• E.g., If the person says SALT while cooking, it can mean:

• Please get the salt

• Where is the salt?

• This needs more salt

• That’s too much salt

• Etc.


Increase turn-taking

Pragmatic Goals, con’t

Whole phrases

• How are you?

• What have you been up to?

• I would like to hear more about that.

Single words

• Can use in a wide variety of situations

• Who?

• What?

• Where?

• When?

• Why?

• How?


Ask partner-focused questions

Example Goals: Semantics

Include core vocabulary

• Vocabulary used by everyone in a wide variety of contexts

• Word lists of core vocabulary are available in English • http://aac.unl.edu/vocabula

ry.html

• Examples: mother, father, big, little, easy, hard, hand, is, like, lunch

Include fringe vocabulary

• Specific to various contexts or activities • E.g., vocabulary needed to

discuss a storybook or complete a cooking activity

• Specific to the individual • Names of friends, family,

pets


Increase expressive vocabulary



Collecting Fringe Vocabulary

Provide family/ educators with a questionnaire

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

Conduct environmental inventories

• Write down what others say in this context

• Examine curriculum materials

• Provide the person using AAC with this same vocabulary


http://ajslp.asha.org/cgi/content/abstract/10/1/81

Example Goals: Syntax

Agent + action + object

• Example context: Storybooks

• Select relevant vocabulary from each book

• Example sentence:

• EMILY ELIZABETH RIDES CLIFFORD


Increase sentence length

Organizing Vocabulary

• Individual symbols

• Visual Scene Displays

• Communication books

• Grids

– Low technology

– High technology


Individual Symbols

• Use with individuals who are emerging symbolic communicators


Visual Scene Display: Photo

• Use with individuals who are emerging symbolic communicator

• Easy to find concepts on one page


Visual Scene Display: Line Drawings

• Hard to move into building sentences

• Move on to individual symbols and grids as soon as you can


Visual Scene Display: High Tech Device

• Adult visual scene display – This one is for a trip to

Canberra

• Each symbol links to other pages


• Visual Scene Displays for Adults with Acquired Disorders

– Focuses on people w/ aphasia – http://www.aac-

rerc.com/pages/news/pdfs/AAC%20and%20Aphasia%20A%20Review%20of%20Visual%20Scenes%20Display%20Project%20handouts.pdf


http://www.aac-rerc.com/pages/news/pdfs/AAC and Aphasia A Review of Visual Scenes Display Project handouts.pdf




Communication Books

• Can set up in many different ways

• Some symbols can be visible at all times

• Can use tabs USU Seminars Binger 2012

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


More Complex Grid

• This one is for a storybook


Another Moderately Complex Grid

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


Picture WordPowerTM Grid

• A more complex grid for someone learning to spell


How to Select the Form & Layout

Do

• Consider personal needs

• E.g., communication in the tub

• Consider diagnosis

• E.g., aphasia, autism

• Ensure access to low-tech backup

Don’t

• Automatically select grids

• Automatically select high tech devices (only)

• Base decisions solely on diagnosis

• E.g., autism = PECS


PROVIDING COMMUNICATION OPPORTUNITIES

Case Studies


Providing Communication Opportunities

• Let’s start by looking at two videos

• Notice differences with

– What the teacher is doing

– What the child is doing


What’s Different in the 2nd Video?

Teacher

• Expects communication

• Provides extra wait time

• Delayed processing

• Provides models using child’s expected mode

• Asks WH questions

• Responds contingently

Child

• Pragmatically •Takes communicative turns

•Points to pictures in the story

•Answers questions

•Vocalizes

• Linguistically •Uses speech

•Uses words on the AAC device

•Puts words together using the AAC device


Necessary but not Sufficient Conditions

• Even in the first video, we had

Identified motivating contexts for communication

Developed appropriate communication boards

Selected appropriate vocabulary

Organized vocabulary appropriately

These steps are necessary but not sufficient for communicative success

Communication partners must change how they interact with AAC clients


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

Timmy is doing a lot pragmatically Taking communicative turns

Pointing to what he wants

Using gestures to communicate

Answering questions

Vocalizing

Timmy is not Using words to communicate


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!


Differences between the 1st and Last 2 Videos

Teacher

• Major change: Use of aided AAC modeling

• This can make all the difference!

Child

• Communicating LINGUISTICALLY, not just pragmatically

• Using syntax rules with graphic symbols


Lessons from Timmy

• Don’t hold your clients back


Provide clients with the communication solutions they need

• Use highly motivating contexts

• Provide easy access to appropriate vocabulary

• Expect success

• Teach language

Challenge your clients!

• Expect them to keep improving

• Increase expectations every time they improve

Ray’s Choice Book & Schedule Board


Lessons from Ray

“Doable chunks”

• Figure out how long a child can attend to a given task, honor that, and build from there

The power of visual schedules

• Helps keep client on task

• Fewer challenging behaviors

• Can put their energies into effective and socially appropriate communication

• Can place them ALL OVER classrooms/ home/ etc.

• Between task schedules

• Within task schedules


Autism Case Study: Corbin

• Age = ~ 3;6

• Could not test receptive language

• Participated in a story reading intervention study

• What communicative behaviors do you see?


Changing Ix: Part I

• Change #1

– Make activities more motivating

– Liked Dr. Seuss better than Little Critter


Intervention, Part II: Making Changes

Chose more motivating activities

•Or better yet, we let him choose

Simplified AAC

•Did not give up on AAC, as he is clearly

•Symbolic

• In need of communication modes in addition speech

Modeled multiple communication modes

•Aided AAC

•Unaided AAC (manual signs)

Used SAME Ix techniques we’d use with anyone else

•See if you can identify….


Ix Techniques

• What ix techniques did you see that you’d use with any child? – Capitalizing on current communication modes

• Vocalizing • Showing by ‘using’ others; taking Mom’s hand (Level III

communication behavior)

– Modeling – Pausing/ expectant delay – Pointing toward device – Providing hand-over-hand models only when other cues failed – Providing contingent responses

• Only difference: provided AAC options to ‘up the ante’ of communication


Lessons Learned from Corbin

Any motivating activity can be a context for communication

• Client motivation is key

• Not much point in communicating otherwise

Map AAC on to current communication attempts

• Same as you would for clients who speak

• Tools just change a bit (sign/voice output instead of speech)

Try multiple modes

• Never know what will or will not work


Providing Communication Opportunities: Summary

Identify meaningful contexts

Select appropriate vocabulary & modes

Organize vocabulary in a meaningful manner

Use visual schedules and other supports to

minimize challenging behaviors

Ensure communication partners use techniques

to encourage communication


Multiple steps

are involved in

creating

meaningful

communication

opportunities

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