Adaptation Station - Augmentative/Alternative Communication (AAC) Strategies

No AAC device or picture board stands alone. Just as children need interaction and reinforcement from adults to learn to speak, they will need the same attention to learn to use AAC. It is helpful to think of learning to use AAC as learning a new language. YOUR ROLE as an adult in the child's life is VITAL to success! The following strategies describe YOUR ROLE in detail. Often, a good teacher uses a combination of the following strategies throughout a single interaction. It must be said one more time - if you think that having pictures and voice output available in your class is all there is to providing AAC to your students, you have missed the boat!

Use the following jump down list to find adaptations for using AAC:

Use the daily routine as a framework | Use motivating messages
Model use of AAC| Give cues and wait time
NEW! Practice the prompt hierarchy
NEW! Build empowerment, initiative and ownership
Provide f eedback | Sabotage | Keep materials accessible | Use symbol system

Use the daily routine as a framework for planning for the use of AAC

When planning for the use of AAC in the classroom, it is helpful to think of the daily routine as a framework. Each part of our routine includes specific activities, expectations and language. To begin, look at a part of the daily routine in which you plan to incorporate the use of AAC. Then determine what kinds of language tasks and expectations are associated with that part of the routine. Then use these language tasks and expectations to plan for the AAC devices and messages you will need to provide for all students to participate. See some examples below:

Use messages that are motivating for the student

When children begin to communicate, they use words to get their wants and needs met. They use language that will get them something tangible (food, toys, etc.) or a social response (hugs, attention, etc.). We need to remember this when introducing a child to augmentative communication. We need to use messages that are what the child would want to say - not what WE want the child to say.

To get an idea what words, phrases or messages to include on a voice output device or language board:

• Listen to verbal children as they play. You will notice that they do a lot more than label the objects around them. They talk about what they see and what they are doing ("I make car go fast!"). They request objects ("Put it on top") and actions ("Come here") from children and adults around them. And they make comments about their activities ("I like it", "Uh-oh", or "Yuck!"). Be sure to include these types of messages for children using augmentative communication.
• For beginning AAC users, use concrete objects and actions that will allow an immediate and reinforcing response, such as: "More cookie", "Rock me again", "Let me see the picture". Pay special attention to actions as they can be just as motivating (if not more so) than objects.
• Include vocabulary for specific activities available in the classroom ("Knock them down" in the block area) and for activities you have planned ("It's sticky!" for a gluing activity at small group).

Model the use of the devices/boards by pointing to the appropriate messages as you speak

Language learning in children occurs as a result of everyday experiences that are linked to words by the adults in a child's life. It is the adult who models the use of oral language ("You want a cookie?") as well as adds meaning to the child's attempts at oral language ("Ba"..."Oh, you want the ball. Here it is.") It is also important to remember that babies do not say words until they have been exposed to language for about a year. If we think of augmentative communication as a "new" language, it is easy to see that we need to model the use of AAC for the children as well. Adults should point to the pictures (or activate the messages on a device) as a natural part of speaking to children, in addition to encouraging the children to point to them. Some children will learn more quickly and some children will need our support in the form of modeling for a longer period until they internalize not only the meaning of the symbols but how to use them functionally.

Modeling the use of voice output and picture communication as a consistent part of the classroom routine also sends an important message that augmentative communication is an accepted and important way for all individuals to communicate.

In addition, many of our students who are verbal but are having difficulty learning language (auditory processing difficulties, home language other than English, visual learners, etc.) can benefit GREATLY from a visual language model paired with verbal speech.

Give cues (expectant pause, facial expression, gesture, body language, etc.) and plenty of wait time for student responses

Some children that use augmentative communication need extra processing time when they are asked to respond or participate in an activity. Some of the things they may need to process are:

• The language/message being presented by the adult
• The fact that they are expected to respond
• What their response will be
• How that response is represented on their communication system
• What muscles to move to indicate their response

It is recommended that after an opportunity to communicate has been presented ("Which song do you want to sing?"), an adult should wait at least 10-15 seconds for a response from the student before giving a verbal cue. That sounds like a long time but you will be surprised that many children will be able to respond given time. Plenty of wait time also sends a non-verbal message to a student that is using picture communication or voice output that what he/she has to say is important and worth waiting for. Remember - it is all about EXPECTATIONS.

Other non-verbal ways to wait expectantly:

• Lean forward
• Raise your eyebrows and maintain eye contact with the student
• Pause without talking or cueing - just pause
• Do not discourage other students from responding verbally but peacefully ignore them and maintain concentration on the student you are waiting for

Practice the prompt hierarchy

The prompt hierarchy is a system of cueing that allows a student the opportunity to communicate. The cues are sequenced from least to most directive (this is counter-intuitive for many special education professionals, but it REALLY WORKS) . By implementing in this order, the cues allow each student a greater number of opportunities to communicate.

1. First step - have the AAC tool in place, present the tool within the context of a motivating activity and wait expectantly (see "give cues and wait time" above)
2. The first cue should be an open-ended question or statement ("I wonder which one you want", "What should we do next?" ) perhaps paired with a gesture (pointing toward the songboard with the picture choices). Pause 10-15 seconds.
3. When it is time to give another cue, the adult should request the intended action from the student ("Choose a song" "Tell me what you want" "You need to ask me") and pause again.
4. If the student still does not respond appropriately, provide part of the answer and pause again:
   • ask a question that contains a choice (“Do you want the red one or the blue one?)
   • give a hint or a clue (“Is it the same color as your shirt?”)
   • model the first few words of the answer (“Give me the ... ”)
5. A gestural cue can be used if the above verbal prompts have not produced results. An adult can gesture in the general direction of a desired response and pause again.
6. Finally, the adult or a peer should model the desired response by pointing to the picture or activating an appropriate message. Then pause again and give the student the opportunity to imitate.
7. It is NOT recommended to use hand-over-hand prompting. This develops dependence and is the exact OPPOSITE of the initiative we are trying to build in our students who use AAC.

If these techniques for cueing are unsuccessful a teacher should reconsider the communication system. Perhaps there are too many choices, the child is physically unable to access it, etc.

Remember, the Pre-K SPED Tech Team is always a phone call away (305-271-5701). We want communicating in the classroom to be successful for both teachers and students and we can help!

Build empowerment, initiative, and ownership

Many students who use AAC become well-practiced responders. They learn to wait for communication opportunities to be offered to them. Our goal is for our students to understand that communication is powerful and for them to take on their own communication roles. We want them to initiate, as well as respond. Some ways to build ownership of picture or voice output communication systems include:

• Talk about your actions as you set up the system - "Let's see, we need the overlay for Wheels on the Bus, here it is, let me slide it in and turn the dial to level 4".
• Better yet, have your students, alone or in pairs, set up the system they need to use. Teach them the steps and then expect them to do it each time (turn on/off, adjust volume, inset overlay, change level, etc.)
• Talk about using words to make ourselves understood, "I want to understand you, so please use your words" (gesture toward pictures or device).
• Expect the child to have the communication system at all times. Set it up as part of the schedule. Cue the child, "Have you forgotten something..."

Provide immediate and consistent feedback to a student's communication attempts

You may wonder how a child learns the communication process with voice output or picture communication. The answer is: exactly the same as it is for a child learning to communicate orally - by TRIAL AND ERROR. Attempts to communicate may be exploratory and random at first. Adults help children build the meaning of communication attempts by providing concrete experiences and feedback. Augmentative communication is NOT ABOUT THE DEVICE but about how we teach it to be used in a functional way.

When a child activates a voice output message or points to a picture or object, an adult should immediately respond in several ways:

• Verbalizing the message back to the child ("Oh, you want the truck", "Yuck, you don't like it", "You want to play in the block area")
• Giving a response ("Here you go", "OK, no more juice", "OK, let's go to the block area")
• Giving immediate feedback can mean saying "no" ("No, it's not time for outside yet, let's check the schedule", "No more cookies, all gone")

Some students, when presented with voice output, like to press all the buttons to explore and/or find out what each one says. This is OK at the beginning if it doesn't start to interfere with purposeful use of the device.

If the exploration of the device seems repetitive, random or non-purposeful, the adult should hold the device in place long enough for the child to press it once, remove the device and give immediate reinforcement for the message even if it appeared to be random. Over time, this teaches that the device is not a toy and it has a specific purpose and there are specific ways of behaving when it is presented. Be consistent and patient. If the child's use of the device does not become purposeful over time, try using a simpler device (perhaps one with only one button/message) or call a member of the Pre-K SPED Tech Team for help (305-271-5701).

Set the stage for communication to occur (sabotage)

Sabotage is a strategy that can work whether students are communicating orally or with augmentative communication. It involves setting up situations that "entice" children to communicate. Some examples are:

• Place a favorite toy just out of reach but make sure the picture symbol or voice output to request the toy is within reach.
• Have fewer materials than children so at least some will have to request what they want/need.
• Conveniently "forget" things, materials, parts of the routine, etc. to see who will remind you.

Keep devices/boards accessible and within easy reach

By storing language boards and voice output devices near where they will be needed, you will save yourself several steps and precious time in setting up an activity. You will also be more likely to use them. Some ideas for accessible storage:

Hang general language boards (that may be used in several different situations) in a central area.

Hang area specific language boards in the area where they belong within reach of both adults and children.

Store activity specific boards on the shelf or in the container with materials from the activity.

Use a symbol system according to the student's needs (objects, miniature objects, photos, drawings, product labels, or Picture Communication Symbols)

Not all children or students who are beginning to communicate understand abstract symbols. Although there are strategies to teach the meaning of symbols within the context of real activities, it may be helpful for some children to begin with more concrete symbolic representations. Some options are outlined below:

Real objects can be used for some children to make choices at mealtimes or playtimes. Offer two objects and the child can indicate his/her choice by looking or reaching for one of the two. Give the indicated item to the child even if the choice seems random, to help build understanding of the choice making process. Use words while you do this, "Which one do you want? You looked at bubbles." This technique can be expanded by adding more objects or by pairing the objects with pictures.

Color photographs can also be used for communication. Photos of objects should be taken with a plain colored background. Photos of people, events, or areas of the classroom should be as simple as possible without a lot of background clutter. This technique is good for objects and simple actions but is nearly impossible for feelings and other abstract concepts (how do you photograph "more"?). A combination of photos and symbols may be necessary.

Product labels are easy to use for symbols because they come directly from the food items and toys we use in the classroom every day. They can be used as is or be attached to a communication board or voice output device.

These are the Boardmaker symbols we use to create communication boards. Many are highly representative and others are more abstract. Many boards and symbols are available for download on this web site - click here

Browse the Adaptation Station HERE

Communication Tools

Augmentative / Alternative Communication (AAC) Strategies

Pre-Writing / Creative Representation

Physical Access to Play and Participation

Books and Literacy (Shared Reading, Phonological Awareness and Story Time)

Positioning, Seating and Mobility

Positive Behavior Supports / Organizational Strategies

Computer Access

Activities of Daily Living / Self-Help

Vision

Hearing