PrAACtical Tools: Evolving Progress Monitoring for Beginning AAC Users- Where Do I Begin?

In a previous post, guest author Sara Ware shared a tool for progress monitoring. Today, she returns to discuss how it is used in her own clinical practice.

Evolving Progress Monitoring for Beginning AAC Users- Where Do I Begin?

As AAC SLPs, we often also assume the roles of coach, cheerleader, teacher, mentor, team member and advocate. However, in order to advocate for AAC, we need to be able to identify the benefits that AAC brings to the lives of our clients. As I mentioned in Part 1 of this series, progress looks different for everyone, particularly beginning AAC users. This is what led to the development of the “Pediatric Prelinguistic and Linguistic Skill Assessment for AAC Users.” You may be asking yourself, where do I begin with this tool or how do I use it?  Let’s dive in with a few examples by meeting AAC users Eddie and Abigail below.

Example One: Eddie

Eddie is a four year old boy who has a diagnosis of Autism. Eddie, unfortunately, did not receive early intervention services and started his speech therapy journey in the outpatient setting. Eddie was not yet speaking at the time of the evaluation. However, he communicated by pointing, guiding, and making sounds. The AAC Finder’s Checklist from Assistiveware was used during the initial evaluation to supplement the report and outline Eddie’s communication needs. Eddie and his family participated in an AAC assessment shortly after beginning therapy. Following the assessment, Eddie trialed the use of a high-technology AAC system. Eddie’s progress while using AAC was most evident in his development of early language skills. Eddie’s family believed that Eddie developed most in his ability to engage meaningfully with others at home. Specifically, Eddie’s family noted positive changes in his ability to build relationships with his older sisters. Below is an excerpt from a report advocating for Eddie to have access to AAC. “Prelinguistic Skills:  Prelinguistic skills include abilities related to social interaction, attention, joint attention, gestures, vocalizations, and more. Prelinguistic skills have a documented positive influence on overall language development. Specifically, research has shown that prelinguistic skills are a positive predictor of later developments in vocalizations, as well as, verbal or symbolic language (Brady, et al., 2004; Amanda Hopkins, et al, 2021). Prelinguistic forms convey meaning and have purpose, and thus build the connection of communication. The development of these skills indicates a significant impact on a child’s overall development and engagement. The Prelinguistic & Linguistic Skill Assessment for AAC Users (Ware and Sparrow, 2024) was used to measure Eddie’s prelinguistic skill development using AAC. This assessment gives quantitative data regarding Eddie’s development in prelinguistic and linguistic skills pre and post AAC intervention. Following a trial of AAC, Eddie demonstrated development of 11 prelinguistic skills that he did not have prior to using the device (61 percent growth). Some of these skills included: reacts to events within the environment, responds to people when they talk, participates in reciprocal play, sustains attention to task, engaged in joint attention with others, understands spoken words, vocalizes with intention, imitates sounds, uses gestures to relay meaning, initiates communication and babbles. Eddie can more effectively participate in his environment and engage with others as a result of the development of these skills while using AAC. Linguistic Skills: In addition to developing prelinguistic skills, Eddie also developed his ability to use AAC to communicate a variety of messages to others. The Prelinguistic & Linguistic Skill Assessment for AAC Users (Ware and Sparrow, 2024) was used to measure Eddie’s linguistic development using AAC. He developed a total of four new language functions. Specifically, he was able to demonstrate growth in the following skills:

• Request for recurrence
• Refuses, rejects and protests
• Yes/no responses
• Communicating the need for help
• Directing the actions of others

Communication Competencies: Light and McNaughton (2014) define communication competence as proficiency in the following four skill domains: linguistic, operational, social and strategic competencies. Eddie demonstrated developments in the following communication competencies: -Linguistic competency: Eddie is now able to communicate a greater variety of language functions that he was not able to do without access to AAC. -Operational competency: Eddie was able to demonstrate the following operational skills using AAC: independence in carrying the device, independent use of the system’s home page, and independent selection of symbols and messages. -Strategic competency: Eddie can now better gain the attention of communication partners and use an alternate form of communication to get his wants and needs met. -Social competency: Eddie has demonstrated several new prelinguistic and linguistic skills that allow him to better engage with others as a result of using AAC. Psychosocial Skill Development: Eddie has also demonstrated psychosocial skill development while using AAC including motivation to communicate using AAC and positive attitude & enthusiasm towards AAC. Participation: As a result of using AAC, Eddie is now able to better participate in his activities of daily living/daily routines to include improved participation in daily routines, play and speech/occupational therapies with a greater number of communication partners. Overall Impact Summary: As a result of using AAC, Eddie has made measurable progress in both prelinguistic and linguistic skills, positively impacting his ability to meaningfully participate and interact across environments. He has also proven an increase in social competence leading to improved relationships and improved participation in his community and environment at large (Light & McNaughton, 2014). Overall, Eddie’s progress was measurable and significant while using AAC for the aforementioned reasons. In alignment with the Communication Bill of Rights, Eddie requires the use of AAC in order to continue to participate across settings.”  This tool highlighted Eddie’s greatest areas of progress and allowed the team to better advocate for him to have access to AAC.

Example Two: Abigail

Abigail is a two-year-old girl with a medical diagnosis of a developmental delay. Abigail has received early intervention speech and occupational therapies. Abigail was also not yet speaking at the time of the assessment. Gail Van Tatenhove’s Pediatric Pre-Assessment Information form as well as the Dynamic AAC Evaluation Protocol (Dynamic Therapy Associates) was used to gather information regarding her current communication strengths and needs. Per family report, Abigail would jump when happy and cry when upset. Abigail would often go to get items herself or may guide adults to desired items. She was often very frustrated at home when communication breakdowns occurred. Following the initial AAC assessment using feature matching techniques, Abigail also participated in a trial of a high technology AAC system. Similar to Eddie, Abigail’s progress was most evident in her overall engagement and participation with others. Abigail’s family reported that she was more happy and less frustrated overall. She was regularly participating in play with her family members at home. Abigail demonstrated development of 10 prelinguistic skills that she did not have prior to using AAC (46.67 percent growth). She was able to develop the following skills: communication of wants and needs/requesting, greetings/farewells, use of polite word forms, directing the actions of others, requesting help and labeling. Abigail was better able to participate in her activities of daily living/daily routines to include improved participation in play, meal times, bedtime routines, bath time routines and speech/occupational therapies with a greater amount of communication partners. Eddie and Abigail were both beginning AAC users learning a new AAC system. Although they were able to use their AAC systems to communicate new messages and language functions, both Eddie and Abigail’s progress was most evident in their ability to engage with others and meaningfully participate in their environment as a result of prelinguistic and linguistic skill development. In using this tool to highlight skills and qualities that so wonderfully support AAC use, teams have been able to better quantify progress and identify skills gained by AAC users as a result of AAC intervention. Further, this tool has allowed teams to better identify next steps or logical targets for future interventions. This tool encourages teams to examine the AAC learning journey as a whole, while considering progress in various forms. In highlighting positivity and accounting for the uniqueness of each child, teams can more accurately describe the impact that AAC has made on an individual’s everyday life. I hope you give it a try!

About the Guest Author

About the Author: Sara Ware is a pediatric Speech-Language Pathologist. Sara is an AAC therapist and an Assistive Technology Professional serving both outpatient and early intervention populations. Sara is passionate about AAC access, outreach and empowering others in their AAC journey. She has presented about AAC at both the state and national levels. She has also been featured on the Take AACtion podcast. You can contact Sara at sarawareslp@gmail.com or follow her on Instagram at @aacandslp.