AACtual Therapy-AAC Intervention for Beginning Communicators: Presume Competence and Be the Fun

Today we learn from a veteran AAC SLP, Lindsey Paden Cargill, who has been working in the field of SLP for 12 years and is passionate about service provision and research in the area of AAC for individuals with developmental disabilities. In addition to her caseload, she is also the Therapy Manager at a private therapy and education center in Columbus, Ohio called Bridgeway Academy. Lindsey is currently collaborating with The Ohio State University on several AAC-related research studies including an immersive AAC classroom and a parent-training course.

AAC Intervention Strategies for Beginning Communicators: Presume Competence and Be the Fun

In the last ten years providing energetic, creative and data-driven AAC language therapy has become my passion… or maybe obsession. My mission statement is for anyone interacting with a new AAC user to “presume competence and be the fun.” To accomplish my goals I have to prioritize several things: providing a robust, well-organized AAC system, setting the right language-based goals, thinking outside the box when providing direct service and lots and lots of training the other team members.  For this post, I will focus on goals and intervention strategies.

Goal Setting: AAC therapy is language therapy

AAC often seems to be this “other” area of the speech therapy field and many clinicians (even school-based SLPs) are reluctant to implement it because of its foreignness. In reality, the hurdle is a small one: AAC therapy *is* language therapy! We do not have to throw out the rules for language development that we know and follow for our verbal clients; we can simply target the same goals using a different modality. When we consider that most beginning AAC users are in Brown’s Stage I, this further simplifies the job: develop a 75-100-word vocabulary, generalize those words across contexts and use them for a variety of communication functions. So a goal for this may look like:

Sam will increase her vocabulary to 100 words including but not limited to at least 20 verbs, 15 adjectives, 4 pronouns, 5 prepositions, 50 nouns, 5 names and one determiner and demonstrate use of those words in at least 3 different contexts with at least 80% accuracy.

This may seem intimidating at first but a spreadsheet (click here) can simplify this process significantly. The words and activities on the list are only suggestions based on typical language development; feel free to edit and use this form if you find it helpful.

To increase communication functions at the single word level, I tend to write goals like:

• Abby will communicate for the function of greeting at least 5x/day with 80% independent accuracy.
• Rachel will communicate for the function of requesting a). objects, b.) recurrence, c.) cessation, d.) actions at least 5x/day with 80% independent accuracy.
• Mark will spontaneously and independently comment using single words at least 20x/day.
• When writing goals for requesting, I find it particularly important to clarify that requesting isn’t just for objects. Too often does AAC intervention seem to become “I want cookie/ball/car” therapy rather than language therapy.

Our device selection and goal writing directly reflect what we believe the child will be able to do. Presuming competence is absolutely vital in these stages. Let’s not set ourselves up for a self-fulfilling prophecy by assuming a child will be unable to develop a large vocabulary and therefore establishing them with an AAC system and goals that prevent them from doing so.

Intervention Strategies: Be the Fun

The primary reason we communicate is to connect with other people, not just gain access to our favorite stuff. When AAC intervention is narrowed down to “I want” phrases we are leaving huge gaps in the spectrum of language use. Sure, I want to be able to order my burrito bowl at Chipotle: “I want a veggie bowl with black beans, brown rice, fajita vegetables, fresh salsa, cheese and guacamole” but once I sit down with my meal, I’m done requesting. Now it’s time to talk to my friends- we’ll tell stories, make each other laugh, make plans, etc.  Communication in the early stages is also about fun and human connections.

My favorite therapy sessions are in empty rooms with no materials. I love for language to be centered around social interaction and being silly together. Tickles, playing chase, singing (even if you’re not great at it) and making funny faces are classic intervention strategies for beginning communicators. Many children I’ve worked with take great pleasure in directing my behavior; they can tell me to “cry” and I turn on the waterworks or tell me to be “sick” and fake a hacking cough.

This year I invested in some colored hair spray and a rainbow of lipsticks to use in therapy sessions. It turned out to be a huge hit. The kids have loved telling me what color to put on my hair and face. If this is a bit too extreme for your tastes I’ve also had fun sticking feathers in my hair and stickers on my face.

When I look for materials to use in therapy for beginning communicators I prioritize finding items that can be made more fun by me pairing myself with them, for example Mardi Gras beads are fun, but can be even more fun if the student can ask me to pick them “up” and then rain them “down.” Poptubes are more fun when you can make them go “fast” or “slow.” I call these toys “shared manipulatives” and one of my favorites this year is called a Galactic Globe (available on amazon.com). It looks like a busted slinky but is a great toy to share with your client as it can roll off your arm and onto your student’s arm, building momentum and giving quite a tickly sensation.

AAC intervention for beginning communicators can look just like any other language therapy. It is vital to remember to set language-based goals and to not get bogged down in simple object requesting by pairing yourself with the motivating stimuli.

Presume competence and be the fun!

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My links:

YouTube: https://www.youtube.com/user/LindseyCargill/videos

Blog: https://lindseysaacblog.wordpress.com/

Twitter: @lindseypaden