From Activity-based AAC to Robust Language: Part 1

As far as I can tell, most AAC learners are taught by people who don’t specialize in AAC. Their school SLPs may have caseloads of 50, 60, 70, or more students with IEPs, 90% of whom have goals for articulation, language, and fluency. Their classroom teachers serve students whose disabilities range from none at all, to dyslexia to cerebral palsy, to significant intellectual disabilities, and everywhere in between. In all likelihood, neither group had much AAC training. What little AAC they know, they’ve picked up on their own from reading, going to workshops and conferences (usually self-funded), talking to colleagues, and exploring online resources.

Many times, their first foray into AAC is with things like choice boards and visual supports, such as daily schedules and first/then boards. From there, they may begin labeling the environment with pictures symbols (e.g., ‘table’ on the table, ‘on/off’ near the light switch), using mini-schedules (e.g., washing hands), and communication boards with relevant vocabulary. Activity-based communication displays (ABCDs) are built for a specific activity, event, or topic. For example, an art-themed ABCD might have words like open, paint, want, marker, pink, glue, help, little, pretty, more, glitter, sticker, and star. This allows the AAC learner to communicate during the activity, primarily to make requests (e.g., want glitter, open paint, help glue) and comment on the materials (e.g., pretty glitter, little sticker). For some learners with little or no functional speech, ABCDs are a real step forward. Clinicians and educators who use use ABCDs often do so because there is not a better communicative option for these students. Through the ABCDs, these students may have their first real opportunities to use language to actively participate in games, crafts, shared book reading, and other activities.

It is WONDERFUL to see the number of practitioners who are taking steps like these so that their students have greater and greater access to communication opportunities. You only have to do a Pinterest search or browse Teachers Pay Teachers, to see the colorful and creative ways that SLPs and educators are trying to build participation and communication skills among students with little or no functional speech. You’ve probably already noticed the proliferation of materials with ABCDs available online either for free (e.g., Boardmaker Online) or for a nominal fee (Teachers Pay Teachers). You can find them for almost any topic, from watching sports on TV, to doing a Halloween craft, to making S’mores, to playing a board game, and everywhere in between.

Most activity-based communication displays include core vocabulary and a variety of word classes: a few pronouns, verbs that relate to the activity, prepositions, modifiers, and object nouns. Sometimes there are also full sentences or questions. If it seems to you like there are lots of good things about activity-based displays, you’re right.

So, what’s the problem? Basically, it’s this: ABCDs don’t build language skills that can be used outside a particular activity.

Once we’re done carving the Halloween pumpkin, the ABCD board for that activity goes away. I can’t use it to tell my friend what we did or how much fun it was or complain that it smelled weird. And, often, the language expressed with ABCD fails to generalize to other situations. When we move on to a new craft or project in the next session, the vocabulary and sentence structures that I used so nicely in the pumpkin activity is unlikely to transfer to reading Cat in the Hat or playing with a train app on the iPad. Some of the words and symbols may be the same, but they are probably in different places and are surrounded by different words/symbols, which can be a bit disorienting.

It’s like the proverbial wisdom about fish and fishing. “Give a man a fish, and you feed him for a day. Teach him to fish and you feed him for a lifetime.”

ABCDs, for the most part, feed our AAC learners for the day (actually, for a single activity within the day). When we build communication teaching around ABCDs, we are handing out fish. Tasty fish. Nutritious fish. But fish that disappear along with the activity. For most learners, ABCDs are not an effective long-term strategy for building language skills.

In some cases, the use of ABCDs is a step forward. The words and messages on the display allow the learner to express him/herself using language, not behavior. It allows for active participation rather than passive observation. It offers exposure to new words and symbols. It gives the learner some control over the environment, too. And those, of course, are very good things.

However, as SLPs, our therapy and the AAC tools we use are (or should be) part of a larger plan to build linguistic competence. We want the gains made in each individual session to add up to something larger the sum of the parts. We want to build generative language so that the learner can communicate in a variety of situations. And switching out communication displays with every new activity or experience is not a great strategy for building language for people with AAC needs.

ABCDs are great in a pinch. They allow for participation and help the adults running the activity know how to actively involve the learner. It takes TIME for us to figure out who this learner is and develop a trusting relationship with him/her. It takes TIME for us to get a sense of these learners’ abilities, and how to work to their strengths. It takes TIME for us to know how to pace the activity and prompt in appropriate ways. It takes TIME for us to get better at key intervention strategies, like aided language input, recasts, and providing effective feedback. For interventionists, using ABCDs is a way to ease into AAC and have some TIME to practice using those strategies with a particular learner.

As long as we understand the limitations, using ABCDs can be a helpful transitional strategy for us and for some learners. We can challenge ourselves to move forward and generalize the intervention skills we’ve developed to other kinds of AAC. By providing learners with more robust AAC systems, we can help them develop language skills that last beyond our fun activities and stay with them throughout the day.

In Part  2 of this series, we’ll explore ways to use ABCDs effectively and to transition into other forms of AAC. Stay tuned.