Growing Our Ranks: An AAC Confessional

It’s funny where life takes you. A former student of mine was unhappy as an attorney, but found deep satisfaction in becoming an SLP. Another one enjoyed her work as an SLP, but reached even more lives by founding a company for low tech communication and literacy materials. As SLP students, we might not have considered the role that people with AAC needs would play on our caseloads. And with over 90% of school-based SLPs serving kids with autism, my guess is that many who are now supporting nonverbal or minimally verbal students had no intention of specializing in AAC. And yet, there they are: a language lifeline for students who cannot communicate effectively through speech.

I am so grateful to today’s guest author, Sara Barnhill, for sharing her own experience in becoming an AAC service provider. Sara is an SLP who has has worked at Children’s Hospital of Richmond at VCU in Richmond, Virginia for five years.  She is a member of the Assistive Technology Core team and VCU’s Center for Craniofacial Care team.  Her caseload includes patients in clinics, outpatient therapy, and on the Transitional Care Unit which provides pediatric long-term care. Sara’s candid comments about how she got into the AAC field (and grew to love it) give me much hope. Enjoy!

My AAConfessional

I never wanted to “do” AAC.  I had completed a brief six week seminar in graduate school.  I had learned all about the different types of symbols systems AND made a lite tech board to accompany Brown Bear.  I obviously had a very clear picture of what AAC was all about so that when, at the end of my Clinical Fellowship, a spot on our Assistive Technology  team was opened to our SLPs, I refused without a second thought.  I had after all created overlays for the GoTalk to allow for labeling of all the clothing items accompanying our Dora the Explorer doll.   Not to mention my “custom” made SpringBoard Lite pages which allowed a child who was NPO to label tiny food erasers based on their availability in the Michael’s dollar section.  All those AAC systems just seemed totally overwhelming; I was definitely not interested.  When the second request for an interested SLP came directly to me I was torn.  I certainly wanted to be a team player and refusing a request from my manager to join a specialty team did not seem like the best way to convey my willingness to collaborate.  After much deliberation I acquiesced to join the team with the one stipulation that I did NOT want my entire caseload to become AAC.

I have now worked at Children’s for five years and been a member of our AT team for four of those years.  My caseload is 80-90% AAC.  And I love it.  I feel so incredibly lucky to be part of a small but mighty team of five (two OTs, three SLPs) that completes six to eight AT evaluations per week, three to four “check-outs” for device receipt and set-up, frequent on-going AAC therapy sessions, and regular training of staff.  I am also immeasurably fortunate to be part of an organization that understands the degree of training and education required to maintain a successful AT program.  As I learned the differences between Dynavox, Prentke Romich, and other devices, as well as the varying access modes and funding processes, I began to realize that perhaps I had not given AAC its due consideration.  As I learned more about core vs. fringe vocabulary, the importance of teaching a variety of language functions, and aided language input, I experienced a seismic shift in my perception not only of augmented communication, but of the SLP field in general.

I think the passion I feel for AAC can best be encapsulated in the story of a patient I saw for several consecutive years on our long-term care unit.  He came to Children’s with no functional communication and severe self-injurious and aggressive behaviors.  We started him on a field of 15 dynamic device targeting core vocabulary.  He was the kiddo who really showed me that sometimes “negative” vocabulary such as ‘don’t want/like,’ and ‘stop’ are the most motivating and important messages.  He transitioned rapidly from the novel core words to 84 Sequenced (in fact, he taught me Sequence!).  His therapy intensely targeted language functions aside from requesting, however, his most frequently produced phrase was without a doubt “I want Barney.”  After nearly three years of working and learning together, he was ready to discharge to his family’s home.  I took advantage of my lunch break (coincidentally during LAMP training) on his last day with us to stop by the unit and tell him good-bye.  I was mildly lamenting the fact that I wished I had done a better job of expanding his language when he sidled up next to me where I was seated on his bench and stated “you get off.”  Those were the last words he said to me and I LOVED each one.  Because of AAC and concepts like core vocabulary, this little boy could independently generate a phrase to direct an adult and advocate for his own space without biting either of us!

Although my “romance” with AAC was a slow starter, it is now without a doubt an all-consuming passion.  I find myself speaking in “Quick Words” to my friends’ toddlers.  I regularly state “I like it!”  I remind my husband to “use your words” (which he loves).  I often find myself targeting core vocabulary with “late talkers” which further reminds me that AAC therapy and evaluations are not all that different from the traditional speech therapy in which I was so invested as a CF.  AAC has not only helped me grow as an SLP, a consultant/collaborator, and a caregiver educator, but ironically, what I once conceived of as a small, niche field, has overarching broadened my understanding of language and communication as a whole.  And to that I say, “I like it!”