Strengthening AAC Outcomes with Instructional Sequences

• Access to robust AAC tools? Check!
• Consistent use of aided language input? Check!
• High-interest activities or materials? Check!
• Supportive interaction style? Check!

Kudos to those professionals whose AAC practices include these important elements. In today’s post, we offer a suggestion for those who seek to strengthen their support and boost AAC learning even further: To maximize gains, be thoughtful in selecting or creating instructional activities and pay special attention as to how those activities are sequenced. Create and use well-planned instructional sequences to help AAC learners gain linguistic competence.

Language learning is complex. We don’t go from 1-word utterances to complex sentences in a single step. Our language doesn’t progress from basic to advanced in one swift leap. It happens over time and with the right opportunities for learning and practice.

Instructional sequences are a powerful means of providing those opportunities. These are specific processes that professionals use to teach particular skills. We use them to break down complex or multi-part skills into components, and then teach those components in ways that allow for systematic skill development. This builds incrementally, progressing smoothly so that each small step allows the learner to be successful and prepares them for the next step in the journey. A track record of small successes builds confidence and leads to skills that are more easily maintained and generalized.

One way we do this is with things like task analysis and chaining. You can learn more about that in the AACtual Therapy: Chaining in AAC.

We also do this by sequencing learning activities.

Here’s an example. Tiana is working to build her vocabulary with the support of her SLP and teacher, each of whom helps her in different ways. In the classroom, Tiana’s teacher uses a vocabulary program that introduces a new set of words each week and starts with a pre-test. Students use a vocabulary workbook and other materials to engage with those words every day. There are different activities each day and the week concludes with a quiz. The cycle begins again the following week with a new set of words. For many students, these experiences are sufficient for them to learn word meanings and use them correctly in conversation and writing. 

Tiana, however, needs additional support. She entered school without the same level of language competence that her speaking peers had, and although she is smart and hard-working, it has been hard for her to catch up. Tiana’s vocabulary skills have remained less sophisticated than her classmates because she has had so many other things to focus on that they never had to worry about. Added support is needed.

Tiana’s SLP collaborates with the classroom teacher to select a few of each week’s vocabulary words and provides sequenced instruction on those words. Let’s look at a typical sequence.

Target words: important, abundant

Session 1 

• Focused language stimulation is embedded throughout the session. This strategy is different from aided language stimulation (input) but they can be used together. (To learn more about this intervention strategy, browse these posts https://bit.ly/3h9sPeB .) 
• They co-create vocabulary cards with the primary meaning, an image that represents the word or shows an example, and examples of the word in sentences. 
• Together, they begin a graphic organizer – a word web. Together, they fill out the parts that show the primary meaning, its part of speech, and some related words. 

 Session 2

• Focused language stimulation continues. There are many opportunities to use the target words. When Tiana misses those opportunities, her therapist recasts those utterances, and models use of the new word in those contexts (e.g., Tiana: ‘It was big good to vote.’ SLP: I agree! It was important to vote.’)
• The target words were kept visible throughout the session. Tiana was challenged to listen for those words and each time the SLP said that word, Tiana smiled and cheered. They gave that word a point/hashmark each time. 
• They review a stack of magazine photos and picture cards and sort them into piles. One pile is for the photos that are examples of or are related to the target word. The other pile is for photos that are not related or are NON-examples of the target words. They discuss each photo as they decide where to place it.

Session 3

• Focused language is ongoing and there continue to be ample opportunities for Tiana to produce the target words. The target words remained visible throughout the session and they continued to call out each new production of those words. 
• Using the photos from the last session, Tiana creates a collage for each target word. She and her clinician discuss each one and why it is a good fit for that word while they are creating the collage. The target word is written boldly on the collage along with some of the phrases or sentences using that word that apply to the pictures. They snap a picture of the collage and text it to Tiana’s parents and teacher.
• They go back to the word web and add antonyms or phrases that are the opposite of the target word (e.g., abundant: not many; few, small number). In doing this, the SLP stays away from words that Tiana doesn’t yet know (e.g., scarce, meager, insufficient).

Session 3

• More focused language stimulation, production opportunities, and informative feedback. The SLP also set up a challenge for Tiana to see if she could use each target word at least once during the session.
• They review the word web and look at some sentences that use the target word. Tiana gives a thumbs-up if she judges the word to belong in that sentence, and a thumbs-down if it doesn’t seem to belong. They discuss her decisions and talk about why that word fits or doesn’t fit. This refines Tiana’s understanding of the word’s meaning.
• They created lists of things in their respective life experiences that related to each of the target words. Tiana and her SLP each made lists of things that were important to them and things they had in abundance. They discussed each new concept as it was added to the list.
• Tiana’s SLP created a language experience survey about one of the words and they used that to find out what others’ experiences of ‘abundance’ or ‘important’ have been. (Learn more about language experience surveys here: https://bit.ly/3fE1u3S .) The responses and stories she hears from her classmates and school staff strengthen her understanding of what these words mean. The stories, especially the funny, shocking, or poignant ones, are memorable and help Tiana retain her knowledge of these word meanings. 

Session 4 

• Continuation of focused language stimulation, experiences in producing the word, and helpful feedback. The challenge for Tiana to use each target word spontaneously was increased to twice per session.
• The SLP wrote word pairs on a stack of sticky notes (e.g., abundant-many; abundant-few; abundant-pink). Together, they sort these into 3 piles: Words That Go Together, Words That Don’t Belong Together, Words That Are Not Related). They have discussions about why each word pair was placed into its category.
• They look at a list of sentences the SLP created, each of which contains some underlined words (e.g., ‘There were a lot of Easter eggs on the lawn.’ ‘There were many choices at the shoe store.’). Tiana’s role is to substitute a target word for the underlined vocabulary word.
• The word web was pulled out once again to add more information. In this session, they added different forms of the word (e.g., importance, abundance) and talked about how they could be used.

Session 5

• Focused language stimulation now includes various forms of the target word, and recasting is used when Tiana produces the target word but in an incorrect form (e.g., ‘She didn’t see the important of voting’ was recasted to ‘She didn’t see the importance of voting’).
• Tiana had been enjoying the challenge of using target words spontaneously, so this was continued as well. Her competitive nature became apparent as she tried to beat the SLP in saying those words.
• The SLP created a list of sentences with the target words in various forms. Tiana gave a thumbs-up if she thought it was the right form of the word for that sentence and a thumbs-down if it was the right word, but used incorrectly. After some discussion, the SLP then modeled the correct form of the word.
• They looked back on the list they created in session 3 about things that were important to each of them or that they had in abundance. Tiana and her clinician used that information to create short sentences with the target words.

Sessions 6 and beyond continued to give Tiana scaffolded experiences with the new words she was learning. When new words were introduced, the SLP kept the previous words visible and continued to provide opportunities for use of those words. What doesn’t get practiced, often gets forgotten.

Thoughtful instructional sequences often begin with an anticipatory set to get attention and buy-in, activate prior knowledge, and prepare AAC learners for what is to come. They proceed to provide new content, lots of modeling, guided practice (with informative feedback), and many opportunities to put new learning in place. It’s an approach to teaching that offers great possibilities for strengthening our AAC intervention.