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Aac October 2008

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  • 1. Augmentative/ Alternative Communication Cassandra M. Mariano, M.A., CCC-SLP Jessica M. Antioco, M.S., CFY
  • 2. Acknowledgements • Students & Families • Dr. Joanne Gerenser, Executive Director • Jan Downey, M.A., CCC-SLP, Director of Speech Services • Eden II Speech Staff, past and present
  • 3. What does AAC stand for? • A – Augmentative • A – Alternative • C – Communication
  • 4. Why do we need to talk about AAC? • Because more than 50% of students at our Granite Ave school alone use an AAC system. • Because Autism significantly impairs a person’s abilities particularly in the areas of language, communication and social relations
  • 5. What exactly is AAC? • The American Speech, Language and Hearing Association defines alternative and augmentative communication (AAC) as an “area of clinical practice that attempts to compensate, either temporarily or permanently, for the impairment and disability patterns of individuals with severe expressive communication disorders.”
  • 6. Why might a student require an AAC system? • They do not use verbal speech as a reliable means of functional communication. • They might require the system: – To Augment their speech – As an alternative to speech
  • 7. Augmentative Communication • Refers to “any approach designed to support, enhance, or supplement the communication of individuals who are not independent verbal communicators in all situations” (Niciosi, Harryman, & Krescheck) • An augmentative communication system supports existing language and communication skills. • Students using a system in an augmentative context should be required to verbally approximate.
  • 8. Alternative Communication • Refers to any approach designed to REPLACE verbal speech.
  • 9. What’s the difference? • Augmentative SUPPORTS verbal speech • Alternative REPLACES verbal speech • Important to note: Whether or not a system is augmentative OR alternative depends on the student not the system itself. Ex: For Johnny, sign language may be an augmentative system. For Billy, sign language may alternative.
  • 10. Things to consider… • Does the student have an effective communication system? • Is the system being used appropriately by the student? • Is the system being used appropriately by the staff? • Is there carry over between home and school?
  • 11. In other words… • AAC systems give students a VOICE.
  • 12. Impact of Autism Hallmarks are : – A breakdown in all three communication components (encoding, transmitting and decoding) – Difficulty understanding language concepts – Failure to comprehend gestures – Lack of spontaneous use of language – Lack of imagination – Deficits in understanding and using appropriate language – Restricted or limited knowledge of vocabulary – Difficulty understanding spoken language
  • 13. Impact of Autism on Speech • 30 – 50 % of individuals with Autism may never develop functional speech • Functional speech is speech that can be understood by people who are not familiar with the speaker under all conditions. • Many of those students who are verbal have articulation and phonological errors, which makes their speech less intelligible.
  • 14. Therefore… • Many individuals with autism are candidates for Augmentative/Alternative Communication (AAC) systems!
  • 15. What are the modes of communication? • Verbal speech • Body language – Gestures – Pointing – Facial expressions – Body posture – Eye contact • AAC systems (Augmentative/Alternative Communication)
  • 16. Benefits of AAC systems • Enhances communicative competence • Faciliates the development of language skills • Research suggests that AAC systems may increase speech production • May increase speech intelligibility in some individuals • Evidence indicates that AAC interventions do not have a negative impact on speech production (Light, Millar, Schlosser 2006)
  • 17. Benefits continued… • Provides an effective and appropriate means of communication in individuals who are unable to meet their communication needs using speech • Decreases inappropriate and maladaptive behaviors that are a result of an inability to communicate effectively • May reduce the pressure from the demands of speech production in order to focus on communication
  • 18. Misconceptions • Inhibits speech production • Negatively impacts the emergence of speech • Individuals may prefer to use their AAC system and not be motivated to learn to use speech • Many clinicians perceive that they must make an “either-or” decision; i.e. pursue speech development or introduce an AAC system. (Light, Millar, Schlosser 2006).
  • 19. “No Tech” Systems • “No Tech” systems – do not require an outside power source. – Picture Exchange Communication System (PECS) – developed by Andy Bondy, PhD and Lori Frost, CCC-SLP in the 80’s. This is a system where pictures on a board or in a book initially represent desired items and activities and then moves on to other language concepts. The student exchanges the picture with a communicative partner. – Sign language – Picture boards – Written scripts
  • 20. PECS book
  • 21. PECS - Pros • The picture exchange requires interaction with a partner. • You can use it to enhance eye contact. • Portable • Inexpensive – you can make your own pictures either with Boardmaker (Mayer Johnson pictures) or any digital image or photo (Google Image is a great place to find some)
  • 22. PECS - Cons • Depending on how many pages a student has, finding the desired picture can be slow. • SO easy to lose pictures. • Can be clumsy.
  • 23. Manual Signs
  • 24. Manual Signs- Pros • Portable • Cost efficient • All communicative functions can be expressed • Fast • Easily paired with vocalizations
  • 25. Manual Signs- Cons • Multiple motor movements • Slow learning • Limited communication partners
  • 26. Picture Board
  • 27. Picture Boards - Pros • Provides direct selection • Visual and concrete • Cost efficient • Durable • Portable • Can be made specific to needs • Easily understood
  • 28. Picture Boards - Cons • Exchange is not required • No turn taking • Requires a point • May reduce eye contact
  • 29. Written Scripts
  • 30. Written scripts - Pros • Reduces prompt dependency (written prompts are easier to fade than verbal prompting) • Made specific to individual’s neds • Can be easily updated • Offers a variety of script fading and prompting options tailored specifically to a student’s need • Allows for consistency across instructors
  • 31. Written scripts - Cons • No verbal model • Requires continuous changes while fading • Does not promote eye contact (when first introducing a script)
  • 32. “Tech” Systems • “Tech” systems – require a power source (batteries or a charger)
  • 33. Voice Output Devices
  • 34. Voice output - Pros • Direct selection • Visual and concrete • Can enhance syntax • Verbal model remains constant • The user can be responded to as a competent speaker • Can be made specific to needs • Easily understood • Easily updated • Can have unlimited vocabulary
  • 35. Voice Output - Cons • Devices can be very expensive • Can break down • Requires programming • May promote stereotypy • Can be heavy/bulky
  • 36. What do our students currently use their AAC systems for? • Requesting • Exchange of personal information • There are SO many more opportunities for language once the system is taught…
  • 37. What COULD our students use their AAC systems for? • Requesting for preferred or needed items and activities. • Requesting for the bathroom. • Commenting – “I like this juice.” • Denying – “No, I didn’t go to the park.” • Labeling – “That’s a dog.” • Initiating greetings • Responding to social questions and exchanging of personal information - “My name is Fred. I live in Staten Island.”
  • 38. Assessment, Referral and Evaluation • Determine an individual’s communicative needs • Evaluate components of their existing communication system • Assess prerequisite skills (fine motor, matching, object/picture identification etc.)
  • 39. Now what? • Parents, speech therapists and teachers may recommend that an individual be referred for an AAC evaluation. • An evaluation by a team of qualified professionals is an important component in the selection of appropriate systems • It is essential that someone on the team has knowledge of Autism and ABA. • An understanding of the unique characteristics of the individual student including learning styles and maladaptive and stereotypical behaviors.
  • 40. Resistance • Sometimes we find that our students parents are initially resistant to the idea of an AAC system. • Why? Because they feel we are giving up on their children becoming verbal communicators.
  • 41. What do we say? • There is no evidence that supports the assumption that use of an AAC system decreases the likelihood of speech development. • Research has shown that when an AAC system is introduced, many children actually demonstrate an increase in speech, language and communication skills. • At this time, there is insufficient evidence to indicate the superiority of one system over another to promote speech.
  • 42. Issues to consider when teaching an AAC system • Identify goals • Plan your targets beforehand • Introduce systematically (For example, we may want to start with one icon and add accordingly). • Begin with highly preferred items – Initially, these items should be “free access” and immediately available.
  • 43. And the survey says… • A survey was recently conducted amongst Eden II and Genesis school staff to gauge feelings and beliefs about AAC systems. • Of those that were invited to participate, respondents included speech pathologists/therapists (40%), teachers (28%), behavior specialists (8%) and teacher assistants (24%). • Of those that responded, 75% have been employed by Eden II/Genesis for 5 years or less. 4.2% worked between 5 and 10 years. 20.8% have been with the agency less than 1 year.
  • 44. Survey results • Respondents 80 were asked to 70 rate how 60 familiar they are 50 Extremely with various 40 familiar Somewhat systems. 30 familiar 20 Not familiar 10 0 Sign PECS Voice Picture output boards
  • 45. How important is it for a child with limited speech to have an AAC system? •  For those that chose “it 80 depends” we got a variety 70 of explanations including - Not “It depends if the child is 60 important educated or advanced 50 Somewhat enough to use it properly.” important 40 “I feel if a child is somewhat Crucial verbal we should be 30 prompting them more to It 20 depends talk. If a child has no 10 speech they should have an AAC system.” 0
  • 46. I work with students who use… 100 90 80 70 Verbal Speech 60 Sign language 50 PECS 40 Voice ouput 30 Picture Board 20 Combination of systems 10 0 types of systems
  • 47. Staff’s level of comfort with systems 90 80 Comfortable with various systems 70 60 That I have been 50 instructed on systems 40 That I understand my 30 student without a system 20 That my student truly 10 needs a system 0 Always Sometimes Never
  • 48. Spontaneity 80 70 60 50 Initiates conversation 40 Initiates requests 30 Initiates social greetings 20 10 0 Always Sometime Never
  • 49. Spontaneity continued • 80% of staff feel that students need consistent prompting to use their AAC system. • Comments made on the survey indicate that most staff feel as though students act mainly as respondents with their systems.
  • 50. Favorite device • 68.2% of staff reported that their favorite system to work with is a voice output device. (Compared with 22.7% who preferred PECS and 4.5% that preferred sign language). • Respondents indicate that they have more experience with a voice output device and see more spontaneity in requests and initiations with it.
  • 51. Why do they like voice output devices? • Responses included: – Provides a child with a voice – Commands attention easily – Gives students a large vocabulary – Voice output provides a model for students to imitate. – Helps promote intelligibility and good articulation
  • 52. Least favorite system • Results of this survey indicated that staff found picture boards to be least preferred. • Only 8.3% feel that they have experience with it and 4% feel that it leads to spontaneous requesting and/or initiations.
  • 53. Why don’t they like picture boards? • Responses included: – Not that familiar with picture boards – Boards are very limited – Boards reduce eye contact – Boards are easily bent and lost
  • 54. Challenges • “The system is not send in from home or device is not sent in charged.” (62.5%) • “My student has a device that is always broken and out for repair.” (54.2%) • “Content on the system does not match what I need in the classroom.” (41.7%) • “The system or device is too bulky or takes up too much room on the desk.”(29.2%)
  • 55. Why aren’t systems out in the classroom? • We know how important it is to have the student’s system available to them at all times. Why then do we see students without their systems? • 80% of respondents say its because the device was not sent in from home or it was not sent in charged. • 10% say they have not been properly trained on the system. • 10% say that they understand their student without their system.
  • 56. Staff need more training – what is appropriate? • 92% of staff 60 feel that they 50 would benefit 40 from Twice a month Once a month 30 increased staff Quarterly training. 20 Twice a year • 58.3% stated 10 that quarterly 0 trainings would suffice.
  • 57. Training for Staff • Training staff on AAC systems, especially voice output device, should include: – Basic device operation (on/off button, restart button, recording and charging) – Teaching methods (correct prompting procedures, knowledge of whether the system is augmentative or alternative and whether we are requiring a verbal approximation) – AAC systems should be with students at all times.
  • 58. Training for parents/caregivers • Are parents/caregivers aware of who to contact regarding AAC system? • Are parents/caregivers trained to use system? • Are parents/caregivers aware that the system must be sent to school daily? And if it’s a device, that it must be charged?
  • 59. Group Activity • What skills do we look for? • What system would YOU give a student?
  • 60. Profile 1 • Male student, 4 years old • Non-verbal communicator, will babble spontaneously during play, indicates wants by reaching and grabbing. • Can receptively identify 15+ objects and between 10-15 pictures. • He can match identical objects, pictures and objects to pictures. • Poor eye contact • Limited fine motor skills
  • 61. Profile 1 • Would this student need an augmentative system or an alternative system? • What system would you pick for this child and why? • What “back up” system would you recommend?
  • 62. Profile 2 • Female student, 13 years old • She is a verbal student with multiple articulation errors, she speaks in a low tone and exhibits rapid speech when frustrated • Not easily understood by unfamiliar listeners • Can receptively and expressively identify a multitude of objects and pictures • Is currently matching categories • Previously used PECS until age 7 when she started using verbal speech. • Often requires prompting to make requests. • Fine motor skills intact • Exhibits hand flapping
  • 63. Profile 2 • Would this student need an augmentative system or an alternative system? • What system would you pick for this child and why? • What “back up” system would you recommend?
  • 64. Profile 3 • Male student, 3.5 years old • He is a able to imitate one syllable words but does not use speech to indicate wants and desires • He reaches and grabs for desired items • Excellent with non- verbal imitations • Good fine motor skills • Can match identical objects • At present time, cannot receptively identify objects • Behaviors include sweeping objects/materials off desk onto floor • Has two one concept commands in discrimination • Responds to name with head turn
  • 65. Profile 3 • Would this student need an augmentative system or an alternative system? • What system would you pick for this child and why? • What “back up” system would you recommend?
  • 66. Profile 4 • Female student, 8 years old • Student is passive and often prompt-dependent • Utilizes verbal speech to make wants and needs known • Excellent fine motor abilities • Is matching categories • Is stronger receptively identifying pictures • Will occasionally cry and/or laugh for unknown reasons • Parents requested for a system that would enable her to be more independent/spontaneous
  • 67. Profile 4 • Would this student need an augmentative system or an alternative system? • What system would you pick for this child and why? • What “back up” system would you recommend?