Charlene Cullen Speech Pathologist Speech Language and AAC Consultant email@example.com Twitter: @chacullen
Today’s Outline 9 – 1pm Good practice in AAC Apps for AAC Additional supports to good practice in AAC 30 minutes morning tea
What is AAC? Augmentative and Alternative Communication (AAC): An area of specialised clinical and educational practice that provides communication options and interventions for people with complex communication needs. The term augmentative in this context means supplemental or additional to speech. Augmentative techniques (e.g. gestures, and facial expressions) are commonly used when communicating and interacting with others. The use of the term alternative acknowledges that there are some individuals whose speech is sufficiently impaired that they must rely completely on standard and special augmentative techniques, which do not augment speech but are alternatives to speech (Vanderheiden & Yoder, 1996). (Speech Pathology Australia AAC Position Paper 2004)
AAC System AAC system: An integrated group of components, including the symbols, aids, strategies and techniques used by individuals to enhance communication. The system serves to supplement any gestural, spoken, and/or written communication abilities (American Speech and Hearing Association, 1991).
Unaided and Aided AAC Unaided AAC: All techniques that do not require any physical aids (e.g. gesture, sign, facial expression). Aided AAC: Techniques where some type of physical object or device is used (e.g. object symbols, communication boards, books, wallets). Aided AAC is often divided into high technology or low/light technology systems. (Speech Pathology Australia AAC Position Paper 2004)
AAC Myths and Legends Introducing AAC will stop someone from developing speech Low tech before High tech Has a little speech so doesn’t need AAC Too cognitively impaired for AAC AAC will fix all communication difficulties Too young for AAC Doesn’t need AAC as they can express basic needs
AAC Myths and Legends - Resources Romski, M.A. & Sevcik, R.A. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18:3, 174-185. YAACK http://aac.unl.edu/yaack/ DynaVox Implementation Toolkit http://www.dynavoxtech.com/implementation-toolkit/learning-paths/list/?id=7
Communicative Competence Light (1989) Linguistic Competence (mastery of the linguistic code) Operational Competence (access methods, on/off) Social Competence Strategic Competence (make the most of the vocab they have)
Aided Language Displays Prospective users must be provided with frequent examples of interactive, generative use to acquire any semblance of proficiency. No one would dispute the fact that it would be very difficult to become a fluent speaker of French, if your instructor seldom used French in your presence. Goossens’, Crain and Elder (1988); Goossens’ (1989)
Aided Language Displays Likewise, it is difficult for a nonspeaker to become a proficient AAC user if other people never model interactive use of their system during all aspects of the day.
Aided Language Displays Aided Language Displays are NOT choice making boards. Choice making boards supplement ALDs. E.g. in music time a choice board of songs is followed by boards for singing the songs.
It is critical for an individual to not only have symbols, but also to have experience with those symbols in a symbol rich environment / print rich environment. The typically developing child will have been exposed to oral language for approximately 4,380 waking hours by the time he begins speaking at about 18 months of age.
If someone is using a different symbol set and only has exposure to it two times a week, for 20-30 minutes each, it will take the alternate symbol user 84 years to have the same experience with his symbols that the typically developing child has with the spoken word in 18 months!!!
The typically developing child will demonstrate language competency around 9-12 years of age having been immersed in and practicing oral language for approximately 36,500 waking hours. For 9-12 years that child has been using and receiving corrective feedback while practicing with the spoken word.
At twice a week, 20-30 minutes each time, it will take the alternate symbol user 701 years to have the same experience Jane Korsten (2011) QIAT Listserv 4th April
Aided Language Displays If children are to gain proficiency in using their aided AAC systems, others must begin to use the children's AAC system to communicate with them.
From “Being a Model Communicator,” ComTEC, 2010
Aided Language Displays By modelling how to use a display to initiate and maintain communication, you show a student how to initiate and maintain – not just respond!
Aided Language Display Design If you (as a person proficient in language) cannot use a communication system or display throughout an interaction then how can you provide Aided Language Stimulation? If you cannot use it, is it designed well?
Exercise In pairs: Design an Aided Language Display for making things from pipecleaners. Remember to include vocabulary such as names, actions, positions, requests, commands....
Storing displays Must be stored in close proximity to where they are needed Must be stored in a way that helps with quick access and set-up E.g. in dress-up box, on back of bookshelf, on walls, in plastic bucket, inside game box, with props, in eye gaze arrangement
CHAT-Now Developed by Gayle Porter (Cerebral Palsy Education Centre) and Marnie Cameron (Communication Resource Centre) Children’s Aided Language Tools Consists of aided language displays for early childhood settings and general interactive board(s)
CHAT-Now A series of ALDs for different activities. Designed for early childhood but suits many special education settings Also includes a general interactive board for use throughout the whole day
Special School Project Approx 80% of students in school with CCN A few have individual systems – generally not being used Lots of visual supports in place – all staff carry key caddies and all classrooms use visual schedules, first then boards etc Commonly used AAC is all adult focused language
Week 5 Use whole board Made up in Tap Speak Choice, AAC App
Weeks 6 - 10 Consolidate use of whole board Ensure all students have yes/no
Special School Project Repeat observations and videos end of term one 10 spontaneous uses of AAC by students observed Next term introducing ALDs for a range of activities Term 3 introducing multi-page generic displays
Pragmatics Pragmatics – social use of language Using language for different purposes, such as greeting, informing, demanding, promising, requesting Changing language according to the needs of the listener Following conversational rules www.asha.org
Pragmatics Need to ensure AAC users have access to and know how to use a range of pragmatic skills Dewart and Summers “Pragmatics Profile” (1998) http://wwwedit.wmin.ac.uk/psychology/pp/
PODD PODDs can have different formats, depending on the individual physical, sensoryand communication needs of the person who will use it.
PODD PODDs have been developed over the past 15 years by Gayle Porter, a speech pathologist with the Cerebral Palsy Education Centre (CPEC) in Victoria. Each PODD format has been shaped by the experiences of both children with Complex Communication Needs (CCN), and their communication partners.
Core Vocabulary Using common English words on an AAC display to enable a user to construct their own sentences. Approach used in lots of high tech systems but not used as much in low tech due to difficulty of arranging vocabulary for access.
Core Vocabulary CORE VOCAB High frequency words Can be combined to get your message across in lots of different situations FRINGE VOCAB Low frequency words Only useful in one or two situations Often related to a specific topic
High Tech and Light Tech Both are just tools Both need good vocabulary design and good modelling to ensure success High Tech can be less forgiving but can offer more access options Some students more motivated by high tech and some don’t like it!! Most people need both – for different situations
Static Display May be more durable Generally cheaper Often run off AA or AAA batteries Overlay based - require Boardmaker or other tool Need to work out system for storing and changing overlays Need to ensure vocabulary is updated Harder to maintain in many ways
Dynamic Display May be more durable Usually rechargeable Tools for generating pages in device – and sometimes in free software too Can change vocabulary on the spot Can change pages and levels easily Generally offer a wider range of access options
Access Options For a user who need alternative access, SGDs can offer: Large range of access options Flexibility Complete control over device and other software
Additional AAC options to support good practice Yes/No ++++ Small Talk About Me Books Storytelling Social Scripts Partner Focused Questions Introducing yourself Taking non-obligatory turns
Social Communication Social communication is a BIG part of our day. We use different forms of social communication – small talk, storytelling, greetings, wrap ups and farewells.
Social Communication Social communication is more than 50% of our daily conversation. Light (1998) found that reasons for communication between adults were (in ranked order) Social closeness Social etiquette Information transfer Wants and Needs
Small Talk A type of conversational exchange used for initiating and maintaining conversational interaction. Some conversation never progresses beyond small talk e.g. at a cocktail party.
Small Talk Small talk is used as a transition between the greeting and information sharing stage, especially when people don’t know each other well or don’t possess a lot of shared information. Small talk is often the first step towards social closeness. A quick check at Amazon showed 16 books aimed at helping people improve their small talk skills. Including “How to get people to like you in 90 seconds”. There are even websites to teach you how to small talk! e.g. www.ehow.com, www.englishclub.com, www.ivillage.co.uk and many more!
AAC Users and Small Talk Many AAC users use little or no small talk This can be because They don’t have access to small talk in their communication system They don’t see the need for it They think it is a waste of time. Light and Binger (1998) found that AAC users were seen as more intelligent, valued and competent communication partners if they used small talk.
Generic Small Talk Generic small talk is small talk that people can use with a variety of different conversational partners because it doesn’t refer to specific shared information. Particularly effective for many AAC users as it has many different uses.
Generic Small Talk Several groups of researchers at the University of Nebraska-Lincoln looked at the frequency and types of generic small talk used by speakers of various ages without disabilities. 3 – 5 year olds - 48% of all utterances at both home and pre-school/school were generic small talk 20 – 30 year olds - 39% of all utterances were generic small talk 65 – 74 year olds – 31% of all utterances were generic small talk 75 – 85 year olds – 26% of all utterances were generic small talk
Generic Small Talk Most of the age groups used continuers as the most common form of small talk. Really? Yeah? Great! Cool! Go to aac.unl.edu for more detailed information.
Differences in Small Talk Vocabulary The small talk vocabulary lists showed that some words were used more frequently than others e.g. OK Some words were common across all age groups e.g. great Some words were specific to certain age groups e.g. “bummer” was used by the 25 – 35 year age group but not by the others. Small talk also differs based on your friendship groups, your geographical location, your interests and life experiences.
Small Talk and Mealtimes Balandin and Iacono (2000) found that it was nearly impossible to script the content-specific vocabulary needed for mealtimes for an adult in the workplace (although there was a good chance on Mondays and Fridays that footie would be the topic during the footie season). In this situation, the only predictable thing was small talk.
George’s Small Talk 21 year old male with athetoid cerebral palsy Attends a day centre for young adults Uses a Dynavox3100 but only uses the spelling page Controls communication device with a head switch
George’s Small Talk Over 20 other people with disabilities and 6 staff attended George’s centre, most of whom talked. George rarely used his device during the day. Staff requested a review of his device because he didn’t “ever” use it. George had previously had a setup with core vocabulary on his device but found it frustrating to find words he wanted when he could just spell them.
George’s Small Talk A speech pathology student observed him in two sessions. He “used” his device constantly but only spoke with it twice. George was accessing his device with a head switch and block/row/column scanning. She observed that by the time he had formulated a message the conversation had moved on and he erased and moved onto a new message. A two pronged approach was used. Firstly, a conversational topic was established before each group e.g. “What are your favourite films?”. This allowed George to compose messages in advance. A small talk page was programmed and George practiced using this in one-to-one and then small group conversation.
George’s Small Talk At the end of 8 weeks the same speech pathology student observed George in the same two sessions. George used his device 46 times. Five of these were topic setters, 41 were small talk continuers. Several other people in the centre commented spontaneously that “George was much cleverer than they thought” or that “They enjoyed talking to George much more”. And….he’s still using it!
Sequenced Social Scripts Sequenced social scripts can really help a user to Get a 'feel' for the anatomy of a conversation Develop turntaking skills Learn to interact with a variety of partners.
What are Social Scripts? They support students in learning to claim, start, and maintain turns in a conversation. Much of the information in this section is taken from “Can We Chat? Co-Planned Sequenced Social Scripts: A Make It / Take It Book of Ideas and Adaptations”by Caroline Musselwhite and Linda Burkhart Also called Participation Scripts
What are Social Scripts? Social Scripts are interactions such as joke-telling, sharing life stories and general conversations. They help persons using augmentative and alternative communication (AAC) move beyond wants and needs to using 'real' communication for conversational purposes. Often give developing communicators a sense of the power of communication.
Anatomy of a social script Attention getters Starters Maintainers, holders and interjections Turn transfers Closings
Attention Getters These are the phrases that start an interaction and make sure that someone is ready to listen. Creative attention getters can motivate a listener to be interested in hearing more. They can also change perceptions of others about the child who is using the script, by conveying, humor, age appropriateness, and initiative. AND they can be very motivating to use!
Hey, you guysWaz upDudeYoHellooCome hereLet’s talk
Starters Starters are used once attention is gained. They set the stage for what the child will be talking about. Setting the context further prepares the listener and allows the child to take charge of the conversation. Like attention getters, creative starters pique the interest of the listener and often get a natural response that encourages the child to go on and tell the story, complete the joke, etc.
Guess what I did?I have a secret!Wait till you hear what I heard!You won’t believe thisDid you see the game?I’ve got something to show youWanna hear a joke?
Maintainers, Holders and Interjections These are phrases such as "Shall I give you a hint?", "You know what happened next", "You will never believe what she said after that", "It was so awesome", It was really scary", etc. They allow the child to add interest to the basic story line while maintaining control of the conversation. They also prompt the listener to make comments and naturally encourage the child to tell the rest of the story.
And thenIt was so funnyGuess what happened next?Wanna hint?I hate that!Can you guess?I’ll give you a clueIt was so embarrassingAnd then it got even worse
Turn Transfers After the child has communicated his story, or sometimes in the middle of a longer story, turn transfers invite the listener to comment or give their opinion. They give the child the power of turning the conversation over to a partner, without ending the conversation.
What do you think?Isn’t it amazing?Can you believe it?You won’t tell anyone will you?How about you?Is that amazing or what?What did you see?
Closings Closings allow the child to take the initiative of ending the conversation. This helps the listener and also avoids that awkward feeling of “well is that all?” Again the child’s personality and humor comes through in the choice of closings used. Often several closings in sequence are appropriate, because people typically take several turns when finishing a conversion.
Nice chatting with youEnough about thatWhat have you been up to?Catch you laterCan you find someone else for me to tell about this?Hasta la vista baby
Exercise In pairs pick a topic e.g. Joke, prank, gossip, message Generate a sequenced social script Find another pair and try your script out
Anatomy of a social script Attention getters Starters Maintainers, holders and interjections Turn transfers Closings
About Me Books Communication Passports Personal Photo Stories
Communication Passports Template available from CALL Centre Scotland www.communicationpassports.org.uk iPhone App coming soon Also from SCOPE UK at http://www.scope.org.uk/help-and-information/publications/scope-communication-passport
Communication Passports Useful for exchanging information about an AAC User between others Often not a tool used by the AAC user directly
Personal Storytelling As we get older the percentage of small talk decreases and the percentage of storytelling increases. Older adults, in particular, use stories to entertain, teach and establish social closeness with their peers. As individuals lose their spouses and move to retirement and care facilities the need to socially connect with individuals their own age becomes important and storytelling becomes a vehicle for this.
Personal Storytelling Schank (1990) discussed story formulation, refinement and storage in detail. He found a few different “types” of stories in common use: First person stories Second person stories Official stories Fantasy stories Marven et al (1994) found that for preschoolers, 9% of their communication at home and 11% at preschool involves fantasy of some sort.
AAC and Storytelling Storytelling with AAC systems has become practical and possible with improved technology. However, we must be careful that the stories are ones which the person would choose to tell. Storytelling is very personal and must be individualised.
John’s “chat” cards John is an 11 year old with autism spectrum disorder. John uses words (which are mostly intelligible to familiar people), signs and a multi-page communication book. John also has some challenging behaviour. Five years ago, John had challenging behaviour every night when he got home from school. His mum felt that this was due to his frustration over trying to tell her about his day. His team decided that “chat” cards about his day would help. They setup a process to write a sentence about each day.
John’s storytelling Many of John’s old chat cards are in a milk crate in his room. John began spontaneously using them with new people a couple of years ago. He selects a few cards and then brings them to the new person. They read them with him and if they show particular interest in one topic e.g. playing basketball he will go and get more things around this topic. He brings out fewer chat cards as people become more familiar with him and understand more of his speech.
Ted’s Storytelling Ted is a 78 year old who had a CVA when he was 72. Following the CVA he regained some spontaneous speech, mostly small talk. He can understand everything that is said and can read the paper and magazines. He cannot speak (apart from small talk) and he cannot write. Prior to the stroke he was president of his local RSL Club. His wife and his friends miss his storytelling. His wife was able to work with him and write out many of his stories. These have now been stored in a Macaw, with one of his friends doing the recording. He and his wife are delighted as he is once again able to tell stories and delight his family and friends.
Sarah’s Storytelling Sarah is a woman in her sixties who lives in her own house. In her forties she was in a motor vehicle accident and is now a quadriplegic. She has a good understanding of spoken English but very limited expressive communication, including very little facial expression. She has control of a single switch with her left thumb, but tends to fatigue quickly, although her stamina is increasing. She has a multi-level communication book which she accesses with eye pointing.
Sarah’s Storytelling She has a range of in-house care staff who tend to stay around for between 5 months and 3 years. Many of these staff assume she doesn’t understand what is said to her because she doesn’t give body language feedback.
Sarah’s Chat Book Inside this book are some of my photos. The writing tells you about them. The questions are things I am interested in about you. Please read out the writing and the questions and we can find out about each other together - but be warned - it might take more than one visit! Sarah
I was born in 1943, but this is the first decent photo of me - sitting at the piano when I was 11 like a good girl! You won’t see that often. Did you learn an instrument? If so, what was it?
Me and my cat in 1955. I’m the one on the right. Did you have a pet as a child. If so, what was it? What was its name?
This is me in 1957 with my family. My brother and I are up the back, my mother and sister are in the middle and my father is at the front. Who is in your family?
And here starts the party girl era…. 20 years old and ready for anything
Peter loved sailing. This was a fantastic day. It would have been sometime in 1984. Have you ever been sailing? Do you like it?
On the 12th of July 1985, Pete and I were hit by a car as we were walking to a restaurant for dinner. My life completely changed after that. Pete died as a result of the accident and I am now severely physically disabled. Pete and I had over six wonderful years together. I still miss him very much as you can imagine. Luckily, I have many great friends and they, and my own determination, have helped me to keep going.
And in 1991, getting familiar with the options in communication technology at the time.
And on to 2002 - some things never change. Recovering from a party and Melbourne Cup day. Do you enjoy a flutter on the cup?
Sarah’s Chat Book Sarah’s chat book has completely changed the way staff see her. Each new staff member sits down and goes through the book with her over a few different sessions. They realise how interested Sarah is in them and they gossip with her more. It also gives them topics to talk about that they think will interest her.
Maggie’s Storytelling A series of photos about a person to give the “listener” a sense of who the person is Can be used to let them have a “conversation” with their “listener”
Just how important is social communication? In Building Communicative Competence with individuals who use Augmentative and Alternative Communication Light and Binger (1998) looked at just three different social communication skills. 1. Use of an introductory strategy when meeting new people 2. Use of nonobligatory turns to increase participation in social interactions 3. Use of partner-focused questions to demonstrate an interest in the partner.
Use of an introductory strategy when meeting new people Teaching a 35 year old with a closed head injury to use an introductory strategy to explain his use of AAC and his communication resulted in much more positive interactions with unfamiliar people, with fewer breakdowns and made the new partners more at ease. Teaching a 44 year old with cerebral palsy to use an introductory strategy allowed her to be more confident and assertive with new people. Twenty adults with no previous experience of AAC viewed tapes of Maureen meeting new people pre and post. 100% of them reported she was a more competent communicator when she used an introductory strategy.
Use of nonobligatory turn taking Teaching a young (4½ year old) child with cerebral palsy to use non-obligatory turn taking via AAC meant that the child was initiating more frequently and was more eager to participate in group activities. One of her peers said she was more fun to play with. Her speech improved and she acquired 30 new words. Teaching a 14 year old with autism to take non-obligatory turns also resulted in a increase in initiating and turn taking. There was a decrease in his inappropriate behaviours and he was less disruptive in class. 20 adults who were not familiar with AAC rated his pre and post videotapes and rated him as a much more competent communicator in the post tapes (although they didn’t know which were pre or post).
Use of partner focused questions Teaching a 13 year old child with developmental disability to use partner focused questions produced a change in the focus of his interactions. His partners began to see his communication as more appropriate. Teaching a 24 year old with athetoid cerebral palsy to use partner focused questions meant that he became a more valued communication partner with those he regularly communicated with.
So how do I decide what’s important in an AAC system? Beukelman (2004) wrote that “vocabulary selection in AAC can be viewed as the process of choosing a small list of words or items from a pool of all possibilities”
Choosing vocabulary for pre-literate individuals For people who are pre-literate those designing an AAC system face a hard task. Generally we consider there are two forms of vocabulary for this group – vocabulary that is needed to communicate essential messages and vocabulary to develop language (which includes small talk and narratives). Many people like to make this decision around core vocabulary ie words and messages which are commonly used and occur frequently. Small talk vocabulary fits well within these criteria.
Choosing vocabulary for non-literate individuals Aim to meet their daily, ongoing communication needs in a variety of environments.
Choosing vocabulary for literate individuals For literate individuals, they may need some phrases or words which need to be pre-stored for quick access either so they can participate in the conversation in a timely way or so they can reduce fatigue.
Many people who use AAC (Kraat, 1985; Light, 1989; Muller and Soto, 2002) Play a passive role Rarely initiate interaction Express a limited number of speech acts Use restricted linguistic forms Limited opportunities to interact with other people
Communication board use is frequently less than one might expect.
When the communication board is used, it is often used primarily to provide information requested by the facilitator.
The range of communicative functions produced is typically restricted.
Functionally non-speaking partners tend to assume a respondent role using primarily yes/no answers and other short provisions of information.
Patterns of turntaking, initiation and conversational control tend to be asymmetrical in nature ie the speaking partner dominates the conversational exchange.
Speaking partners are frequently observed a) to ask closed-ended questions and specific Wh-questions and b) to repeat and rephrase previous turns, often initiating topics without expecting a response from the child.
In the classroom setting, AAC users tend to communicate predominantly with the adults in the class, not their classmates.
Used frequently, interactively and generatively to express a wide range of communicative intents;
Occurring during at least 80% of ongoing classroom programming (as speech or manual sign use is);
Being used to mediate communication with classmates as well as personnel (ie teachers, aides, therapists, clinicians);
Being designed and implemented in as time and cost effective a manner as possible.
What we know Communication displays and devices are often not used AAC users are typically responders not initiators Interaction patterns focus on “closed” questions such as “What do you want?” Conversational partners control interactions (turn taking is unequal) Peer interaction is minimal (Kraat, 1985)
Four main issues Lack of Modelling Lack of Access to Vocabulary Communicative Competence Passivity/Learned Helplessness
We know how to fix this... We just need to do it! And model, model, model