As a speech-language pathologist for almost 40 years, I am passionate about giving other SLPs, parents, special education teachers the tools they need to implement AAC with fidelity and evidence based practices. I give workshops, provide training to school district staff, speak at national conferences, and provide evaluations for speech-language and AAC.
Our AAC users need a lot of skills to be able to use their ‘talking tool’ competently. I call it a tool, because that is what it is; a tool that individuals can use to help them to communicate with the world around them. And it is our job to teach them how to use the tool.
Janice Light listed 4 areas of competency that AAC users need to develop:
Linguistic refers to receptive and expressive language skills; including grammar, syntax, word relationships
Social refers to those social skills needed to communicate; such as asking & answering questions, greetings, repairing breakdowns
Operational refers to the ability to use the system; such as powering a device on and off, or moving between pages
Strategic refers to understanding and use of the skills needed to facilitate communication; such as getting a partner’s attention
Today I’d like to talk for a minute about the operation skills needed to use an AAC system; in particular the navigating between pages that are necessary in any dynamic display system (note that in addition to electronic devices this also includes the navigation conventions of a PODD book or other flip-book-type system).
The ability - or inability - to navigate is often cited as a reason why a child is not given a dynamic display device. But, like any skill, this is something that needs to be taught.
One of the ways we teach this skill - as with any skill in AAC use - Aided Language Stimulation is our friend. It is always the first step in AAC implementation. Children who need to use pictures to communicate need to see models of others using this language system, just as speaking children need to hear us talk.
Unfortunately, while using ALgS is crucial, it is not always sufficient For many of our students more direct instruction is required. One of the important skills in AAC use is that of categorization.
Now, I’m sure all the SLPs out there reading this will recognize a skill we spend a LOT of time working on with many of our children receiving therapy. This skill helps a child know that if he wants an apple, he needs to look in the “Food” page, and then, maybe, even on the “fruits” page. If he wants to talk about where he went over the weekend, he'll need to find the “Places” page. You get the idea.
Fortunately, we don’t necessarily need anything fancy or new or different to teach categorization skills to our AAC users. All of the therapy materials you are using to work on these skills can be used with these children. Only the mode of response is different. Rather than naming the category, or listing its members orally, the AAC user will need to find the item after navigating to that page.
The AAC user needs to understand that to get to a specific item, he will need to find its category page.
One of the fun ways I work on this skill is with sorting tasks and games. For instance, in my Category Catch All resource, students sort transportation into air, land, and sea vehicles, or sort animals into zoo, ocean or farm habitats.
Another favorite is Categorizing & Describing Flower Power. There are many different ways of sorting and categorizing items in this resource; including general categories (animals, foods, clothing), descriptor (green things from red things and bumpy things from smooth things), family members, land forms, and more.
With either of these resources - or using whatever you have in your therapy room or home - you have the student respond using their “voice” - their AAC system. In this way they get practice with finding where things are, without it feeling like a test. Turning learning into a game helps to keep kids engaged.
AAC users need to learn where to find words in their AAC system, but without us constantly asking them to “Find (X).” or “Point to (Y).”
Till next time, keep sorting, and….Keep on talking!
First of all, READ. Good books. All kinds of books. Fiction and nonfiction. Funny books and meaningful books. Enrichment books, which have interesting text which is supported by illustrations, provide students with experiences they might not otherwise have, can offer them characters they can relate to and places that feel familiar. They can also provide a window to activities the child might not be able to do himself.
Storybooks can be relatable because of their characters, setting, or problem with which the child may be familiar. They teach the child about the relationship between characters and settings, the steps to solving a problem, and the story elements of plot sequences.
Nonfiction books can provide valuable information, teach concepts, and give access to topics the child might not be able to see, touch, or feel otherwise. Informational texts introduce children to things in the world around them.
Talk about the book while you’re reading. Point out illustration details. Ask questions about key concepts or story details. Talk about vocabulary. Describe characters and settings. Predict solutions.
Retell the story. Practice this retelling with the child. Use visuals or the illustrations to support the retelling. Extend the story by having the child “write” or co-create his own stories that use the same basic story structure as a book he likes, but with the personal connection of himself as the character or his environment as the setting, or his experiences as plot lines. Children love books about themselves, so create his own personal bookshelf of familiar stories. Experiences with which he is familiar become easy-to-tell stories.
In case you haven't been following me, I have recently published a book on AAC implementation. Augmentative-Alternative Communication is a relatively young area of speech-language pathology and one in which there was limited research until relatively recently. Which meant that we often didn't know a lot about what we were trying to do for a number of years. And, like many fields, information derived from the research wasn't always good about making it into practice.
But we now have a lot more information to inform our best practices. We have determined some of the best Evidence Based Practice and clinicians have that available to them from a variety of sources.
Even so, it's tough to get the many thousands of speech-language pathologists to be comfortable with an area of practice they often have limited cause to use.
In the book, I outline the types of AAC, the myths and misperceptions, and the terminology. Because we don't want anyone left hanging because they don't know the vocabulary! Then I go on to outline steps needed to go from nonverbal to communicating with pictures. I offer simple steps, tips, strategies and ideas for implementing AAC. I give examples. And, I hope, I give - well, hope.
In my 45 years working with kids with nonverbal autism - and so many other conditions that impact language - I have watched literally thousands of parents cry in frustration. And that doesn't need to be.
So, if you or someone you know and love needs this book, hop on over to the website (MaketheConnectionBook.com) or go straight to Amazon and grab it. (That's an affiliate link).
Want to know a little more before you buy? I'll be making my second appearance on NBC Morning News in Palm Springs on April 2 and will post a link to the interview as soon as it's available. In the meantime, here are some free handouts I hope provide you with some useful information. No opt-in necessary; just a free link.
Recently, sensory bins are a big “thing” in speech therapy and a big hit with students. While I never used sensory bins in therapy (my last therapy gig was more than 20 years ago), I can see why kids would like the process of “digging for buried treasure.”
Two of my favorite goals to target involve increasing students’ abilities to describe and increasing their ability to tell a story. So I thought I’d make a few suggestions for using sensory bins with your students with limited language - or AAC users who are developing language skills.
First, for those of you unacquainted with sensory bins, these are containers of almost any sort (shoe boxes, plastic tubs, big baskets) filled with any of a variety of filler materials - beans, cotton balls, raw pasta shapes, rice, sand. (Warning: that last one can get messier than the others).
Students “dig” through the filler to find the treasures; which can be laminated pictures, small figures, or other objects related to your topic or theme.
I’ve suggested using sensory bins with books to colleagues. You know me; gotta get that literacy tie-in everywhere I go!
Choose a story to work with. Copy the illustrations of people, animals, even places (it is legal to make a copy of a book you own for a student who has difficulty accessing print) and laminate them. Cut out the figures and bury them in the filler.
You can also purchase small plastic figures in thematic sets. If you happen to own Playmobile or Lego figures that are pirates, animals, superheroes, etc. that’s terrific. But they can be expensive to purchase for all your sensory bins.
A bit less expensive are sets like this one: (contains affiliate links)
Next, set your target. If you’re working just on describing and defining, You might have a random collection of items to hunt for. Or you might stick to a single category with a variety of members.
If you’re working more on narratives, you might choose items that represent characters and objects in a specific story.
Then set the parameters for the ‘treasure hunt’ itself. You can have students find items randomly and describe whatever they’ve found. This is great for having AAC users practice using the core words on their describing page.
Or, you can have students choose one figure at a time and build a round-robin story. The first student begins the story by saying something around what he has chosen from the bin. The next student builds on the story, and so on. AAC users can get lots of practice with people and actions pages of their system.
Or, you might hide story elements from a single story, and have students identify the element and describe it or tell about its place in the story. You can also have students pick items from the bin and re-tell the story once everyone has a piece.
There are many ways you can use these sensory bins in therapy to make building language more fun for your students.
Have students who have a hard time grasping small items? Try these, from Amazon:
Looking for more ideas for implementing AAC in therapy and at home? Try my book; Make the Connection!: A Practical Guide to Parents and Practitioners for Teaching the Nonverbal Child to Communicate with AAC.
I recently had the pleasure of being on-aid at NBC Morning News studios in Palm Springs. They asked me to come and talk to them about Read Across America Day and how to include students with Autism and other significant language disabilities participate in this day that celebrates literacy.
So many of our students have not been taught literacy skills historically, and many still aren't included in reading activities.
I talked about a couple of ways nonverbal students can participate in phonological awareness activities. I've been invited back for April 2 Autism Awareness (and Acceptance) Day. I'll be talking about.... you got it! AAC!
Playing can be lots of fun. It can also be hard work. The work of young children is to play. Literally. So many skills are developed through playing. In particular, children learn language and build knowledge through play.
They talk about what they are doing and listen to us as we describe what is happening.
They talk with peers as they play; building social skills and social language.
They learn about toys and what they can do, and build background knowledge about what the toys represent.
For example, how many of you have used a play kitchen when “working” with children? What do you talk about? There are so many actions that happen in a kitchen, and action words (verbs) are core words.
And sequences of actions in the kitchen are often basic routine sequences that help students map out how things work.
Thematic units lend themselves to play routines, as children build awareness of the vocabulary and sequences involved in the theme. Children learn about things they may not have a lot of experience with. Perhaps your student with a disability isn’t allowed in the kitchen during meal prep. Or maybe your student with a disability doesn’t get to go to many of the same community events as his peers.
Many of our students with disabilities fail to acquire the same background knowledge as their peers, due to lack of exposure to the same activities.
One way to compensate for this lack is to use dramatic play themes. A speech pathologist friend of mine creates dramatic play units which she sells in her Teachers Pay Teachers store.
I recently took a look at some of her resources and thought how well they would work with my AAC users.
Thematic units allow therapists and teachers to build that background knowledge while incorporating the language needed within that theme. Students get the opportunity to learn the concepts involved and the vocabulary needed.
And the same thematic vocabulary runs through lessons on various subject areas while maintaining stability of words and concepts throughout. You might have a dramatic play kitchen, a related read aloud, integration with science or social studies or math. And you might even tie your play lessons to Common Core State Standards.
Thematic lessons allow for hands-on activities that are related and provide multiple opportunities for repetition of the vocabulary within the teaching time for the unit.
You might have adapted materials in the play area. You should definitely have visuals; images that tie in with the topic and place. You might create a customized book; either to read before or during play, one made with pictures of the student(s) playing in the area, with text describing the activity, the sequence, the concepts.
Tamatha from TLC Talk Shop, has a lot of fun dramatic play resources in her shop. The Vet Clinic can be found here. It is packed with fun, information, and loads of visuals to use to create the topic.
Each one of her units comes with vocabulary cards, articulation practice using thematic vocabulary, categorization activities, play activities, a barrier game, phonological awareness activities, and sensory skills ideas.
I took a look at this Vet Clinic, and found lots of ways to use and play with the vocabulary cards, including labeling, writing, telling functions and categories, and more. She provides opportunities to describe and compare.
Most fun for the students, though, are the dramatic play forms.
Students get a chance to pretend being the vet, the vet tech, and the customer. There are questions to be asked and answered, symptoms to list and describe, appointments to make, and even X-Rays to use.
Animal graphics can be used with the X-Rays, as well as bandages provided. Work on body parts, directions, shapes, colors, and more.
Grooming tools allow for labeling and describing, as well as verb tense practice.
In my last post, I wrote about sequencing, a skill that is crucial for academic and social success. We sequence our way through daily events; such as eating breakfast before lunch and dinner after lunch. We need to understand and use sequencing when we’re telling a story in a conversation (We made lunch before we went to the park to have a picnic and after we ate we played ball). And we need to know the sequence of events in history, particularly when one is the cause of another or that specific events happened before or after another; such as knowing the Revolutionary War came before the Civil War. Science, too, depends on sequences; such as in life cycles or chemical reactions.
One of the topics I have written about frequently is routines. Routines build language; it is as simple as that. Routines are events that occur regularly, frequently, and predictably. Routines in our lives are repetitive, the steps we follow, and the words we use during those steps are predictable.
Another topic I speak about frequently is core word use in AAC. Core words are the building blocks of language, the most frequently used words that we use to generate our messages. Using core words in our AAC implementation means using the most common words in all of our activities; particularly repeated routines.
Last month I wrote a post about common 2 core word phrases and provided a free little booklet you could download and make with your students, and I talked about the top 5 two-core-word phrases.
So, now let me tie it all together, talking about using routines to build language, using core words, and using them in the correct order. Sequencing of core words in routines!
Research tells us that routines are at the heart of symbol and language development. Routines are sequences of actions or events that are repeated over and over again. Always in the same sequence. Routines are reliable, consistent, constant, and repetitious frameworks that provide us with the opportunity to provide consistent language targets. Routines identify predictable vocabulary and activities that use the same context specific vocabulary consistently. They also identify consistent core vocabulary. Routines, in short, provide a consistent schedule of multiple opportunities to learn communication.
Every routine can be broken down into smaller and smaller components. Each of these components is influenced by the responses and reactions of those involved. The reactions and responses become symbols that are used in this interaction to signal to each other.
When the routine always follows the same sequence, the signal between the two people involved become shared symbols. Routines help us build symbolic awareness, and symbols become communicative when they come to have a more standardized or conventional meaning among a larger group.
This helps us realize why it is important to develop routines in thinking about intervention for AAC (Lonke, 2014) and for understanding the impact of aided language stimulation.
We want to use consistent vocabulary and sequences within frequently occurring classroom or therapy room routines. Utilize simple scripts within routines so that staff are consistently modeling the same vocabulary and sentence types. Make sure to model vocabulary used during routines that goes beyond requesting; to include commenting, providing information, asking questions, and other communication functions
For example, if I’m moving from single to 2-word utterances with core, I might work with “again.” “Do it again.” This finds its way into many play activities, social routines, gross motor routines. Read the book again. Throw me up into the air again. Hide again. Throughout these types of activities, also use the word and the icon, modeling for the student consistently.
Children learn language from models, from those models that are familiar and consistent and predictable - in other words, from routines. Routines have a high rate of opportunity, and we know our AAC users need 200 opportunities per day to learn to use their AAC.
Routines have a structure. You can break routines into a series of small steps that happen in the same way and the same order each time while using the same words.
Routines can be created around cleaning the room, washing hands, getting dressed for outside, preparing a snack, reading a book, going to the bathroom, brushing teeth, wiping the board, and more.
Use concise, simple language (“Up. Pull up pants.”). Prepare the student verbally (“It’s recess time. Put on jacket.”). Narrate what you’re doing (verbal referencing; say, “It’s time to brush your teeth,” while getting out the toothbrush and toothpaste). Encourage the student to respond with simple questions (“Where are the napkins?”). Give the student the chance to make choices when appropriate and possible (“Which pajamas do you want to wear?”)
Let’s take a look again at the sequence for “Put on,” Here is a common 2-word phrase using core words within a routine that offers multiple opportunities. How about “Clean up.” Both as a therapist and a mother I can’t tell you how often I used to say that phrase. “Clean up the room.” “Clean up the toys.” “Clean up your clothes.” “Clean up the table.” You get the idea.
And often, these directions are part of a sequence. You need to clean up the room before recess. “Clean up the clothes, then take them to the laundry room, then put them in the washer.” More than 50% of those words are core words. And you couldn’t put them in a different order and have it work. It’s not possible to wash the clothes if they are scattered all over your room.
So, I’ve been writing this blog for almost 6 years, now. And while I’ve got plenty of ideas for continuing on, I’d really like to give my readers what they want.
So……. what do y’all want? I’d love to know what it is you would like me to talk about here. So, leave me a comment below and let me know what you’d like me to cover in the AAC world.
In the meantime, listen in on my interview with Al Cole, on CBS radio. embed code for al cole interview Thanks so much for being loyal readers. It means a lot to me. More to come soon. In the meantime…. keep on talking!
Looking for some gifts for your Valentine? A copy of my book is a wonderful gift for a parent wanting to hear their child say, "I love you." Try these other fun items from Amazon.
In a couple of previous posts about sequencing, I offered some insights into why we work on sequencing skills, and even included a free activity appropriate for the time of year (here in the U.S. it is a cold, snowy winter).
Sequencing is important for daily living skills, conversational skills, storytelling and retelling skills, and even learning in History or Science classes. This seemingly simple skill is crucial in so many areas of a student’s life; so much so that we spend a lot of time on it.
Sequencing involves ordering language and information into an accurate or efficient order. Students with language disorders may have difficulty with not just steps of a task, but also words in a phrase or sentence. Students might also have difficulty with working memory; causing them to “lose” some of the steps.
From sequencing the meals in a day or the steps of a simple routine task to telling the steps of an activity or retelling War and Peace, sequencing plays a crucial role in helping students to organize themselves and their world.
Sequencing requires us to break down a task or an event into smaller steps that we then put in order. We need to understand the sequence in order to perform the task.
Sequencing also requires us to break down an event or story into its component smaller events in order to tell about it or understand someone else’s telling.
In order to understand sequencing, the student needs to understand ordinal order; that there is a first, a next, and a last. I usually begin with 3-step sequences; such as the order of meals we eat in a day. Sometimes, you may even need to start with just two steps. I begin by providing large illustrations of each step or event. I gradually reduce the size of the visual cue; moving from a single picture per word or phrase to a small visual per sentence and then paragraph.
Eventually, I want to get rid of the visual cues, if possible.
Expository and narrative tasks are different in how the mind processes them. Stories about ourselves and events are easier to understand and tell about than how-to tasks, which are a later developmental step.
Important for both types of sequencing tasks is the understanding and use of temporal words; such as ‘first,’ ‘then,’ ‘last,’ ‘and after that,’ etc. Use these words as often as possible in all appropriate contexts to help students understand them. And don’t forget numerical order; such as first, second, third.
In my storybook companion resources on TPT I always include sequencing the story as one of the linguistic tasks, including a variety of visual cues for different sequence lengths.
Use the verbal and the visual together to help scaffold comprehension.
Additionally, I have a variety of life-skills sequencing resources; such as this one.
I was recently asked to talk about SPARK Cards, which are designed to “…encourage children to observe picture details and to improve their picture interpretation skills.” Each picture set contains 6 related pictures, but they can be modified to only use 2-3 or 4. The colorful cards depict common activities, but you should make sure your particular student has some background knowledge about each specific sequence that you use.
The cards can be used simply to put in order, or to tell a complete story. Their use can also be extended to answering Wh questions, problem solving, and predicting. Each topic card contains information about each picture in the sequence and Wh questions that can be asked; ranging from What and Where to Why and How.
The SPARK cards contain 8 sequences of 6 cards each, including:
going to the library
making a lemonade stand
preparing for a hurricane
going to the vet
a trip to the beach
setting the table
For some of these activities you may need to activate background knowledge or even create it. Using storybooks can help with that, as can role playing games. You might also need to match more concrete visuals to your speaking. Addition of color cues is also helpful.
Whether your student is learning to sequence two words (or symbols) together for communicating or sequencing multiple steps and events in a complete, complex story, you don’t want to skip this skill in your intervention.
(affiliate link) Until next time - keep on talking!
This past week I had the honor of appearing on Autism Live! They had asked me to come and talk about my book, "Make the Connection!: A Practical Guide to Parents and Practitioners to Teach the Nonverbal Child to Communicate with AAC."
So, I took the drive up to L.A. on Tuesday and showed up to the CARD office on Wednesday morning. Here is the clip, for your watching pleasure. I talk about the 3 top tips for parents, and why I think some SLPs miss the boat with AAC.
Major Communication Tips with Susan Berkowitz - YouTube