Beyond the Boundaries: Alternative & Augmentative Communication Strategies

1. Beyond the Boundaries: Alternative & Augmentative Communication Strategies Judith L. Page, Ph.D., CCC-SLP, ASHA-F, ATP Associate Professor & Director Division of Communication Disorders University of Kentucky

2. Assistive Technology Considerations for Communication: • No tech objects or symbols • Light tech communication board or book • Single message voice output device • Simple voice output device • Voice output device with levels • Voice output device with dynamic display • Voice output device with icons • Voice output devices that rely on spelling

3. Laws for Applying Technology • Law of Parsimony • Law of Minimal Learning • Law of Minimal Energy • Law of Minimal Interference • Law of Best Fit • Law of Practicality & Use

4. Make sure that, very early in the teaching process, the child is able to communicate effectively and efficiently at least a little bit with his or her newly-learned skills. This clearly demonstrates the value of communication and increases the motivation of the child. Early success is one of the best predictors of future effort and diligence.

5. Make sure that both the AAC system and choice of goals and objectives are developmentally appropriate. • Too hard = failure • Too easy = boredom • The resulting behaviors look very similar

6. Don’t replace existing idiosyncratic modes with conventional modes • Undermines value and benefit of communication • Being taught a new, more difficult replacement • There are situations where teaching more conventional is appropriate

7. Replace old method when: • It is harmful to child or others • It is socially unacceptable or age inappropriate • New method is easier • New method is more effective/more easily understood • New method is more efficient

8. AAC can be categorized by • Materials required • Level of technology used • Characteristics of display • Manner of selection • Type of output

9. Materials Required • Unaided: requires only the users body • speech • sign • gestures • Aided: requires something in addition to users body • objects • symbols • communication boards • electronic devices

10. Level of Technology • No tech: Any communication system that does not require a power source. • Low tech systems: Any communication system that requires a source of power and is very easy to program. • Mid tech systems: Any communication system that requires a power source and requires some level of training to adequately program and maintain the device. • High tech systems: Any communication system that requires a power source and extensive training to competently program and maintain the device.

11. Characteristics of Display • Components • messages • symbols & codes • operational commands • Physical Characteristics • number of items • size • spacing and arrangements • orientation of display • Types of Displays • fixed • dynamic

12. FIXED/STATIC DISPLAY

13. DYNAMIC DISPLAY

14. Manner of Selection • Direct Selection • selection options • physical pressure • physical contact • pointing (no contact) (includes eye gaze) • voice recognition • Scanning • scanning patterns • circular • linear • group-item • auditory

15. Type of Output • Visual • Signs/gestures • Symbols/objects • Communication board • Auditory • Talking switches • Voice output communication aid (VOCA)

16. Provide materials that are appropriate for student coralreef Tangible Symbols PCS Symbols • Tactile Symbols http://www.ohsu.edu/oidd/d2l/ts/index.cfm http://www.tsbvi.edu/Education/vmi/tactile_symbols.htm www.mayer-johnson-symbols.com

17. SYMBOL HIERARCHY • Real Objects Concrete • Miniatures • Photographs • Colored Pictures • B & W Pictures • Line Drawings • Printed Words • Alphabet Abstract

18. Moving Through the Symbol Hierarchy • Increase number of symbols in vocabulary • Increase size of symbol array presented • Provide opportunities for generalization to other contexts • Encourage student to use symbols fordifferent communicative functions (e.g. labeling, requesting, commenting) • Teach multi-symbolic utterances • Make symbols smaller, more portable to transition to 2-dimensional symbols

19. Be consistent! Communicate with team so all are using same strategies (e.g. show cue card to student to prompt focus on the teacher when she is speaking)

20. Encourage independence! Plan communication opportunities in a variety of settings with a variety of partners. • With IEP team, prioritize curriculum content. • Collaborate to monitor progress • Roles and responsibilities • Sample chart

21. Adaptations/Modifications • Visual consultation • Contrasting background w/o clutter • Proper positioning • Big Mac switches with messages paired with objects • Vertical presentation of switches & objects • Time delay procedures • Small motor preparation • Implementers Teacher, OT, PT, SLP

22. Overview of Strategies • Training Alternate Responses to Disruptive Behaviors • Aided Language Stimulation • Language Modeling • Instructional Strategies

23. What is Aided Language Stimulation? • A strategy in which the facilitator models symbol use while speaking to the child

24. Language Modeling Strategies • Speak slightly slower than usual • Insert numerous pauses • Use single words followed by short phrases • Emphasize key words

25. Pair manual sign or symbol with its corresponding key word • Keep phrases and sentence short and grammatical • Provide frequent examples of language concepts

26. Modelling Example: AAC • Popcorn….Let’s make some popcorn… • First open (as assist child in opening bag of popcorn)…. • Open the popcorn…. Now pour….. • Pour it in …. More …. We need more …. • Pour it in ……

27. TRAINING ALTERNATE RESPONSES TO CHALLENGING BEHAVIOR

28. Some Examples: • Bill is a 17-year old male with severe developmental delays and very poor vision. He does not eat green peas. Whenever he is given peas at meal time, he picks them up one at a time and throws them across the room. • What are two possible communicative messages Bill could be sending via this behavior?

29. Rodney is an 8 year old child with autism. Rodney has a history of escaping from classrooms and running outside. Fortunately, his current classroom has a door that can be locked. Rodney’s teacher reports that he has developed a troubling new behavior – he gets up from his seat, goes to the back of the room and bangs his head repeatedly against the wall. She is concerned that he will hurt himself. • Is there a possible communicative message in Rodney’s behavior? • What questions might you ask Rodney’s teacher to help sort out this problem?

30. Principles • Principle of Functional Equivalence: the replacement behavior must serve the same function as the challenging behavior. • Principle of Efficiency: alternative behavior must be at least as easy to produce as the challenging behavior

31. Principle of Response Effectiveness: alternative behavior must be as effective in obtaining desired outcome as the problem behavior • Principle of Appropriate Listening: sometimes the best solution is to identify the function of the problem behavior and alter the environment to fulfill that function

32. Teaching Basic Rejecting • relationship to challenging behavior • rejection is the underlying communicative function of many so-called behavior problems • functional communication training incorporates AAC means to express “break”, “no”, “done”, “go”, “stop” • Look for subtle behaviors that precede challenging behavior

33. Remove negative stimulus as soon as subtle behavior is noted / model socially acceptable behavior • Continue modeling acceptable behavior / insert pause • Begin requiring correct response to remove negative stimulus

34. First, Then & Break

35. Training Facilitators • be attentive to communicative attempts • provide comfort, support and affection • create positive environments for interactions • focus on the individual’s needs • use age-appropriate interaction strategies • be more consistent in response to communication attempts • respond to random signals as if they were intentional

36. TRAINING SYMBOLIC COMMUNICATION

37. Basic Choice Making & Requesting • choice-making opportunities • ID when, where and by whom choices can be offered during day • initial goal is to expand opportunities for choice-making, rather than develop more sophisticated ways to make choices • choice-making items or symbols • initially use real, meaningful items • shift to symbols

38. Making Choices • Choice-making formats • Active vs. passive • Number of choices • Actual or symbolic • Preferred/non-preferred • Choice-making arrays • # of items in display • Levels • Spacing of items • Horizontal vs. vertical spacing • Cross vs. four corners

39. Organization of Display Determined by: • User’s motor ability • User’s cognitive ability • User’s language ability • User’s visual ability

40. Natural consequences • Don’t provide corrective feedback

41. Strategies • Place items out of child’s reach • WAIT, WAIT, WAIT • Up the ante • Provide many opportunities for choices (forced choice) • Block access • “Play dumb” • “Mess up”, forget parts, something’s wrong here • Disrupt expectations • Provide natural consequences: respond, acknowledge, map-translate into words, get what you ask for • Provide prompts: time delay, gaze intersection, verbal (Stremel-Campbell, l985; MacDonald, 1982; Neetz, 1984; Kaiser, 1986; Halle, 1984; Schumacher, 1988; Smith & Kleinert, 1989)

42. Specific Strategies

43. Calendar/Schedule Systems • Purposes • intro concept of symbolization • provide an overview of a sequence of activities • provide specific info on what will happen next • ease transitions • part of a behavioral support plan for students who need predictability • Used for • dual sensory impairments • visual,cognitive or multiple disabilities

44. Organizing the system • ID daily schedule • ID symbols to represent each activityconstruct a container • devise a system to mark “finished” • Using the system • go to system & remove symbol for next activity • discard at completion • discarded always available • try to comply if remove symbol from box to request

45. Talking Switch Techniques • Purposes • intro symbolic communication • provide limited context communication with voice output • Examples • Commercial talking switches (e.g. BigMACK, Brix) • Some have a sequence of message and levels (e.g. Step-by-Step with Levels)

46. Picture Exchange Communication System (PECS) • A training package that allows children and adults with autism and other social-communication deficits to initiate communication • Developed for preschool children with autism, pervasive developmental disorders (PDD), and other social-communication disorders who display no functional or socially acceptable speech - expanded to include individuals of all ages with a wide variety of communicative disorders

47. Allows a mode of communication within a social context as children are taught to approach and give a picture of a desired item to a communicative partner in exchange for that item. This allows the child to initiate a communicative act for a concrete outcome within a social context

48. Begins with teaching a student to exchange a picture of a desired item with a teacher, who immediately honors the request. No verbal prompts are used at this point, which builds immediate initiation and prevents prompt dependency

49. techniques include backward chaining, shaping, anticipatory prompting, delayed prompting, and fading of physical prompts. Incidental training is also used once the physical exchange is mastered

50. Intervention with Eye Gaze