Creating Opportunities for AAC Use: All Day, Every Day

Charlene Cullen

Inclusive Technology Consultant

Speech Pathologist

Tell me about...

• What you have communicated so far today• How you communicated• Why did you communicate?

Communication helps us to

• Chat• Get what we need and want • Enhance our lives

• We can.. greet, comment, make requests, protest/reject, give opinions, answer questions and more!

AAC

• People with complex communication needs use augmentative or alternative communication (AAC) strategies

What is AAC?

Augmentative and Alternative Communication (AAC)

• Augmentative Communication uses other forms of communication (e.g. pictures, gestures, signing) with speech

• Alternative Communication uses other forms of communication instead of speech

What AAC strategies have you used?

Unaided and Aided AAC

• Unaided AAC: All techniques that do not require any physical aids

• Aided AAC: Techniques where some type of physical object or device is used. Aided AAC is often divided into high technology or low/light technology systems.

(Speech Pathology Australia AAC Position Paper 2004)

Unaided AAC

Aided AAC

• Messages (words, phrases, sentences) are symbolically represented as photographs, line drawings, tangible objects or letters/words.

Low/Light Tech AAC

High Tech AAC

• Custom Speech Generating Devices

• Mainstream Technology• iPod touch/iPad• Android Phones/Tablets• Laptops

AAC Myths and Legends

• Will stop someone from developing speech• Low tech before High tech• Has a little speech so doesn’t need AAC• Too cognitively impaired• Will fix all communication difficulties• No need, as person can express basic needs

AAC Myths and Legends - Resources

• DynaVox Implementation Toolkit http://www.dynavoxtech.com/implementation-toolkit/learning-paths/list/?id=7

• 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/

AAC Myths and Legends - Resources

So how do we introduce AAC?

Good practice approaches

• Aided Language Displays (ALDs)• Engineering the Environment• PODD• Core Vocabulary• CHAT Now

Aided Language Displays

Aided Language Displays

• Use a teaching method called Aided Language Stimulation

• Requires modelling language using aided symbols

• Individuals learn to communicate in the way they experience the system of communication being used

Let’s have a look

Aided Language Displays

• 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.

• 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

• Prospective users must be provided with frequent examples of interactive, generative use to acquire any semblance of proficiency.

Have a go!

Aided Language Displays

• Aided Language Displays are NOT choice making boards.

• Choice making boards supplement ALDs.• E.g. during lunch time there is a choice board for

foods followed by lunch conversation board

Lunchtime ALD

Aided Language Displays

• If an individual is to gain proficiency in using their aided AAC systems, others must begin to use the AAC system to communicate with them.

Creating ALDs

Choosing activities for ALDs

• What happens across the day?

• How frequently does it occur?

• What activities are motivating?

Aided Language Displays

• If you cannot use a communication system or display throughout an interaction then how can you provide modelling?

• If you cannot use it, is it designed well?

Choosing messages for ALDs

• Should enable you to keep a running commentary of an activity.

• Should always be messages that the user could “say”.

• 16 - 36 messages per activity• Write them down and rank them

Food preparation – word based1. Let me 13. Careful 25. Burn

2. More 14. Finished 26. Hurry

3. Get 15. Turn on 27. Set the timer

4. Open 16. Turn off 28. Cold

5. Put in 17. Hot 29. Cook

6. Stir 18. Look 30. Cut

7. No, don’t 19. Smell 31. Where

8. Yuck 20. Pour 32. What?

9. Uh oh 21. Make 33. When?

10. Taste 22. Spill 34. Please

11. Take out 23. Bowl 35. Spread

12. Good 24. Spoon 36. Close

Food preparation – Phrase/Sentence based1. Let me 13. It’s hot 25. It’s done

2. Put it in 14. This is fun 26. Turn it off

3. Open it 15. Tastes yummy 27. Wanna save it for later

4. Turn it on 16. Not done yet 28. It’s your turn

5. Need some more 17. I know how 29. Help me please

6. No, don’t! 18. Take it out 30. Smells good

7. It’s yuckie 19. That’s too much 31. My mum makes this

8. Uh ohhh 20. I think it’s burning 32. It’s all gone

9. Be careful! 21. That’s my favourite 33. What a mess!

10. You forgot! 22. It’s not your turn 34. It’s cold

11. Is it done yet? 23. Can I take some home 35. Close it

12. That’s enough 24. Don’t forget 36. Gotta clean up

Words or phrases on ALDs?

• Cognitive level of the user• Language goals• Selection technique• Time dependent nature of the activity

Have a go!

• Choose a motivating high frequency activity

• Fold paper to 4 x 3 grid• Design an ALD• Remember to include vocabulary

such as names, actions, positions, requests, commands....

Software for making ALDs

• Online:• http://connectability.ca/visuals-engine/• http://mrsriley.com/home

• Boardmaker Software Family• Matrix Maker

www.boardmakershare.com

Selection Technique

• Finger point, Fist point, Eye point, Head pointer, Scanning

• Must not be too physically taxing• Can work on a new technique in other activities

while an easy technique is used for communication

ALD format

• 9 cell, 12 cell, 16 cell, 32 cell, 36 cell etc• Matrix or horse shoe

Meaningful learning

• Often we teach in stimulus response activities eg. Find the shoes, find pants

• Need to teach in contexts that allow the adult to see symbols being used• repeatedly• interactively• and generatively during meaningful activity

Meaningful learning

• By modelling how to use a display to initiate and maintain communication, you show the adult how to initiate and maintain – not just respond!

Meaningful Learning

• May help to “script” activities• Needs to occur at least 80% of the time• Slow and a few concepts to begin with, gradually

increasing in speed and complexity.

Engineering the Environment

• Storage• 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. on back of bookshelf, on walls, cupboard doors,

on tables, inside the recipe folder, on kitchen pin up board

Engineering the Environment

Engineering the Environment

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 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.

PODD

• PODD is a way of organising whole word and symbol vocabulary in a communication book or speech generating device to provide immersion and modelling for learning. 

PODD

• The aim of a PODD is to provide vocabulary:• for continuous communication all the time• for a range of messages• across a range of topics • in multiple environments.

PODD

• PODDs can have different formats, depending on the individual physical, sensory and communication needs of the person who will use it.

Let’s have a look....

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

• FRINGE VOCAB• Low frequency words• Only useful in one or

two situations• Often related to a

specific topic

• CORE VOCAB• High frequency words• Can be combined to

get your message across in lots of different situations

Core Vocabulary

Core Vocabulary

•WordPower 24 in TouchChat, AAC App

Core Vocab to supplement ALDS

• From the Disability Services Commission WA

http://www.boardmakershare.com/Activity/969086/Core-Vocabulary-Display

Speak for Yourself

• Uses core vocabulary• 13,000 words and only up to 2 key

presses• Gives user enough language so that

language development isn’t held back• Allows enough language for good

modelling throughout the day

CHAT-Now

• General interactive multi-level

Technology

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

Speech Generating Devices

• DYNAMIC DISPLAY • STATIC DISPLAY

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

Mobile devices

What’s a good app?

Many AAC apps don’t reflect good practice• 20% AAC apps are category based apps• Some don’t include speech• Some app manuals advise use of the app a

couple times per week until competence improves

Apps for AAC

http://www.spectronicsinoz.com/article/iphoneipad-apps-for-aac

Apps for AAC

• Tap Speak Sequence• Tap Speak Choice• Scene & Heard• Touch Chat HD• Verbally• Predictable• RIDBC Auslan Tutor

Blue2 Bluetooth Switch

By Ablenet

Switchbox

by Therapy Box

Access

Switch4Apps

by Pretorian

Access

Accessories

Let’s have a look

Have a look!Think about:

• Vocabulary• Ease of programming?• Access options• Portability and size

• Try programming a message• Who might benefit from using it?• What situations could you use it for?

InterAACtion Manual and CD

• resource is for people who live or work with adults who have communication impairment

• Ideas for age-appropriate communication ideas

• Templates and steps to develop your own communication aids

Communication about the individual

• About Me Books/Communication Passports• Personal Communication Dictionary

About Me Books

• Also known as Communication Passports• For support people • Gives information about how the person likes to

be supported during daily routines• Useful for exchanging information about an AAC

User between others• Often not a tool used by the AAC user directly

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

Apps to create Passports

• Pictello, Creative Book Builder, Click n’ Talk, Story Patch

• Encourage AAC User to participate in creating the book

• Model using it multiple times• Keep low tech back ups too!

Personal Communication Dictionary

• A Personal communication dictionary records and suggests meanings for the unique gestures, body language, facial expressions, and vocalisations of people who appear not to have any formal method of communication

Personal Communication Dictionary

Additional AAC options

• Community Request Cards

• Chat Book/ Personal Storytelling

• Small Talk• Social Scripts

Community Request Cards

• to request a service or object• only need to have a “passing”

behaviour• Use large print for easy reading

for communication partner and symbol for person who uses AAC

• Must be self explanatory • Specific to person and situation

Community Request Card apps

• Most of them can be used this way if they are editable

• TapSpeak Button, TapSpeak Sequence and Scene & Heard etc

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

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.

• There are even websites to teach you how to small talk

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

• 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

Specific Small Talk

How is your family?

How is your wife?

What’s happening?

What are you doing?

Don’t you look nice!

Nice haircut.

She’s great.

She’s a great teacher.

Generic Small Talk

• researchers 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 eg. Really? Yeah? Great! Cool!

• Some words were specific to certain age groups e.g. “bummer” used only by the 25 – 35 year olds

• Differences also based on friendship groups, geographical location, interests and life experiences.

Small Talk and Mealtimes

• Balandin and Iacono (2000) tried to script the content-specific vocabulary needed for mealtimes for an adult in the workplace

• In this situation, the only predictable thing was small talk (and often sports after the weekend!)

Adult Generic Small Talk

Try it out…

Adult Generic Small Talk

George’s Small Talk

George’s Small Talk

• Young man with athetoid cerebral palsy• Attends a day centre for adults• Uses a device 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’s Small Talk

• A speech pathology student observed him in two sessions. He “used” his device constantly but only spoke with it twice

• 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• A conversational topic was established before each group e.g. “What

are your favourite films?” and then George could 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 - 5 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”

Fat Cat Snappy Chat

• One of a series of apps• Addresses areas of weakness in AAC

systems or that AAC users don’t use• Small Talk in Snappy Chat• Communication Breakdown in Chat

Repair• Useful in combination with other systems

not stand alone

Sequenced Social Scripts

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• Enjoy successful interactions

What are Social Scripts?

• support individuals in learning to claim, start, and maintain turns in a conversation

• Also called Participation Scripts• 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

What are Social Scripts?

• Social Scripts are interactions such as joke-telling, sharing life stories and general conversations

• They help persons using 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 person 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

• Once attention is gained, starters set the stage for what the person will be talking about

• Setting the context further prepares the listener and allows the person 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 person 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

• Phrases such as "Shall I give you a hint?", "You know what happened next", "You will never believe what she said after that“ etc.

• Allow the person 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 person to tell the rest of the story

It 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 person 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 person 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 person to take the initiative of ending the conversation

• It helps the listener and also avoids that awkward feeling of “well is that all?”

• Again the person’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

TapSpeak Sequence

• Opportunity for quick errorless communication• Jokes• News• Cheering at sports events• Gossip• Messages• Interviews etc.

Have a go!

• In pairs pick a topic e.g. Joke, prank, gossip, message

• Generate a sequenced social script• Find another pair and try your script out

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

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 individualized

Alexicom Elements Story Maker

• We build social closeness through storytelling

• We use stories to identify people we might want to be friends with

• This app allows storytelling on the fly – easy to add pages as you go between

Michael’s Storytelling

• Michael is a young teenage boy• Lives with his Mum, Dad and

brother in Perth• He has intellectual disability• He uses gestures, words, sounds,

facial expression and a Maestro for communication

The Royal Show

The Royal Show• 1    We went to the Royal Show• 2    I like to go up the Ferris Wheel• 3    I petted the baby animals• 5    The Katich family came with us too• 6    Daddy & I went on the bumper cars• 7    We watched some people chop wood• 8    Mummy bought us some fairy floss• 9    Fireworks• 10    Money• 11    We had to buy some tickets• 12    We had something to eat

Sarah’s Storytelling

Sarah’s Storytelling

• 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 BookInside 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

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?

•The wedding day - myself and Pete.

•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

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 and it gives them topics to talk about that they think will interest her

Other Resources• Practical AAC

http://sites.google.com/site/praacticalaac/• AAC Rerc

http://aac-rerc.psu.edu/

• Delicioushttp://www.delicious.com/chacullen/AAC

• Twitter#aacapps #augcomm #TweetAAC #assitivetech #SLPeeps

• FacebookAugmentative Communication Resources and Help

Assistive Technology• http://www.scopevic.org.au/index.php/site/resources/communicationaids

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