We hear a lot of reasons for not beginning high-tech Augmentative and Alternative Communication (AAC) with students who have Complex Communication Needs (CCN)…A LOT of reasons. I’ve chosen the top six and created a flow chart. I like flow charts, but for those of you who do not, I’ve also written a narrative version, with related links.
Cognition Myth: “His/Her cognitive skills are too low to learn to use AAC. The individual has the cognitive skills of a 9 month old. That system is for ‘higher functioning’ kids.”
I am starting with this myth because it is the one that makes the hair on the back of my neck stand up. These statements are demeaning, and I have heard people make comments like this in front of the student. If the individual is not able to communicate at the same level as peers, his/her communication difficulties may be interfering with his/her ability to accurately express intelligence. If this individual is currently using AAC, the system may be too limiting. Research shows that when you expect more from a child, his/her intelligence increases. Give the individual the benefit of a positive self-fulfilling prophecy.
Behavior Myth: “We have to get his/her behaviors under control and then we can consider communication. We don’t want the device to be thrown and damaged.”
If the individual does not have a reliable, effective way to communicate, he/she has no choice but to use behaviors. Appropriate, functional, comprehensive communication is necessary for “appropriate” behavior.
If this individual is currently using AAC, the system may be too limiting.
Proof of desire myth: “We’re waiting for him/her to develop more verbal speech so that we can tell if he/she actually wants to communicate.”
Acknowledge button presses as intentional communication, even if you don’t understand the relevance. Presume competence and give the individual your respect and attention as they learn the power and value of communication.
If the individual does not have access to a large expressive vocabulary, someone else has determined the (frequently small) vocabulary available to him/her. If the limited system insults the individual or doesn’t have what he/she wants to say, it is often ignored.
When you give individuals with complex communication needs (CCN) a system with an extensive vocabulary, you give them the opportunity to explore language and talk about what THEY want, and that can make all the difference. We all enjoy talking to people who share our interests or who are at least willing to listen. It is the foundation of relationships and socialization.
Hierarchy Myth: “He/She can’t use an AAC device unless the individual is able to combine 3 icons in the communication book.”
Get another opinion. Making individuals prove themselves before they are given access to a comprehensive communication system is archaic. If PECs or sign (for a hearing child) are being used, it should be for a brief time as a long term system is evaluated. These systems do not provide auditory feedback and are not universally understood.
Kate Ahern wrote about this and you can link to her blog here. If a professional tells you that your child has to climb a hierarchy and prove that he can use a high tech device, find a new professional.
Motor skills myth: “They need bigger buttons (less language) because their motor skills are too poor for little buttons.”
Is the individual able to purposefully move his/her hand? Is he able to access his mom’s iPhone to get into YouTube?
Use a key guard and/or limit vocabulary on the screen initially to allow for more accurate “hits.” Fine motor skills frequently improve with use of AAC as the child’s language grows. Frequently, key guards improve accuracy more successfully than increasing the button size. This is especially true if the individual is having difficulty with finger isolation. Fingers dragging in the screen will access larger buttons just as readily as the smaller ones. If someone evaluates your child and says he can only access large buttons, ask if a key guard was trialed.
If the individual has severe physical impairments that make them unable to move purposefully, contact device companies that offer eye gaze technology. This technology allows cameras to read individuals eye movements and speak the words that they look at for a certain amount if time. Physical limitations can be challenging and require additional expertise and/or equipment, but they are not a reason to deny access to a comprehensive communication system.
Age Myth: “He/She has to be a certain age before we introduce AAC.” Or, “Wait until kindergarten (2nd grade, middle school, high school…) and then we’ll take a look at AAC.”
Are other people able to say words and use language at this age? If your answer is yes, then the individual is a candidate for AAC. If your baby is at risk for speech or language delays or there is any indication that speech may be delayed/difficult for this baby (I.e. No cooing or babbling, diagnosis, surgeries, traumatic or premature birth…), start modeling as soon as you’re concerned. Keep in mind that babies are immersed in language immediately, but it takes them two years to start putting words together.
Whether you are concerned or not, play and talk to your baby. Narrate your actions: explain what you’re doing and why. Respond when he/she vocalizes. Cherish his/her words and enjoy the beautiful phenomenon of language development that so many take for granted.
Monitor speech milestones. If your baby regresses or begins missing milestones, don’t “wait and see”… Introduce AAC as soon as you notice your child’s frustration or regression. AAC use will support – NOT inhibit- verbal speech development.
Enough Verbal Speech Myth: “He/She has enough verbal speech and can say sentences so the individual doesn’t need AAC.”
This one isn’t on the flow chart because, well, the flow chart was getting a little crowded.
Individuals with verbal speech may also be AAC candidates. If a child is only able to say the same scripted, limited sentences (“I want a cookie please.” “I want computer please.” “I watch Sponge Bob.”), he/she may be having difficulty segmenting where one word starts and another ends. In essence, he may be handling each of those sentences like one big, long word. The benefit of being able to segment words is that they can then be re-combined to form novel utterances.
Some individuals who express themselves very well verbally may have times (I.e. following seizures or when they’re exhausted or sick) when they are not able to speak verbally. AAC is appropriate and beneficial for these individuals to allow them to have a voice when they are at their most vulnerable.
Symbol representation myth: “He/She has to understand symbol representation before we can introduce AAC.”
This is also not on the flow chart, but it’s worth mentioning. Symbols are abstract to everyone. We learn their meaning through exposure and experience. If you want a child to have symbol representation, use AAC. If she loves to play ball and every time she touches the ball and the device says “ball” and someone throws a ball to her, she’ll start to understand the representation of that symbol and use it functionally.
The bottom line is: Individuals are candidates for high-tech AAC if they are not able to express wants, needs, ideas, thoughts, questions, fears, and pain to whoever they want, whenever they want.
High tech, comprehensive AAC provides the means to: express cognition, replace behaviors with appropriate communication, and initiate conversations about self-selected (and sometimes surprising!) topics – which then leads to an increased interest in true, meaningful communication. There is no age requirement to start modeling and immersing a child in AAC. AAC WILL NOT HINDER A CHILD’S VERBAL SPEECH. The consistent auditory feedback provides a model and reduced pressure frequently improve verbal speech skills. Often, a “side effect” of AAC use is the improvement of fine motor skills and attention, driven by the motivation to communicate.
Communication is a basic human right, and there is no pre-requisite skill that justifies delaying access to that right. On the contrary, communication IS the pre-requisite skill to academic, social, and behavioral success.
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