AAC Modeling Part 1: A Piece of Cake and a Bite of Broccoli

If you are at all familiar with augmentative and alternative communication (AAC) implementation, you have likely heard of modeling, also referred to as aided language input and aided language stimulation. In my daily conversations, I get the feeling that dedicated teachers, parents, and therapists often have the misconception that they’re not doing enough for their AAC user if they “just model.” If the child doesn’t join in quickly and begin using the device independently, they feel as if it’s not working.

There is a comparison that’s frequently stated in AAC groups online that we speak to typical children for a year before we expect them to say anything back to us. We immerse new language learners in language and talk to them with the expectation that they’re taking it all in, and eventually, when they’re ready, they’ll begin using language. For the most part, that analogy works. We need to give children time and exposure to language before we expect them to use it.

There are two major differences when comparing a new baby’s acquisition of language to a child who has complex communication needs learning to develop language through the use of AAC.  These differences are important to consider when we’re modeling for AAC users.

First, for typically developing children, language is easy. We talk to babies and there’s all of this neurological “magic” that happens, and they pretty effortlessly start talking. Unless there is cause for concern, verbal speech development is taken for granted. Ask any parent of a typically developing toddler how they taught their child to talk, and the likely response will be a confused look and something along the lines of “They just did it.” It’s like saying you had to teach your child to eat cake. As soon as you give a child a taste of icing, they dive in for more. Children have an evidence-based innate liking for sweetness.* You don’t have to teach a child to like it. For typically developing children, speech and language are “a piece of cake.”

For learners with CCN, language expression and production is not easy. In keeping with the food analogy, it more closely resembles learning to like broccoli.  It takes exposure, encouragement and persistence to get a child to even try it in many cases.

Another key difference between a child with complex communication needs (CCN) and a new baby acquiring language is that the child with CCN has spent their entire life taking in the language, but without a way to express their knowledge to the world. They’ve had more experience in sheer time listening to language around them. For learners with CCN, language expression and production are not easy.

Parents and/or professionals want results quickly and are often not willing to wait a year for the child to say his first words on a device. An AAC evaluation is frequently completed during one meeting with the student. An average device trial period following an AAC evaluation is 4-6 weeks. In that short time, evaluators are supposed to be able to write an addendum and document progress with examples of language growth for a new AAC user to substantiate that the child is worthy of full time, permanent access to language (sarcasm intended).

I am impressed by how many AAC users I’ve known over the years who start using their devices relatively immediately. AAC users have extra years of experience listening to language and waiting for the words so that they can finally tell the people in their lives their wants, needs, ideas, thoughts, opinions, and feelings. Some jump in eagerly, reading the words and putting them together during the evaluation, screaming to even the most stringent gatekeepers, “Give me language! I am capable!”

But what about the students who aren’t eager to prove themselves to a stranger? What about the experiential learners who need to learn through exploration and responses, but have never had the ability to produce language? Students with CCN are individuals with their own personalities, idiosyncrasies, preferences, and dislikes. If they’re not given the time and opportunity to learn to express them, we risk losing the chance to know them better.

Modeling is important for all AAC users, but for the more reluctant students, it’s crucial. For these students, OUR understanding of the purposes and expectations of providing aided language input on an AAC device is the difference between communication and frustration for that individual. When we have a strong belief in our own actions and intentions, we take the burden of proving competence off of the learner and place it on ourselves. We are responsible for finding a way to engage the child. We have to provide enough input that the student feels valued and confident. We have to prove that we are worth the work it takes to learn to use an AAC device to communicate. We have to convince them to take a (metaphorical) bite of broccoli, until they learn to like it enough that they pick it up on their own.

To continue with the food analogy, one of the keys to having a child develop a palate that accepts a variety of foods is persistent exposure. When explaining aided language input to new “modelers,” one of the questions that’s often asked is “What if they’re not paying attention?” The answer is that they are. You’ll see.

Part two of this post will describe different layers of modeling attention and engagement, along with some example videos, a graphic, and a mnemonic device.

*Feeding research citations:

1. Benton D (2004). Role of parents in the determination of the food preferences of children and the development of obesity. International Journal of Obesity 28:858-869.

2. Wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham A, Lawson M (2003). Increasing children’s acceptance of vegetables; a randomized trial of parent-led exposure. Appetite 40(2):155-162.

3. Wind M, de Bourdeaudhuij I, te Velde SJ, Sandvik C, Due P, Klepp KI, Brug J (2006). Correlates of fruit and vegetable consumption among 11-year-old Belgian-Flemish and Dutch schoolchildren. Journal of Nutrition Education and Behavior 38(4):211-221.