Does (AAC Button) Size Really Matter?

“Those buttons are so small!”

In the almost 4 years that the Speak for Yourself Augmentative and Alternative Communication (AAC) app has been on the market, this is the feedback that we receive most frequently. Yes, the buttons in Speak for Yourself are small and you can not change the button size.

In case you’re thinking, “Well of course they’re going to try to get people to use smaller buttons…after all, their app has small buttons,” let me answer that. Speak for Yourself has small buttons on purpose. Our experience that students were more successful AAC users when we gave them smaller buttons with compensation for their fine motor challenges and less navigational demands drove the button size in the Speak for Yourself app. However, this post is not only about Speak for Yourself, and in some ways, this post may be more important for those of you who are NOT using Speak for Yourself.

I say that because the size of the buttons in Speak for Yourself is already decided. In other apps, someone has to make a decision about the size of the buttons – and therefore the amount of potential language access- the AAC user is going to have. If you are the “someone,” appreciate that in choosing a button size, you are choosing the quantity of language that you place in that individual’s hands. You are choosing to eliminate or grant access to thousands of words. In that first decision, you are setting the expectation for that learner and beginning to scaffold his/her language foundation. No pressure, right?

If you are not the one who is choosing the button size, it’s important to ask how that decision is being made. Over the years, I have been asked if I could make the buttons bigger (even prior to the iPad and Speak for Yourself) for children with stellar fine motor skills because the aide’s vision wasn’t great and she hadn’t updated her glasses so she couldn’t read the buttons. Sorry, but no. He can see them and use them perfectly.  AAC users are not required to make accommodations at the expense of their communication. We all agree that it’s important for the adults in an AAC user’s life to use and model the AAC system, but selecting a button size shouldn’t be taken lightly.

Let’s do some AAC math.

Since the purpose of this post is to demonstrate a point and not teach inverse relationships and logarithmic calculations, let’s keep it simple. For the examples in this post, all of the buttons are only going to link to one additional page with the same number of buttons. I’m using the Speak for Yourself button measurements for the 120 button information, but for the other measurements, I left a small amount of space for the message window and no space between the buttons. So my measurements for the 60 and 20 button sizes are the largest possible measurements on a full size iPad. Depending on the app you’re using, and how much space is between the buttons or how much space is occupied by borders and toolbars, the buttons may be smaller than the measurements I’m using in this post. **As an important side note, starting with the smallest buttons that the user can access is also applicable for eye gaze users on their eye gaze devices.**

AAC math at the most basic level is that smaller buttons provide access to more language with less page navigation.

When you examine this “equation” with actual numbers, you can see that cutting the number of buttons in half doesn’t cut the language capacity in half; it actually reduces it by 75%!

And if you’re someone who benefits from visuals, here is a graph reflecting the chart above:

Maybe you’re thinking, “Well, yeah, that’s great, but my child/the students I work with have significant fine motor issues and she/they NEED the bigger buttons!”

You’ll also notice that reducing the number of buttons in a grid by half doesn’t double the size of the buttons.On a regular iPad, reducing the number of buttons from 120 to 60 causes the buttons to gain a 0.4 centimeter (2/5 of a centimeter) border. So the question becomes: Is a .4 cm border worth sacrificing the long term potential of an additional 10,800 language-filled buttons?

Here’s the scene we frequently encounter, and you may also:

I am in a conference exhibit hall and Sally Decider (parent or professional) walks up to our booth. She picks up the iPad with confidence. She’s comfortable with AAC and explores Speak for Yourself. She asks questions- intelligent, knowledgeable questions. She’s taking a mental inventory of the students in her life and feature matching in her mind. I’ve been there. I do the same thing every time I look at something new. Could this help any of the students I know?

Sally explores the app a little longer and says, “The buttons are so small! ” or “Can you make the buttons bigger?” Which is usually followed by “My students/child couldn’t use it.” (Either out loud or to herself). If she says it out loud, I go through a quick few items on my have-you-tried-this-list, which is based on compensatory strategies that individuals are using to successfully access Speak for Yourself – despite their “severe fine motor issues.”

If Sally walks away, decisive in her assessment that the buttons are too small for the students to access, she walks away from a large amount of language potential for those students. Possibly, she walks away from providing language that would have sparked their interest in AAC. There’s a chance that she walks away from providing verb conjugations or morphology that her students understand but don’t have a way to express.

Quite a few individuals with moderate to severe motor issues are able to use Speak for Yourself successfully and independently. When asked if we ever intend to give the option to have a grid with larger buttons, I think of them. They are AAC users who would have most likely been given larger buttons, and therefore less language. Would they have been able to access the words that motivated them to use AAC? Would they have been given an entire page of tiny animals? Would they have had access to the word “exceptional”? It’s unlikely.

There are three main reasons, I think, that we are seeing more individuals who have significant fine motor impairment using Speak for Yourself successfully.

1. The decreased navigational demands. When they access a button, it is only linked to one additional screen, so they are able to use motor planning to reduce the visual and motor demands of scanning and then accessing the buttons.

2. There are a lot of students who have fine motor issues who are able to use it because masking a majority of the vocabulary allows them to fine tune their precision. The “dead space” on the screen allows them to be less accurate without activating buttons accidentally. If they’re not able to pull their fingers together to isolate the index finger, the hanging fingers often hit the screen and activate the larger buttons unintentionally bc buttons occupy the entire screen.

3. The presumption of competence. If you look at a child and presume that he has a lot to say, and you need to give him “all of the words,” it’s going to be very important to figure out how to help him access a slightly smaller button to provide the potential for an additional 10,000 words.

Here are some strategies that some individuals have found helpful and some of my have-you-tried-this? suggestions:

• Using a keyguard (others have been very annoyed by this and for students with visual issues, a keyguard sometimes further impairs their vision of the buttons)
• Using an occluder. An occluder is a small piece of card stock (usually black) that has a hole the size of the targeted button cut in it. It blocks off the other buttons for teaching so that the child is able to improve precision by targeting an isolated opening. There’s a great picture and explanation in this post.
• Using a glove with the finger cut out. Only the open finger activates the button. Here’s a  detailed post about that.
• Changing positioning. Putting the device flat and centered in the lap has worked for a couple of students I know personally. For others, putting it off center at an angle towards them has allowed them to be more precise.
• Making sure the user’s core is stabilized. If someone has to worry about their balance, they are generally less accurate and not able to focus on fine motor tasks. Most people can only think about one movement – everything else has to be automatic.
• Color coding. The black background with different colored button backgrounds sometimes helps people to discriminate more successfully.
• Trying a mini. I know it sounds counterproductive but sometimes the smaller screen allows them to brace their fingers on the edge and use their thumbs to access the screen.
• Time. Some of our students with moderate to severe motor limitations take some time to  figure out how to access the device. This child, whose mom writes the Family Synapse blog, and this child , whose mom writes the Star in her Eye blog, come to mind. They’ve been using Speak for Yourself for a year and are putting together 3 word utterances. They started with modeling and difficulty isolating a finger.
• Don’t require use of the index finger. Many AAC users will choose to use the access method that is most reliable. If that happens to be the thumb, middle finger, knuckle, or toe, keep in mind that the end goal is successful, reliable, independent access.
• Using a stylus. If a child can hold something more easily than he control his fingers, see if his use/accuracy improve with a stylus.
• Selecting on release – You can change this in the iPad settings by going to  General>Accesssibility>Touch Accommodations in iOS 9 and above.
• Asking if the child access iPhone buttons? Many times, the people close to the child will talk about how severe the child’s fine motor issues are and how they are using two large buttons for AAC…as the child flips through their dad’s iPhone to access YouTube videos.

Back to our original question: Does AAC Button Size Really Matter? The answer is it matters immensely. Obviously, I’m not saying that Speak for Yourself will work for everyone. However, regardless of the app or device someone is using, let them try to access smaller buttons. Before you limit the amount of language availability, on behalf of the AAC users in your life, let them get their hands on it and see how they compensate or which supports or accommodations may make a difference. You’ll never know unless you try!