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Post by Matteo Anglisani.

Meaningful and Evidence-Based Goals - Part One AAC

When writing communication goals and objectives for learners with complex communication needs one place
to start is the research.  What does it say about the skills needed to be a competent communicator?

In 1988 Janice Light et al wrote of four competencies for AAC users: Linguistic, Operational, Social, and Strategic.  I would add one other for our more involved AAC users - Self-Advocacy.  Breaking down an overall goal to increase communicative competencies into these five parts is a great way to make sure you are addressing all areas of need.

Linguistic: this competency focuses on actual language skills.

• Early Communicator: the goals for these students might be tricky, we want to presume competence while at the same time being sure to build skills that will lead to functional, generative communication beyond requests.  It is never too early to start to build core vocabulary use in our students regardless of their skills so modeling core vocabulary through aided language stimulation is important regardless of skills level.  The early communicator should have access to a more robust vocabulary than just a few objects or pictures of items.  Even if you are working on making a choice between two real items or photographs this should be paired with use of core words.  For example, perhaps your student is working on choosing an activity and you are showing them two items.  Instead of writing a goal that says that the student will make a choice from a field of two write that, "Given a choice of two photographs of items, one of which has just been used and one of which has not been used with the the symbol for "more" attached to the first and the symbol for "different" attached to the second, Jane will choose an item by reaching for it independently three times in a fifteen minute session."  Another idea is to use a voice output communication aide (such as a Big Mac Switch) paired with a core word such as "all done" and write an objective such as, "Given a switch with a voice recording paired with the picture symbol for "all done" Joe will indicate when he is done with an activity following a natural and gestural cue by activating the switch at least four times per day at the completion of an activity."

• Emergent Communicator: this is where we start using early core words such as more, stop, go, like and don't.  We can write out benchmarks in a such a way that we reinforce modeling and teaching of these or other core words such as, "Given her communication system and ongoing aided language stimulation during highly motivating activities, Jane will use two different core words from the following list {more, stop, go, like, don't} to appropriately communicate an idea with no more than one gestural prompt."  As you can see the use of  aided language stimulation and the prompt hierarchy, both best practices, are embedded into the benchmark.  Another goal for an beginning communicator might be, "Given his communication system of 9-12 core words and ongoing aided language stimulation across the school day Joe will communicate for three different purposes (such as greeting, commenting, requesting, labeling, asking and answering questions) during a 20 minute group activity with no more than two indirect verbal cues (hints). 

• Functional Communicator: more skilled communicators this might be a benchmark about combining words into phrases, knowing how to ask different kinds of questions.  As you can see nowhere in these samples are the common "80% accuracy" or in "4 out of 5 trials" because real communication isn't about percentages and real communication doesn't happen in trials.  Real communication is a living and evolving endeavor.  

Social: this competency focuses on social interactions and pragmatics.

• Early Communicator:  For the very early communicator social communication is able creating social closeness.  Some ideas for objectives might be to make eye contact when a new person arrives, to reach out to a communication partner physically or by using a talking switch to gain attention or to engage in joint attention during a play or leisure activity by shifting eye gaze from the activity to the communication partner and back.  Again we must use aided language stimulation and core words with these early communicators.

• Emergent Communicator: this benchmark might be about greeting and taking leave, but there is so much more to social language!  At this level the communicator knows that communication through body language and eye gaze are all about connection as well as getting needs met.  We can move our students beyond this by giving them access to core words such as "like" and "don't like".  An objective might be, "Given his communication system and intensive aided language stimulation, Joe will use the core words, "like" and "don't like" to indicate preferences and opinions in naturally occurring situations across the school day at least three times per week with natural and verbal cues." 

• Functional Communicator:  You can write social benchmarks about making relevant comments, expressing opinions, engaging in conversational turn taking or beginning and terminating topics.  A sample might be, "Given her communication system and visual supports, Jane will make at least three relevant comments about a discussion topic or passage read allow in a 20 minute period with 100% independence" or "Given her communication system used Jane will wait for a response to a question or comment before activating another button at least four times per day with no more than one verbal cue across all settings."

Operational:  this competency focuses on the ability to handle the actual physical use of a system.

• Early Communicator: for the very early communicator operational skills focus physical skills needed to access communication and on building the cognitive connection that whatever means of communication we are offering is meant to be used to share a desire, thought or idea.  For example this might be where we write a goal such as, "Given aided language stimulation of core vocabulary words, Joe will look at the communication display for a minimum of two seconds before looking away at least 10 times per day, across the school day" or "Given a single message voice output communication device paired with a core word symbol Jane will look at the symbol, reach and press down on the switch to activate the message given a light physical cue at least three times in a fifteen minute session, twice per day." 

• Emergent Communicator: for the emergent communicator this is a great place to write benchmarks for accurately linking between pages of a dynamic display device or turning the pages of a communication book for example an objective might read, "Given her communication book and a natural or indirect verbal cue (hint), Jane will independently turn the pages of her book to the page she needs to start or continue her message at least five times per day across all school and community settings."

• Functional Communicator:  For a user with more experience and skill this might be turning up and down the volume at relevant times or alerting an adult when the low battery alert appears. For example, "Given visual supports and direct instruction, Jane will turn up and down the volume on her communication device given natural (i.e. turning it down when entering the library) or indirect verbal cues (i.e. turning up the volume if someone comments they can't hear her) at least twice per week across all school and community settings."

Strategic:  this competency focuses on the ability to notice and fix communication problem, as skill all of us, not just AAC users need to practice!

• Early Communicators: this benchmark might be about gaining attention of a communication partner before communicating a message.  Another idea for a strategic benchmark for this level of user is to start to teach a "none of these" option when offering choices.  So frequently we offer two choices without giving the student a way to say that we are offering the wrong choices.  For an early communicator a "none of these" benchmark might look like this, "Given ongoing modeling and the creation of a choice making opportunity when an item Joe is indicated a desire for through positive affect or visual attention and a choice between two other items and "none of these" symbol, Joe will choose "none of these" by looking at the symbol when the item he desires is not offered at least once per session with gestural and verbal cues." You will of course then need to offer Joe another choice with the preferred item in the array! 

• Emergent Communicators:  Similar to learning to use a "none of these" symbol for early communicators learning to use a "the message I want is not here", "ask me yes or no questions" or "I need a new word/message on my system" is a great place to start for strategic skills for an emergent communicator.  Another important thing to consider as an objective for this level of communicator is frustration toleration for when a communication partner does understand (i.e. not having a meltdown when your communication partner doesn't get it).  

• Functional Communicators: For more advanced users this objective could be about using a message to say, "What I want to say is not here"  and for even more skilled users it might be learning to say "You don't understand" or even a cold, warm, hot system of giving hints to communication partners when a message isn't easily understood.  For an eye gaze device user it might be reminding people not to stand behind her while she communicates (as their eye gaze might interfere with hers).  An example of a benchmark might be, "Given her communication device and an unfamiliar communication partner, Jane will independently use communication repair strategies such as explaining how her communication system words, asking for additional time time compose a message or requesting the communication user give her space as appropriate at least twice per two week data collection period."  Beyond that using hints to tell about a person, place, thing or event that is not on your device. 

Self-Advocacy: this "bonus" competency is a must for alternative communicators with more complex needs.

• Early Communicator:  This learner might focus on a student asking to "stop" before he or she becomes frustrated.  This may take an attuned communication partner who can offer the "stop" sign symbol or switch with symbol before the student is "in the weeds".  

• Emergent Communicator:  this learner might focus on sharing a physical or emotional need.  The student might work on requesting a break, food, drink or hygiene care.  Using a format like, "I am upset because/you can help me by" might be helpful.

• Functional Communicator:  For some students working on communicating, "Don't talk to me like a baby" or "I'm not stupid" might be appropriate.  Additionally it can work on getting physical needs met, like asking to eat, drink or take a break.  For more advanced users it might be about asking for an explanation, giving detailed instructions to meet care needs (get a napkin from the front pocket of my bag and wipe my mouth) or reporting neglect and abuse (something happened on the bus, I was scared) .  The skill set being worked on is the learner identifying, expressing and directing others to meet their needs, physical and emotional.  

AAC Camp Round-Up 2014

Camp Communicate, Maine

Last year I had the time of my life volunteering at Camp Communicate in Maine!  It was inspiring and I learned so much.

AAC camp is a unique opportunity for AAC users and sometimes siblings and families to learn more communication skills and have fun while they do it.  Please recommend an AAC camp near you to your students who qualify!

California

• Building Bridges Camp, overnight camp, children with complex communication needs, ages 5-17

Colorado

• Talking with Technology Camp, overnight camp, AAC users, ages 5-21

Idaho

• AAC Camp, day camp with overnight option, AAC device users, ages 5-21

Maine

• Camp Communicate, overnight family camp/retreat, emergent to fluent device users, ages 8-20

Massachusetts

• Camp Talk2U, day camp, high or low tech AAC users, tweens to teens 
• AAC Communicare, day camp, AAC users

Mississippi

• Camp Jabber Jaw

New Jersey

• Camp Chattervox, overnight family camp, functional to fluent high tech device users, ages 5-16

New York

• CHAT Camp, day camp, AAC device users

North Carolina

• Camp R.E.A.C.H. 

Pennsylvania

• Camp ALEC, overnight literacy camp for AAC users, adolescents 
• ICAN Talk Camp, AAC system users, ages 5-21 

Wisconsin

• Authentic Voices of America Camp, overnight camp, AAC users, ages 12-21 

Also there is the day camp in Portugal at ISAAC Conference!  

In Australia look for Big Mouth Camp and Motor Mouth Camp.

Teaching Core Words with Games

Mad Libs

Mad Libs, the classic fill-in-the-blank game, is a fantastic way to work on parts of speech.  You can do this game using store-bought Mad Libs, Mad Libs or similar type activities from the internet or simply by eliminating words from a story or essay you already have.  It may be helpful to create parts of speech cue cards using the color coding in the AAC system.  If working in a one-to-one or small group situation you can hold up the cue card and ask the student(s) to give you a word matching the category.  In a large class situation it might be ideal to go around the room asking the students to each give a word for the part-of-speech named.  The fun comes in the end when you read back the silly story you have written.

Silly Sentences

A version of this game is available commercially, but it is easy enough to create and play on your own.  You will need to create a sentence grid for each player.  How you create these will depend on the needs of your students, the simples grids would be two squares labeled, “Noun. Verb.”  A higher level grid would be, perhaps, five squares labeled, “Adjective. Noun. Verb. Adjective. Noun.”  You may wish to use symbols on the grids and/or color code the square using the same color coding in the AAC user’s system.  Laminate the grids so they can be written on with dry erase markers.

You will also need a spinner that has the parts of speech used on the grids.  You can use an Ablenet All-Turn-It Spinner, one of the many create your own spinner apps on an iPad, the free interactive spinner available at www.tripico.co.uk or make your own.  You could also use custom dice.

To play the game each player spins the spinner.  If the player spins a part of speech needed for his or her silly sentence then that player names a word to fill in the box that is the correct part of speech.  The player or a helper writes the named word onto the sentence grid.  However, if the student names a word from the wrong part of speech the turn is lost.  If the player spins a part of speech which is not needed the turn is also lost.  The first player to complete their sentence wins the game.  That player, or the whole group, corrects the sentence, filling in noun markers and other missing words as well as correcting verb tense and then the sentence is read aloud.  

Word Hunts

            Word Races

Word races are a fun way to practice finding vocabulary on an AAC system.  This activity works with two or more AAC users, a combination of AAC users and typical peers working on dictionary skills or an AAC user and an adult who is also using an AAC device for the game.  A list of words is preparing, focusing on vocabulary the student needs to learn to locate.  The words can be written on cards, printed out in symbol form or displayed on a computer, mobile device or interactive white board.   Each word is reveled and then the participants race to find the word, AAC users on their device and typical peers in the dictionary.  Two points are awarded for finding the word first and one point for finding the word in general.  The winner is the player with the most points!

Read the Room

Read-the-room is an activity found in many early elementary classrooms.  A variation of this, to promote AAC use, is to play a version where an adult or peer goes around the room and points to an item, for example the door.  The AAC user then finds the word in his or her device.  Another way to play is for the AAC user to have to find a word related to the item which is a named part of speech.  Thus if the word were, “door” and the part of speech was verb the student may “find” the word “go”, “shut” or “slam”. 

Describing Games

            Guess Who?

You can play this with the commercial game, with the commercial game replacing the cards with your own or you can create your own game.  To create your own you need to print out two sets of photographs of people (can be real people in your setting, celebrities or characters of books, etc).   Using a velcro board or similar hang up one set of pictures.  Choose a student to be "it", preferably one who is working on yes/no.  Allow that child to pick a person from the second set of photo cards.  Once chosen the other players ask yes/no questions and the child who is "it" answers.  Students asking the question using AAC can focus asking questions which use descriptions, “Does the person have black hair?” The player who asks the question which narrows the choices down to one option wins and is then “it” for the next round.  Variations include playing "Who Passed the Gas?" using pictures of people in the room and activating a whoopie cushion as a reward for finding out who!  Also using characters from a theme unit or book as the people to guess.

            Guess What?           

This game is played in a similar fashion to guess who only it uses objects instead of people.  You will need two sets of identical objects, photos of objects or symbols of objects.  One student is chosen to be “it” and privately selects chosen object.  The full set of objects (or photos/symbols of objects) is displayed.  The other players, using AAC, then ask questions using describing words to eliminate choices.  Questions might be, “Is it shiny?” or “Is it big?”  The player to successfully eliminate all but one choice is “it” for the next game.

            Magic Bag

For this game you will need a large opaque bag and an assortment of objects.  The adult hides an object in the bag.  Then one player reaches in and handles it without taking it out of the bag.  In the first version of this game the other players ask the child reaching in the bag yes or no questions using their speech devices until they guess what it is.  In the second version of this game the child reaching in the bag creates descriptive statements about the object, such as “It feels cold” and the other players guess what it might be.  You can also play this with the commercial “Ned’s Head” game.

            Where is it?

For this game you need a motivating prize.  One student is chosen to be “it” and hide the prize in the room while all of the other players close their eyes.  No peaking!  Then the players ask the chosen student yes or no questions about the location of the prize.  Adults can help the students focus on using position words such as under and near in their questions.  The student who is able to correct guess where the object is wins the prize. 

Alternate version:  In this version a visual scene of a location is created using paper cut outs on a Velcro background.  The scene might be a classroom, a restaurant, a store or a forest.  A cut out character is also created to go into the scene.  The character might be a cut out photo of a child in the class, a character from a story or a fictional creature like a leprechaun or cupid.  If it were a forest there might be a rock, a tree, a stream, a bush and a stump in the scene.  One child, privately, points to where they will hide the character.  For students who have difficulty remembering it may help to have a picture symbol of each object in the scene so that they can hold it and refer to it as a reminder.  The other players then ask questions to guess where the character is hiding.  So they might ask, “Is he getting wet?” or more directly, “Is he behind a tree?”  The player who guesses correctly gets to be the “hider” during the next game.

Adapting Commercial Games

Many commercial and traditional games can be adapted to make them learning experiences for AAC.  Here are some examples.

Candy Land:  use the colors of the squares to ask students to find parts on speech in their AAC systems.  You can do this by creating new cards to replace those that come with the game, by writing on the included cards or by writing on the squares.  For example drawing a green square means the child has to find an action word on her system. 

Go Fish:  you can create your own cards which feature core AAC vocabulary words on them.  This way students will practice finding core words just to ask, “Do you have a ____?” 

Connect Four:  Label each of the columns on the grid with a word.  (Try printing on re-stick-able labels.)  Students must find the word on their device to drop the piece in that column. 

Stacey's Serve-a-Thon

Every year we hold a Serve-a-Thon in memory of my sister, Stacey. What is a Serve-a-Thon you ask? Basically everyone who wants to donates one hour of their time or one hour's pay to the service agency of their choice.

Stacey, among many other things, a brain injury survivor who spoke for a time using Augmentative and Alternative Communication.  She was generous and helped others.  (She could also be obnoxious and annoying, but I'm her big sister, so I'm supposed to feel that way!)

So far people have donated time or money to the following agencies - though you can pick any charity you want.  We invite you to do the same and tell us about it at the Stacey's Serve-a-Thon website or the comments here.

• NEADS Service Dogs
• Society for Suicide Prevention
• Children of the Night
• Federation for Children with Special Needs
• Nashua Humane Society
• Daily Bread/Boston Food Bank

Why "Prove it with Low Tech First" Doesn't Work

I have student who is only able to use eye gaze for communication.  For years he used a low technology
eye gaze system from a field of two and consistently chose the item on the left.  He did somewhat better if you arranged his two choices vertically, but not much.  Fast forward five years.  He is now using a speech generating device with 25 buttons per page. He can hit the smallest targets I have ever seen on his device, buttons only centimeters in size.  Why can he communicate via eye gaze on an eye tracking device and not using low tech?

Who knows?  It could be that having a person in his space to hold up his choices distracted him.  It could be that he was bored with the two choices he was being given.  It could be that two choices being held up in space did not have a clear enough figure ground for him to visually distinguish them.  It could be because secretly he was saying, "I hate you and your two ridiculous choice cards!" I honestly don't know why he cannot respond accurately to low technology eye gaze choices yet he can communicate on a high technology system.  More over I am not sure it matters.  What matters is that his TEAM at the time, especially his parents and his augmentative and alternative communication specialist decided to try high technology eye gaze anyway.  And thank heavens they did!  AAC through high technology eye gaze changed his whole world.

Access to augmentative and alternative communication is not a hierarchy, though so many of us in the field want it to be.  We want to believe our students will work from using objects to photographs to picture symbols.  We want to believe we start with two choices and move to four and then eight and then sixteen before we try dynamic display.  We desperately want to believe less is more with emergent communicators.

The problem is what if we are wrong?  What if our stubbornness leads to us creating individuals who cannot communicate, not because of their disabilities, but because we never let them!  Because we never gave them the correct tools for them?   Living the least dangerous assumption means that we don't restrict our learners because of our own belief systems.  We assume that they can. We presume competence.  Using a hierarchical system of AAC is not living the least dangerous assumption.  It, instead, is making a very dangerous assumption.  It is assuming that the child in front of you is going to use a prescribed series of steps with mastery at each step sequentially to learn to communicate. (Which, I should note, is NOT how typical communicators develop!)  It also assumes that if the child cannot master a certain step then they cannot go beyond it - EVER. Additionally it assumes that low technology communication skills are transferable to high technology communication - which is not always the case.  Using partner assisted auditory or visual scanning is NOT the same thing as using auditory or visual scanning with a switch.  Using PECS or pointing to pictures or using a "Go Talk" is NOT the same as using a conductive touch screen with dynamic display.  Using eye gaze to look at objects or photos or picture symbols is NOT the same as using an eye tracking computer system. Just because a student can do one does not mean they can do the other and just because a student cannot do one does not mean they cannot do the other!

This hierarchy is our construction as professionals and sometimes it is right.  The worry is that sometimes it is very wrong!  We have so many more tools now that we did when I started in this field.  We have so much more research.  We have research that says that just one or three weeks of intensive aided language stimulation generally increases AAC skills (and we get to have 22 weeks with our students!  Why aren't we embracing this?).  Yet we still "drill and kill" with field of two choices for beginning communicators.

There is so much high tech can do that low tech cannot, such as:

• be explored with visual and auditory feedback independent of a communication partner
• be used to call for someone or say something when you aren't expected to (when your communication partner isn't standing at the ready)
• get immediate feedback visually and auditorially
• access highly motivating games and activities to train access skills
• be completely consistent in response no matter where you are and who you are talking to
• be precisely calibrated just for the individual and his or her best means of access
• allow different means of access depending on the day and the student's status
• be understood by unfamiliar listeners instantly
• instantly create respect in unfamiliar listeners in a way low tech cannot
• a "cool" factor that just can't be beat

There are, of course, many things low tech can do that high tech can't as well, but since I have never, ever heard anyone argue that all AAC users should "prove themselves" on high tech first I am not going to enumerate them here!

Long story short it is time for a new paradigm.  It is time to scrap the hierarchy that is so pervasive in AAC.  It is time to BELIEVE in our students.  It is time to give them a chance.  It is time to allow them a chance to try, really try, high technology AAC even if they haven't "proven themselves" with low technology first!  

Instruct, Model, Practice, Praise

Years ago one of my responsibilities was to help train new paraprofessionals to work in special needs classrooms.  One of the things I would stress was that the way we teach any skill is to instruct, model, practice, praise.  It's so simple really.  How does anyone learn anything?  There is some kind of instruction - usually a person acting as a teacher explaining to the learner. Then the teacher shows the learner how to do the new things. Next the learner tries it themselves, practices, the new skill. Finally the teacher praises what worked in practice and begins again with instructing and modeling what didn't work.

Instruct.
Model.
Practice.
Praise.

Repeat as needed.

We've all learned this way.  Think of learning to tie your shoes or ride a bike or do a task analysis or create an alternative assessment portfolio! Someone told you, "Pick up the laces and cross them..." or "Choose the standard you want to assess...."  They showed you.  Maybe you practiced with hand-over-hand support, maybe you saw samples of the process, maybe you tried it on your own.  When you got it right there was acknowledgement and praise.  (Though in the case of alt-assessment I wouldn't count on it.)

It is such a natural process we don't think about about it.  I wonder, however, why when we are teaching learners with significant special needs we forget that this is how to teach a new skill? Especially when it comes to augmentative and alternative communication!  We often don't instruct much at all and we rarely model.  We skip straight to the practice and sometimes we even turn the practice into testing. Testing has no part in learning.  Testing, if it happens at all, is for after we teach a new skill; after we have instructed, modeled, practiced and praised.

Yet we have all seen this and some of us have done it - the endless testing by drilling the student or asking them to do a task before we explained or showed them how to do it.  I am not sure why we do this.  Maybe it is the never ending drive to collect data at any cost? Maybe it is the crunch for time that happens with feeding and ADLs and everything else that needs to happen?  Maybe we have simply lost touch with the way that teaching looks?

Worse yet some teachers blame the student for failing to learn when they never actually instructed or modeled.  They say the student is "too low".  They say the student "isn't ready".  They say the student "hasn't met mastery".  How can this be if the teacher hasn't taught?

What would it be like in our classrooms if we looked at each task our students are asked to learn and then used this natural way of teaching a skill?  What if we tossed aside our "ask, ask, ask" mentality (which is really testing) and turned to teaching?  What can you do to return to teaching by using the steps of instruct, model, practice and praise?