Sunday, August 5, 2012

In AAC it matters little what church you belong to, as long as you BELIEVE!

I spent the past week at the International Society for Augmentative and Alternative Communication Biannual Conference, held this year in Pittsburgh, PA (and in 2014 it will be in Portugal).  I learned a lot and enjoyed my time meeting people I had only known online before then.  A few days into the conference, however, I started joking that we all needed color coded dots on our name tags as shorthand to tell others which "church" of AAC we have joined.

What I mean is that people who believe dogmatically in a certain system of AAC (or device or symbols) to the exclusion of others and are such fervent believers that they appear to belong to a sect or a very demanding church.  Some people needed green dot because of their belief in Facilitated Communication (now sometimes called supported typing) while others needed a red dot because of their belief in PODD (Pragmatic Organization for Dynamic Display).  Still others needed other color dots for Visual Scene Displays, MinSpeak/Unity, Word Power, and Bliss Symbolics.  Of course there were also people who needed some identification to show that it was a specific hardware or system they followed, the PRC people (and correspondingly MinSpeak/Unity/LAMP), the Dynavox folks, etc.  And then there where those who needed some kind of mark to show they followed a personality more so than anything else, Bruce Baker, Gayle Porter and Janice Light (to name only a very small few).

There is nothing wrong with believing strongly in any of these "churches" of thought in AAC.  All these people and the people behind all of these systems are trying to do good.  They believe in the power of augmentative and alternative communication.

The problem seems to come when followers of any of these believe in them so ardently that they cannot allow for the fact that there are other ways of doing things.  The problem increases when we in the field push one means or method of AAC over another merely because it is what we know well, it is the church we belong to, at the exclusion of systems or supports that may be more suited to the situation at hand.  Additionally, proselytizing our own churches of AAC to parents and future AAC users can give the false impression that the system, symbols or device are more important than how we implement it.

Families and future AAC users are frequently lead to believe that if we just, "get it right" with the selection of a system, device or symbols then communication will happen, like magic.  This isn't true.  Learning to be an efficient and functional AAC user takes years and years of instruction and hard work.  Professionals bemoan families who will not use AAC systems or devices at home, but we don't spend much time looking at how our actions created this reality.  We, usually without meaning to, create the idea that getting the system is the cure, then we fail to follow best practice in implementation.  Truthfully, communication success with AAC depends much more on implementation than anything else, on how we teach and present AAC.

If we moved our focus from our "churches" to how we implement AAC, no matter which system, device or symbols, we would see more competent communication users and less abandoned devices.

Some suggestions:

Before anything else, as I was reminded in the comments, but should always state - Presume Competence! There is no such thing as "too low to communicate".

  • Create a language rich environment - label everything, not just with the symbol for the thing but also with sentence strips using core vocabulary, so instead of the symbol for "light switch" by the light switch but a sentence strip of "Turn the light on" over the switch and "Turn the light off" under the switch.  Then model by pointing to each word on the label, and if possible in the communication system, EVERY time you use it.  Use visual schedules.  Model, model, model these adaptations ALL THE TIME.

  • Train all those who work with students who use AAC, including professionals outside special education and speech such as PT and OT as well as parents, siblings and peers in implementation techniques

  • Use more symbols not less, assuming you should "start small" seems obvious, but with only 4, 6, 8 or 10 symbols there is not much to say and little to model.  Start with a larger vocabulary for best results.

  • Aided Language Stimulation is a must - all those involved in implementation MUST consistently and constantly model the use of the communication system (no matter which communication system)
    • you can do this by using the student's device yourself and having others use it
    • you can do this with wall charts 
    • you can do this with another system or device for the adult to use to model
    • you can do this with a printed version of a higher-tech system
    • you can do this with an ELMO camera placed over a low or high tech device
    • you can do this in so many other ways, your imagination is the only limit
    • using Aided Language Stimulation will slow the teacher/therapist/communication partner down, increasing time for verbal processing
    • think of Aided Language Stimulation as "Immersion", everyone agrees that immersion is the best way to learn a foreign language, creating an immersion environment for AAC is also the best way to learn Augmented Communication
  • Zip your lips and wait.  Nothing is more important than quieting yourself and allowing an AAC user to listen, think, form a message and respond.  I will say it again, ZIP your lips and WAIT!
  • Use the "expectant pause" during conversations, when it is the AAC users turn to participate, learn forward, keep your eyes kindly on the user, look ready but patient and BE QUIET.
  • After the message use re-casting to edit the user's message - If the child makes the message, "I good." You re-cast it by saying, "I am good."  (This one comes naturally to moms and those who spend time with small children.)  
  • Ask open ended questions to expand, "I think you are good.  Why do you think you are good?"
  • Respond to every communication attempt - even if it is just to say you heard him or her and the answer is no.  
  • Assume intentionality to teach intentionality.  One of the worse things we can possibly do is doubt the child's communication.  How many times have you heard someone say, "I don't think he meant that", right in front of the student?  We must assume that all communication is purposeful for the child to learn that communication is a worthwhile endeavor.  
  • Make sure the device or system is always available, how else will the user learn how important and valuable it is if we don't go through that trouble?
  • You are not the blue fairy, you do no good to anyone by magically reading an AAC users mind and providing everything they need whether they ask or not.  (Yes, maybe you are his or her mother, but how would you like it if YOUR mother tried to read YOUR mind?)  Learn to step back and wait for requests, if you must take action then model how to request on the user's device before you do
  • Have a low tech back up to high tech systems, and teach how to use that too
  • Beyond all else, BELIEVE!  Believe in the power of AAC.  Believe in your power to give the gift of communication.  BELIEVE that your student or child can learn how to communicate.
Can I get an, "Amen"?

P.S.  I had many, many conversations with and watched many presentation by teenagers and adults who use AAC fluently at the ISAAC conference.  Some used Words+, some used RollTalks, some used Toby Churchill Lightwriters, Some used PODD, some used Dynavox, some used iPads, some used Tobii C-eye and many used PRC devices.  I even watched a girl at the airport use her Dynavox to ask her father a million and one questions about their holiday in New York after the conference.  There is NO such thing as one size fits all in AAC. 


  1. As a proud Aherniac, a true believer in the Church of Kate, I reckon that this flavor of AAC religion values independent thinking and criticism.

    So here I can utter that our most respected priest this time failed terribly by not listing the first commandment, the over and over repeated precept to PRESUME COMPETENCE whenever interacting with an AAC user.

    After this being said, I give you an


  2. I love this post! I would like to make copies of it and distribute it to all the support people (therapists, teachers, etc.) that we've encountered in the past and to the ones we are working with now.
    I will give you and "Amen" and then some!
    I follow you on Facebook but are you on Twitter as well?
    Thanks for sharing,
    Stacey (More Than Words)

  3. By all means print and share, and link and share. I am on twitter but don't post much there. I kind of "don't get" twitter (the techie in me does not like to admit that).

  4. Great post, Kate. I'll tweet it out as I'm more of a twitter user than a FB user.

  5. Another AMEN here! Nicely written Kate!! You're the bomb!!!!

  6. As a parent new to AAC, I am thrilled to see these helpful hints! Thanks for posting

  7. AMEN!
    I had this same observation about all therapy streams early on in my experience raising a child with complex needs. In some respects it can be a powerful good - people believing in their niche passionately and advocating strongly. But in so many cases it was a negative for me - being 'dropped' by a physio for trying something they didn't support; being shunned for not 'complying' with the advice to use AFOs; struggling to access AAC with switching for a child who has severe dystonia but great vision - we're moving on to eye gaze now, etc.
    Most people 'inherit' their religion from their parents without making a deliberate choice to follow it. This seems to happen with families and therapy choices - we inherit from a therapist because it's what they know and believe in. These decisions are often being made during those crucial early intervention years when therapy can have the biggest impact but parents are still in shock about the diagnosis and learning how to navigate the system and advocate for their child. During these years we need balanced information to help us weigh up the pros and cons of these decisions - not just the 'trust me - I studied this at school and you didn't' attitude I get so often.
    My plea to all therapists - hold your convictions gently and be open to discussing why a family might consider another approach for their individual child and be willing to refer to another person for input.
    Thanks for creating the discussion Kate!

  8. Amen!

    (I'm finally getting a handle on the twitter thing! @SpecialAppsSK )

  9. Amen. I would like to add everyone communicates and the earlier that people are given options the better. Also I would add that when learning a different language in High school it is taught 5 days a week one period a day. Some how we feel students with multiple needs can learn AAC in so much less time. We don't go into their environment to support them to communicate there. We get them out of class to a speech room away from peers and the classroom activity.

  10. How did I miss this fantastic post, Kate?! Yes, yes, yes! And gay's comment about how we teach language to typical kids in high school yet expecting students with multiple needs to just kind of "pick it up?" SPOT.ON!


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