Recognition and Response:
Applications for
Augmentative Communication
in Preschool Settings
Sandra M. Grether, Ph.D.
[email protected]
Cincinnati Children’s Hospital Medical Center
Developmental and Behavioral Pediatrics
University of Cincinnati
Objectives for Session
• Describe tiers of Response to
Intervention (RTI) and
application to Recognition and
Response (R&R)
• Identify roles of SLP in
relationship to R&R and the
use of AAC in the preschool
classroom
• Discuss strategies to support
preschool children using AAC
systems
Impact of Diagnosis
Cognition/language
High
Motor Severe
Issues
Mild
Low
Why Do We Communicate?
Behavior Regulation
• Requesting
Objects
• Requesting
Actions
• Protesting
Wetherby,
Cain,Yonklas, and
Walker, 1988
Why Do We Communicate?
Social Interaction
• Requesting Social
Routines
• Showing Off
• Greeting
• Calling
• Acknowledgement
• Requesting
Permission
Wetherby, Cain,Yonklas,
and Walker, 1988
Why Do We Communicate?
Joint Attention
• Commenting
• Asking for
Information
• Clarification
Information
Wetherby, Cain, Yonklas,
and Walker, 1988
Ways to Communicate
• Eye Gaze/Facial
•
Expression
• Vocalization
•
• Speech
•
• Gestures/Sign
Language
• Writing
• Pointing to: object,
photograph, line
drawing, symbol
Speech Generating Device
(SGD)
Cell phone (calling/texting)
Mobile technologies
– Apple’s iOS, iPhone,
iPod touch, iPad
– Google’s Android
– HP/Palm’s Web OS
– Microsoft’s Windows 7
and 7 Mobile
Families & Teachers Have Questions
• Do some AAC techniques discourage
speech development?
• How much emphasis and time should we
devote to working on AAC approaches?
• What technology is worth investing in?
When?
• What are the most effective kinds of AAC
treatment approaches for my child with
severe communication issues?
• Who can help?
Families and Teachers …..
….. Need to feel comfortable that we are not
trying to substitute for the normal
development of speech and language.
There is no documentation to support that
AAC reduces an individual’s motivation to
verbally communicate or develop speech.
Millar, Light, Schlosser, 2006
Augmented communication does not hinder, &
actually aides, speech production abilities in
young children with developmental delays.
Romski, Sevcik, Adamson et al, 2010
Challenge
• To help your preschooler “communicate”
effectively and to express novel ideas
using their native language
• To help develop socially effective
communication across settings
• To find communication tools that will
help preschooler learn language
(including literacy skills)
• To communicate efficiently and
QUICKLY in all situations.
Communicative Competence
The goals of
communicative
competence are
similar whether
one uses natural
speech or
augmented means
to communicate.
Light, 1989
Communicative Competence
Intrinsic Factors Light, 1989
Factors
Specific Aspects
• Knowledge,
Judgment, and
skills
•
•
•
•
Linguistic
Operational
Social
Strategic
• Psychosocial
factors
•
•
•
•
Motivation
Attitude toward AAC
Confidence
Resilience
Communication Competence
Extrinsic Factors Light, 1989
Factors
Specific Aspects
• Communication
Demands
• Social Roles
• Interaction Goals
• Environmental
Barriers and/or
Supports
•
•
•
•
•
Policy
Practice
Attitude
Knowledge
Skill
“Language Code” Skills Needed
Nelson, 1992
• How to use AAC symbols or pictures to
represent meaning
• How to combine symbols to express more
complex ideas
• Need system that allows flexible shifting
among strategies, with the ability to call on a
variety of semantic (vocabulary), syntactic
grammar), cognitive, and social interaction
skills.
• An individual needs more than a limited set
of knowledge and skills to communicate
effectively
Response to Intervention (RTI)
Fuchs & Fuchs, 2001
• Multi-tiered intervention approach
– Universal screening
– Progress monitoring
– Identification of individual students struggling
in classroom
• Need to identify supports for successful learning
• Interventions more intense as student moves
across tiers
• Recognition and Response Project uses this
multi-tiered model in the preschool setting
Recognition
& Response
(RTI) Model
Further testing
More intensive,
individualized
approaches
Classroom intervention- effective instructional
practices
Strategies require minimal adjustments to classroom
routines
Monitor identified students
Collect data – track progress
Screening, Monitoring, Identifying Struggling Students
Determine if whole class needs modification
Universal Design Principles
Indicators of Success in
Inclusive Classrooms
Soto, Muller, Hunt, Goetz, 2001
• Ownership of the student by the general
educator
• Collaborative teaming
• Appropriate training
• Presence of an effective instructional assistant
• Natural supports from classmates
• Social interaction between the focus student
and peers
• Academic participation by the focus student
Indicators of Success in
Inclusive Classrooms
Soto, Muller, Hunt, Goetz, 2001
•
•
•
•
Successful use of the device
Supports and services in place
Focus-student membership and belonging
Classroom structure that supports the learning
and participation of a heterogeneous classroom
• Philosophical support of inclusive education at
the school district level
• Adequate classroom support
Tier One AAC Services
• Delivered in the classroom, speech/language
pathologist (SLP) and/or teacher are initially
screening to determine who is at risk
• Instructional team charged with improving
instructional environment before further
student referral
– Improve overall quality of the classroom
– AAC based interventions can benefit every
student in the classroom - many students are
visual learners and may benefit from symbolbased/picture support for instruction
Tier One
Language Rich Environments
Justice, 2004
1. Experience language frequently and in
various contexts
2. Use across all activities – exposing children to
new vocabulary/language use
3. Increase opportunities to use language
4. Teach many different words/word types and
sentence types across a variety of situations
and activities
5. Recognize and validate children’s
communicative attempts
Tier One AAC Interventions
What are you already doing as best
practice for all students??
Circle Time/Morning Meeting
• Counting
– Days of the week, month, days already in
school
– Use calendar as visual support
– Paper clips used – small for ones; large
for tens; giant clip for “100”
– 100’s chart to count by 5’s, 10’s
Circle Time
(continued)
• Weather – move spin arrow to point to day’s
weather (symbols, photos), dress paper doll on
bulletin board, make graph of weather for
month
• Name – sing song, match first and last name,
find name (on carpet square, wall board, job
chart) – words only or with picture/photo cue
• Finger plays – choose verbal or from picture
board
• Daily Schedule – use symbols/words organize on
bulletin board, middle of gathering circle to put
day’s events in order
Tier Two AAC Services
• Typically provided in the classroom with SLP
collaboratively problem solving with
classroom teacher to design a
supplementary, diagnostic instructional trial
tailored to the needs of the student (Fuchs &
Fuchs, 2007)
• Classroom teacher can receive additional
support ranging from professional
development to support from other
educational professionals to provide
intervention and/or monitor progress.
Tier Two AAC Services
• Identify response modes needed for each
educational task by students using AAC
– Vocalizations/Verbalizations/Approximations
– Pointing to pictures, words, letters
– Gestures/Sign language
– Speech generating device/computer
• SLP and teacher (and IEP team) work
collaboratively on plan (i.e. break down tasks
to maximize participation of student using AAC)
• Preschool setting - choice making, creating,
interacting, playing, discovering
Engineering the Environment
• Create communication
opportunities thoughtfully
and deliberately
• Identify what is motivating to
the child with CCN
• Set up the situation so the
child with CCN has to
communicate (e.g. using
AAC) to complete the
activity, find an object, or
correct a problem
(“environmental sabotage”).
Tier Three AAC Services
• IEP contains AAC specific goals
• Important for classroom teacher and SLP to
collaborate and determine level of support
needed for each child in the classroom
• Child may receive “traditional” pull-out therapy
to teach specific concepts and use of low tech
communication board/system or speech
generating device
• Immediately incorporate concepts/techniques
taught during pull-out back into the
classroom setting to benefit all learners
Tiers for Reading a Book??
Tier 1
• Students will predict a pattern in a story.
• Student will recognize basic sight words.
• Students will respond to simple questions about
the story.
Tier 2
• Students will engage in the story and predict
events.
• Students will point to pictures in response to
simple questions related to the story.
Tier 3
• Students will activate a talking switch with
repeated text with visual cues.
Child Play Theme
Students with ASD
Cafiero, 2005
• Difficulties with motor planning (affects
pointing)
• Do not always understand what is spoken to
them
• Sometimes have great difficulty speaking
meaningfully (e.g. may be able to repeat entire
commercial but not tell you what they want to
watch)
• AAC helps clarify or add information to speech
and gestures/signs
• AAC helps increase language by increasing
vocabulary: include verbs, descriptors,
exclamatory comments, in addition to
nouns/object words
Behaviors Are Also Communication
- Tiered approach to intervention
• Interpret behaviors as having communicative
intent
• Shape into more acceptable forms if needed
• Keep a communication diary of all child’s
gestures or ways to indicate what he/she
wants so all their communication partners will
know and recognize them
• Consider non-symbolic (objects/gestures) if
child isn’t ready for symbolic
(pictures/symbols)
Communicative
Function
Requests Objects
Requests Info
Asks questions
Answers yes/no
questions
Answers wh
questions
Social Exchanges
(compliments)
Protests
Statements/
Stories/Shares
experiences.
Gives Feedback
(Too hard.)
Does
not
comm
Ges
ture/
sign
Points Points Vocali
to
To
zation
object picture
Verba Speech
lizes Gen.
Device
Behavior Regulation
Aided Language Stimulation
• Natural Aided Language (NAL) (Goossens,
Crain, & Elder, 1992; Cafiero, 1995)
• System for Augmenting Language (SAL)
(Romski & Sevcik, 1996)
• Model use of communication board
receptively & expressively
• All communicative attempts are
acknowledged and responded to
• Speech paired with pointing to visual symbols
(e.g. introducing a “second language”)
Modeling Social Interaction
Exchange
Plan: Identify Environment
• Identify where communication board or
device will be initially used
• Introduce during familiar routines that
provide opportunities for frequent
communicative attempts (e.g. circle time,
snack, free choice)
• Need to be generally positive
opportunities
• Elicit natural response from
communication partner
Plan: Identify Vocabulary
• Need vocabulary appropriate to the
learner and environment
• Words and phrases are age and
developmentally appropriate
• Words and phrases are meaningful and
motivating to the learner
• Words and phrases serve an identifiable
communicative function (e.g.
requesting, greeting, protesting,
commenting, questioning)
Determine Methods of Access to
AAC Systems
• Consider physical abilities
• Access methods may vary
on the activity
• Make sure view of activity is
not blocked by the
communication system
• Make sure access to
communication display also
helps participation
opportunities with peers
and/or materials
Low Tech Displays
• Make them FUN and EASY to use.
• Make displays activity-based and
MEANINGFUL to the student.
• Don’t get hung up on nouns! Verbs and
descriptors are important!
• Represent and organize vocabulary
meaningfully.
• Vocabulary should give the student a way to
control activities and people.
• Provide SOCIAL vocabulary.
• Provide access to a larger vocabulary than you
expect the student to use for modeling.
Topic Specific Activity Overlays for
Learning Centers
Organizing a Vocabulary System
Beukelman & Mirenda, 2005
Linguistic organization – Modified Fitzgerald
Key
• left to right linguistic order
• arranged in classes according to their typical
position in a sentence
• color coded
• questions (purple), followed by people
(yellow), action words (green), descriptors
(blue), and finally object nouns (orange),
(social/phrases – pink)
Child Play Theme
Increasing Vocabulary
• Increase number of symbols in single
field
• Increase number of overlays/pages
• Increase types of words – pronouns,
verbs, adjectives/descriptors, prepositions
• Increase morphological markers –
tense (“ing”, “ed”), plural (“s”), possessive
(“s”)
Core versus Fringe Vocabulary –
Need a Mix of Both!
Core
• Highly functional words and/or common
words and phrases (e.g. me/you, want, stop,
more)
• Items related to basic needs or short social
messages (e.g. help, no, hi/bye)
Fringe
• Words are specific to the content of a lesson
or activity or related to a specific topic (e.g.
baseball, book, recess/playground)
• May be specific to particular individuals
What core and fringe
words would tell this story?
If You Give a Mouse a Cookie
Visual Scenes Add Context
Training Strategies – Light Cueing
• Shadow light cueing - designed to help
child select message more independently
– Constant/flashing light cue
– Pause - momentary light cue
– Search light cue - cues when to use SGD
• Prompt hierarchy - does child need cue
because he has not yet learned the
message to use or doesn’t recognize the
corresponding symbol/picture yet?
Levels of Cueing
Light, Roberts, Dimarco, Greiner, 1998
• Move from least support to most support –
try to provide only support that is needed
• Insert pause time (4-5 seconds) before
using prompt (consider child’s attention
span, motor planning abilities, & moods)
• Allow child time to scan pictures and
choose one that is most appropriate
• Physical over verbal (e.g. light vs. physical
point; general vs. specific; row vs. symbol)
Allow Learner to Explore
• Give opportunities
for child to
independently
explore any
communication
device or system.
• We learn through
play and
exploration!
Literacy Outcomes
Light & McNaughton, 2007
• Learners with complex communication
needs often have poor reading and
writing outcomes
• Historically many have been excluded
from literacy instruction
• Most literacy curricula require learners to
say words and letters sounds out loud
Literacy Learning
• Opportunities to
interact with other
students/adults
• Repeated learning
opportunities
• Early access to a
keyboard
• Work towards
independence
Phonological Awareness
• Use speech generating device or
computer when child cannot practice
using his speech
• Use keyboard or pages with practice
words
– Sound blending (c-a-t = cat)
– Phoneme segmentation (cat = c+a+t)
– Rhyming (bat, rat, hat)
Vocabulary
• Help child learn
new words by
connecting to
background
knowledge (what
they already know)
• Activities should be
fun and interactive
Soto & Zangari, 2009
Literacy Instruction Curriculum
Light & McNaughton, 2009 http://aacliteracy.psu.edu
• Literacy Instruction for Individuals with Autism,
Cerebral Palsy, Down syndrome, & Other
Disabilities
• Specially designed for learners who have
difficulty using speech to communicate
• Identifies skills learners need to participate in the
curriculum
• Targets: language skills; phonological awareness
skills; letter-sound correspondences, decoding
skills & application of decoding, sight word
recognition, reading/understanding simple texts
Writing
• Make sure items are easily accessible
• Place markers and crayons in holders
• Try computer programs:
– Kid Pix 4 by The Learning Company
– Communicate: Symwriter by Widgit
– Boardmaker Symbolate
– Kidspiration by Inspiration Software, Inc.
• Investigate apps for writing
• Use keyboard and blank screen for early
scribbling
Writing with Symbols 2000
by Mayer-Johnson, Inc.
Discontinued – replaced by Communicate Symwriter
Boardmaker Plus developed new program called Symbolate.
The Importance of a Plan
AAC Participation Plan is the “action plan”
- integrated with the school curriculum.
• Defines daily activities
• Establishes communication needs pragmatic (social) and vocabulary
• Establishes augmentative communication
options if needed
• Defines supports
Plans need to be fluid and change
throughout the course of treatm ent
and intervention!
Participation Plan
ACTIVITY
HALLWAY/
HOME
ROOM/
OPENING
ACTIVITIES M-F
TIME:
CLASS:
DAYS:
TIME:
IEP
GOALS
EXPECTATION OF
TYPICAL
STUDENT
EXPECTATION OF
________
ASSISTIVE
TECH
LOW
HIGH
PEER
STRATEGIES/SUPPORTS
I AIDE/
PARENT RESOURCE
TEACHER
TEACHER/
SLP/OT/PT
Identify
Activities/Environments
• Identify routines or activities that occur
throughout each day – include both
academic and social (e.g. circle
time/morning routine, snack, recess,
science, reading, writing, math)
• Identify IEP goals that can be addressed
(and documented) during this activity.
AAC Goals - Linguistic
• Independent
– Understands and uses morphological endings to
denote time concepts (past “ed”/present “ing”
– Produces messages with increased
length/complexity (i.e. different sentence forms;
questions)
• Context Dependent
– Understands and uses descriptive words
(adjectives) to clarify nouns
– Able to denote more than one
• Emergent
– reliable choice making; single button messages
AAC Goals - Operational
• Independent
– Stores customized messages, & sequences with
writing/spelling support
– Beginning to use invented spelling and word
prediction on keyboard page
• Context Dependent
– Selection of page back button with consistent
location of all pages
– Programming participation (symbol and
message selection with choice
• Emergent
– carrying own device; turning device on/off
AAC Goals - Social
• Independent
– Requests clarification
– Use of partner focused questioning to continue
conversation
• Context Dependent
– Spontaneous greeting and farewells with
navigation
– Asks partner focused questions
• Emergent
– demonstrates turn-taking; requests motivating
activities/objects
AAC Goals – Strategic
• Independent
– Chooses appropriate message/strategy to signal
a communication breakdown
– Signals a topic change with appropriate message
• Context Dependent
– Selects message to signal a misunderstood
message (i.e. Let me tell you another way.)
– Utilizes 1 or more strategies to repair
misunderstanding (i.e. rephrases message)
• Emergent
– Cause & effect; gains partners attention;
introduces self when appropriate
Expectations for Students
• Identify expectations for other students in
the classroom for this activity.
• Match the expectations of your student as
closely as possible to what the other
students will be doing during this activity.
• Accommodations (number, low tech, high
tech) should level the playing field.
Low Tech vs. High Tech
• Low tech includes
gestures, signs, and
vocalizations
• Low tech
communication boards
developed as back-up
when high tech is not
available
• Balance speed versus
flexibility of message
Support Persons/Partners
• Peers are powerful mentors and partners
• Train team members to program and use
the speech generating device (SGD) –
determine primary (back-up)
• One team member may be primary
contact with manufacturer or go-to person
when SGD not working properly
• Data collection on goals – revise when
needed
Partner Training
• Pause and wait for student to construct the
message. Be patient. It might take
awhile. (10 second rule)
• Don’t feel you have to keep talking all the
time. Teach a slower rhythm for
exchanging information.
• Give student an opportunity to ask
questions or make comments.
Partner Training
• Interact at eye level if at all possible. Grab a
chair if partner is in a wheelchair. Pay
attention to facial expressions and gestures.
• Be honest. If you don’t understand the
message - admit it. Ask them to repeat or
provide more information to clarify.
• If you understand the message, don’t insist
that the student use his/her device or
board. Accept whatever mode is used.
Allow for a combination of modes if needed.
The Assessment-Instruction
Connection
• Assessment is a continuum and should be
happening all the time.
• Assessment is linked directly to
instruction.
• Assessment is not an isolated event.
• Assessment is not only to identify what is
needed, but if it is still appropriate.
Keep Raising the Bar!!!
Success in the Classroom
• Juggling many
communication modes
(e.g. speaking, gestures,
signing, pictures, speech
generating device)
• Supporting activity specific
and school-based
vocabulary
• Involving peers
• Raising expectations
• Making communication
positively motivating
• Support when needed
Go Team! Hi 5!!
Questions??
Web Resources
Augmentative Communication News
• http://www.augcominc.com
• Newsletter with information on a wide variety of
AAC issues. All issues now available for free and
archived on the website.
The Center for AAC and Autism
• http://www.aacandautism.com
• Excellent resources for working with people with
autism. Info on Language Acquisition through
Motor Planning (LAMP), a therapeutic approach
based on neurological and motor learning
principle.
(Current) Apps for AAC
by Jane Farrall at Spectronics
• Symbols/Pictures
only Apps
• Symbols and Text-toSpeech Apps
• Text Based
• Updates and
Additions
www.spectronicsinoz.co
m/article/iphoneipadapps-for-aac
•
•
•
•
App
Device
Symbol System
Pre-programmed
pages and
customization
• Voice Output/Speech
• Access Options
• Rating
Apps Feature Match
Gosnell, Costello, & Shane 2011
Will be downloadable at the Children’s Hospital Boston’s
website www.childrenshospital.org/acp after October 3, 2011.
Web Resources
YaacK (Augmentative and Alternative
Communication (AAC) Connecting Young Kids)
• http://aac.unl.edu/yaack
• Covers issues related to AAC and young children.
Provides information and guidance to families,
teachers, speech/language pathologists and anyone
else who is involved with a child with special
communication needs
ISAAC (International Society for Augmentative and
Alternative Communication)
• http://www.isaac-online.org
• Links to many AAC sites that may be helpful on
advocacy, organizations, publications, & AAC
technology/manufacturers
References
Binger, C & Light, J (2007). The effect of aided AAC
modeling on the expression of multi-symbol
messages by preschoolers who use AAC.
Augmentative and Alternative Communication 23 (1),
30-43.
Cafiero, JM (2005). Meaning exchanges for people with
autism: an introduction to augmentative and
alternative communication. Bethesda, MD: Woodbine
House.
Downing, JE (2005). Teaching communication skills to
students with severe disabilities, 2nd Edition.
Baltimore, MD: P.H. Brookes Publishing Co.
Downing, JE (2008). Including students with
severe and multiple disabilities in typical
classrooms: Practical strategies for teachers, 3rd
Edition. Baltimore, MD: Paul H. Brookes
Publishing Co.
Gosnell, J, Costello, J, & Shane, H (2011). Using a
clinical approach to answer…”What
communication apps should we use?”,
Perspectives in Augmentative Communication,
20 (2).
Harris, M & Reichle, J (2004). The impact of aided
language stimulation on symbol comprehension
and production in children with moderate
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communicative competence for individuals using
augmentative & alternative communication
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Light, JC (1997). “Communication is the essence of
human life”: Reflections on communicative
competence. Augmentative and Alternative
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communication intervention on the speech
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Romski, MA, Sevcik, R, Adamson, L, Cheslock, M,
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