Choosing the right AAC system is only one step in the journey towards independent communication. For people of all ages & abilities who use AAC, implementation strategies should be delivered with intention then constantly re-evaluated.
Even for the most experienced people who use AAC, there is always something new to learn about all the facets of communication & of the many functions & features residing in their device. The collection of ideas & concepts below is not exhaustive, but it does introduce some of the strategies & principles highly valued by Liberator.
Aided Language Stimulation / Modelling
“The typically-developing child will have been exposed to oral language for approximately 4,380 waking hours by the time he begins speaking at about 18 months of age. If someone is using a different symbol set and only has exposure to it two times a week, for 20–30 minutes each, it will take the alternate symbol user 84 years to have the same experience with his symbols that the typically developing child has with the spoken word in 18 months!” - Jane Korsten (2011)
Children learn to speak by interacting with & observing others. People learning to use AAC also need to receive language input in the method they will use to communicate. Aided Language Stimulation (ALgS) is where the communication partner/s use AAC (often the individual’s own system, or other visual aids) to model language. There is an extensive and growing body of research to demonstrate the effectiveness of this technique.
Gail Van Tatenhove outlines these steps for ALgS:
Ensure the person is attending. It does no good to model if the person is not watching which pictures, codes, or navigational sequences are being selected.
Provide visual input at a pace that allows the person to see to what symbol(s) you are pointing and process that information. The point of this step is not to “show off” your proficiency and speed with the device, but to model vocabulary, vocabulary codes/navigations, and word order to the person.
Vary the amount of visual model provided based on the proficiency of the person. It may be necessary for some people with limited proficiency with their device to model only 1 or 2 targeted core words. A general rule of thumb is to model at least 1 word beyond the person’s current mean length of utterance in morphemes and/or words.
Pair the visual model with verbal input, filling in the gaps to ensure the student hears a complete sentence.
The Rocky Bay Positive AACTion Kit provides some excellent handouts for communication partners learning more about ALgS and modelling: http://www.rockybay.org.au/resources/aackit/
Supporting Communication Partners
Communication partners may be teachers, parents, siblings, therapists, friends, support workers… and it is vital that these individuals are educated in the use of AAC. Although they do not need to be fluent in using the device, they should be able to understand the basic device operation & know how to find words to model. Liberator’s consultant team can provide training in the use of new devices to assist this process.
There are many low-tech resources that can assist communication partners to use AAC. You can use the NuVoice PASS software for PRC devices or Chat Editor to create low-tech boards for modelling, or Smart Charts to help find icon sequences. See our Resources section for examples. The AAC Language Lab also has some great free low-tech resources: https://aaclanguagelab.com/resources/free
Many people who use AAC have never met another person who communicates in the way they do. Some may benefit from working with an AAC mentor, usually another person who is already a skilled AAC user, who could be their guide by teaching new skills and sharing different experiences. If you would like to engage with, an AAC mentor - please contact the Liberator team. Also if you would like to become such a mentor get in touch, since this role is encouraged & even funded by the NDIS.
Therapy Services Provided by a Speech Pathologist
Speech Pathologists play a critical role in supporting people who use AAC due to specific expertise in communication and language. Speech Pathology Australia outlines in their AAC Clinical Guideline that "to address the person’s communication needs, interventions include: (i) individual work with the person with complex communication needs (direct services), (ii) work with a family member, guardian, or significant other (indirect services), (iii) collaborative consultation, and (iv) education and training of significant others in the community." As highlighted, the role of the Speech Pathologist extends far beyond time spent in brief, 1:1 sessions with the individual.
Owing to the diverse group of people who use AAC, giving an exact figure around the dosage of intervention required to support AAC is not really possible. However, Speech Pathology Australia advises that "extensive and ongoing supports may be required in order to establish appropriate and functional communication. The duration and intensity of support will be determined in part by the nature of the needs and goals of the individual and his/her communication partners as well as the communication context/s."
Providing an individual with a communication system in the absence of regular specific instruction, training for the entire team, and ongoing measurement of performance and outcomes, does not give the individual an adequate opportunity to develop communicative competence and may lead to device abandonment.
There are a number of evidence-based interventions & strategies that speech pathologists with experience in AAC intervention may use to support communication development. These could include LAMP Therapy, Descriptive Teaching strategies, appropriate use of prompting hierarchies & modelling, and many others. AAC strategies may be implemented alongside other interventions, including speech therapy.
Ongoing Assessment & Goal Setting
Speech pathologists are aware of the need to conduct assessments & set goals in AAC evaluations. This should not end once the device is received – people who use AAC and their teams must work together to decide on short & long-term intervention goals, to ensure they are achieving maximum benefit from the device & communicating with competence.
Observing the stages of typical language development can assist with formulation of goals. You can find a clear overview of the stages of typical language development, and the types of words we might expect at each level, at PRC’s AAC Language Lab: https://aaclanguagelab.com/slp/stages.
Eminent speech pathologist Gail Van Tatenhove has outlined practical strategies for AAC implementation based on typical development in this document. Gail’s website, http://www.vantatenhove.com/, is also loaded with practical resources for AAC assessment & implementation.
Lists of high-frequency vocabulary may also guide selection of language targets. The 300 word list suggests useful core vocabulary to focus on each step of the way.
Van Tatenhove – Building Language Competence with Students Using AAC Devices: Six Challenges (ASHA)
Enders 2016 – Moving beyond a common roadblock to successful AAC Implementation
Speech Pathology Australia Clinical Guideline – Augmentative & Alternative Communication