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We all use it
n AAC is a set of tools and strategies that an
individual uses to solve everyday communicative challenges. n Everyone uses multiple forms of communication, based upon the context and our communication partner. n The form is less important than the successful understanding of the message.
Taken from: http://www.isaac-online.org/english/what-is-aac
Communication
n Communication is the essence of human
interaction and learning. n Communication is what makes us uniquely human, all individuals have the right to communicate to their fullest potential (American Speech-Language-Hearing Association, 2005).
If all my possessions were taken from me, I would choose to keep the ability to communicate because with it I would win back all the rest.
n
Daniel Webster
minimally verbal, or non-verbal, with a variety of diagnoses (e.g., cerebral palsy, autism, Down syndrome, apraxia, traumatic brain injury).
AAC should be introduced only after giving up all hope of natural speech
n It is virtually impossible to predict the future development of
speech in a young child (Beukelman & Mirenda, 1992). n Children with severe communication deficits who receive only speech therapy often endure years of being without an effective means of communication. n A child who is not able to communicate effectively is at great risk for cognitive, social, emotional and behavioral problems ( Berry, 1987; Silverman, 1980).
natural speech-even in situations in which no speech therapy has been given (Berry, 1987; Daniels, 1994; Romski & Sevcik, 1993; Konstantareas, 1984; Silverman, 1980).
n Studies have shown that even normally developing children who
are communicated with in both sign language and speech during infancy appear to begin to communicate (initially with signs) and develop spoken language at a much younger age than would otherwise have been expected ( Holmes & Holmes, 1980)
behavior well before the development of language. These early exchanges are very important in that they form the basis for later formal, symbolic communication ( Reichle, York, & Sigafoos, 1991).
and benefiting from AAC (Beukelman & Mirenda, 1992; Romski & Sevcik, 1993; Kangas & Lloyd, 1988; Silverman, 1980). n It is impossible to accurately predict a childs ability to learn AAC
holds that in the absence of conclusive data, educational decisions ought to be based on assumptions which, if incorrect, will have the least dangerous effect on the likelihood that students will be able to function independently as adults (Donnellan, 1985)
n www.inclusive-solutions.com/leastdangerousassumption.asp
speech is echolalic or just limited, while waiting for functional speech to develop we might see (Light, Collier, & Partners, 1985; National Research Council, 2001):
Difficulty building social relationships n Difficulty Acquiring Language n Difficulty Meeting Educational Goals n Challenging Behaviors
n
reality there is room for both AAC and natural speech. When both are utilized:
Can see increases in the use of multiple modes of communication at the same time (Schepis, 1996) n AAC can be a catalyst to verbal productions
n
Challenging behavior is viewed as communicative (Mirenda, 2005) n Why? Because it has a function (Durand, 1990)
n
Use of AAC can decrease challenging behaviors (Durand, 1999; Sigafoos, OReilly, & Lancioni, 2008; Wilkinson & Reichle, 2008)
Participation Model
n Historically, guidelines for AAC intervention
better when it is delivered in multiple modes (verbal and pictorial), sensory modalities (auditory and visual), or media (computers and lecturers) than when delivered in only a single mode, modality, or medium. Dual codes provide richer and more varied representations that allow more memory retrieval routes
(Graesser, 2008, p.2)
AAC Tools
n No tech - do not require anything beyond the
computers
technology of PCTs creates a scientific lag behind empirically based treatments that target communicative goals. (Alliano, Herriger, Koutsoftas, & Bartolotta, 2012).
n Recommendations about the use of an AAC high-
tech device should flow from the evaluation and feature matching process.(McBride, 2011)
Where Do I start?
n Communicative Intent n What is the childs understanding of visual
representations objects, photographs, pictures? n WARNING!!! There is a difference between teaching the meaning behind visual representation in a show me style versus as a means of communication. Teach visual representations as a means of communication in order to provide context.
Visual n Auditory n Motor n Language Needs (e.g. Spanish) n Additional Needs/ Considerations:
n
n n n n n
n Ability to navigate
n n n
n There is no one best AAC intervention n key is matching your childs individual
strengths and needs with the most appropriate type(s) of AAC n Some children may respond best to a combination of different types of AAC n A child communication system refers to multiple modes of communication (e.g., SGD, sign language, pictures, etc.).
Mobile Devices
n Pros
n Mainstream
technology/ Societal norm n Attractive price point n Accessible to people quickly n Other apps: educational, entertainment, schedules, rewards n Reduced fear factor
Mobile Devices
nCons
nDurability nSound nTechnical
Assessment Process
n Use same clinical approach pre and post
mobile device era n If iDevice is deemed to be the right platform, feature matching needs to be continued to select the appropriate application
Technology alone does not make a competent communicator any more than a piano makes a musician or a basketball and a hoop make an athlete. (Beukelman & Mirenda,1998) n The goal of AAC should be the most effective interactive communication possible (Hill, 2005; On-line: www.asha.org) n How? n Need to know in order to teach (i.e., take a hands-on, exploratory approach to learn systems) n Just use good language therapy; in normal language development, children begin using individual words and word combinations; AAC uses the same basic rules (Hill, 2005)
n
Provide increased opportunities for communication (Light, Dattilo, English, Gutierrez & Hartz, 1992) Wait time/Expectant Delay (Angelo & Goldstein, 1990; Light & Binger, 1998) Aided Language Stimulation (Goosens, Crain & Elder, 1992) Re-casting (Lund & Light, 2003) Support with navigation (Light, 2005) Sabotage/Communication Temptations (Wetherby & Prizant, 1989) Peer Partners/Modeling (Buzolich & Lunger, 1995) Open-ended Questions (Basil, 1992; Bruno & Dribbon, 1998) Natural Conversation, Pragmatic Cues, Topic Cues
Parent Perspective
n Always building towards something. Its all
about foundation. The talker taught him receptive language, the concept of social exchange, and academics. Using the talker jump started his language and ability to engage in conversation
Steve Hemelstrand, father
References
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American Speech-Language-Hearing Association. (2005). Roles and responsibilities of speech-language pathologists with respect to Augmentative and Alternative Communication: Position statement. Available from www.asha.org/policy Ashley Alliano, Kimberly Herriger, Anthony D. Koutsoftas, and Theresa E. Bartolotta (2012). A Review of 21 iPad Applications for Augmentative and Alternative Communication Purposes. Perspectives on Augmentative and Alternative Communication 2012;21 60-71 Beukelman, D.R. & Mirenda, P. (2005). Augmentative & Alternative Communication: Supporting children and adults with complex communication needs (3rd ed.). Baltimore, MD: Paul H. Brookes. Blischak, D.M., Lombardino, L.J., & Dyson, A.T. (2003). Use of speech-generating devices: In support of natural speech. Augmentative and Alternative Communication, 19, 29-35. Bodine, C. & Beukelman, D. R. (1991). Prediction of future speech performance among potential users of AAC systems: A survey. Augmentative and Alternative Communication, 7, 100-111 Does AAC impede natural speech?and other fears (1999-2004). (On-line.) Ruth Ballinger - YAACK: AAC Connecting Young Kids. Available: http://aac.unl.edu/yaack/b2.html Dowden, P.A. (1997). Augmentative and alternative communication decision making for children with severely unintelligible speech. Augmentative and Alternative Communication, 13, 48-58. Gorenflo, C.W., & Gorenflo, D.W. (1991). The effects of information and augmentative communication technique on attitudes toward nonspeaking individuals. Journal of Speech and Hearing Research, 34, 19-26.
Gosnell, J., Costello, J., & Shane, H. (2011, September). Using a clinical approach to answer what communication Apps should we use?. Perspectives on Augmentative and Alternative Communication, 20, 8796. Hustad, K.C., & Shapely, K.L. (2003). AAC and natural speech in individuals with developmental disabilities. In Janice C.Light, David R. Beukelman, & Joe Reichle (Eds.), Communicative Competence for individuals who use AAC: From research to effective practice. Baltimore, MD: Paul H. Brookes. Improving Natural Speech: AAC devices increase word production in children with developmental delays (2004). (On-line.) Available: http://speech-language-pathology-audiology.advanceweb.com/common/editorial/editorial.aspx?CC=12409 Introduction to Augmentative and Alternative Communication (1997-2004). (On-line.) American Speech-Language-Hearing Association. Available: http://www.asha.org/public/speech/disorders/Augmentative-and-Alternative.htm Lilienfeld, M. & Alant, E. (2002). Attitudes of children toward an unfamiliar peer using an AAC device with and without voice output. Augmentative and Alternative Communication, 18, 91-101. McBride (2011). AAC Evaluations and New Mobile Technologies: Asking and Answering the Right Questions. Perspectives on Augmentative and Alternative Communication, 20, 9-16 Millar, D., Light, J., & Schlosser, R. (2000, August). The impact of AAC on natural speech development: A Meta-Analysis. Paper presented at the Biennial Conference of the International Society for Augmentative and Alternative Communication, Washington, D.C. Romski, M.A., & Sevcik, R. (1996). Breaking the speech barrier: Language development through augmented means. Baltimore: Paul H. Brookes Publishing Co. What is AAC (2012). (On-line.) International Society for Augmentative and Alternative Communication. Available: http://www.isaac-online.org/english/what-is-aac