We have AAC: now what?

image of an iPad screen with Speak for Yourself, and a list of animals in the message bar: banana, cookie, cat, dog...

Access to AAC is a fundamental human right, but it’s one that tends to be forgotten and overlooked in many spaces still today. October is AAC awareness month, which means lots of people are hearing about AAC or gaining access for the first time. The first few steps can feel overwhelming to families and professionals new to this journey. There is a fear about “doing it right” and “doing it enough”. I promise that you can do it. You can do it. You must do it. And it will be worth every step. 

Get excited. It can be really easy for AAC to be seen as a chore or “another thing to do”. It can seem like that to families, to professionals, and to AAC users themselves — especially when drilling methods are used to teach its use. It’s really important for all of us that we don’t associate AAC with “work”. We need to stop seeing on AAC as a way to drill our students on all the things they already have a way to say. We need to see AAC as a tool that allows our students to express all the other things they have to say. This isn’t to say that learning a new language isn’t hard (it is) or that magic moments happen every single day. Learning to read and to write and to speak a new language — all of these things can be challenging at times. But they are all things we see as worth it, because of the long-term benefits. We find the joy in all of the moments along the way. The first time our child spells a word by themselves, the first time they “read” their favorite memorized picture book, the first novel we pick out. AAC is like that. Sometimes easy, sometimes hard, and always worth it. 

Make sure the system is available. This is the first thing I always tell families or new teachers to do. Spend the first few weeks getting into the habit of always having the system. Problem-solve what you need to make it happen, whether it’s straps, a Post-it note on the door, a different case, etc. Assign staff members who get systems out of backpacks. Figure out a plan and space for charging if it’s high-tech. This shows your student that you truly value their AAC system, that you believe in its importance, and that you want to hear what they have to say. It’s also really hard to model on or use an AAC system if it’s not there. 

Assume intentionality. Please, please, please, please, whatever you do, please never say “I don’t think they meant it” in front of a student. I wish you wouldn’t even think it, but please don’t say it. Always respond as if your student meant it. There is no harm in this assumption, but there is so much harm in telling kids’ that you do not believe their words. If you don’t understand, be honest. Ask. “I don’t understand what you mean, can you try telling me another way?” or “Hmm, I have to think about that, can you tell me more?” These are not hard things to say. 

Encourage exploration. Treat a talker like a voice. Do not take it away. Do not remove it or block it. Do not put it on the teacher’s desk to be used later or when it’s appropriate. You cannot do this with speech, and so you cannot do this with a talker. Exploration is wonderful. Exploration is learning. Exploration is ownership. There’s a million reasons for children to babble and stim and enjoy their systems. They could be learning the locations of words — how else will they find them, especially if they are not yet reading and spelling. They could be playing with sound and exploring words and language, just as young ones do when first learning how their mouths can make different shapes and noises. They could be engaging in self-talk. They could just be having fun with sound, and that’s fine too. They have a right to autonomy with their AAC systems, the same autonomy that they would have with their speech, the same autonomy they should have with their bodies. 

Familiarize yourself with the language system. Adults often complain about not being able to find words or finding systems not intuitive. I’ve found the hands-down best solution is to explore the system. Find a picture book and comment on all of the pages — with the AAC system. Watch a favorite TV show or movie, one where you know all the best parts already, and do the same. Think about words you might want to use on a daily basis — search for them. It truly comes down to practice. There’s a reason so many adults tend to prefer the system they know the best… Once you’re familiar with it, it becomes easy. If you don’t have access to the system itself, see if you can get access to a low-tech version, watch videos of people using it online… Give yourself time and grace to learn something new, but keep learning it. 

Model, model, model. And then — start modeling. Modeling is a fancy word for saying “talk with the talker”. Don’t overthink it. When you talk, highlight one or two of the words you say on the talker. If you’re wondering what your child could be thinking, highlight one or two possibilities on the talker (“I wonder if you’re tired? Sad?”) Start with modeling just a couple words or modeling at meals or spending some 1:1 time with your student’s AAC system and their favorite toy. Yes, you can start that small. Yes, you can start by modeling 3-4 words as the opportunity arises during the day. Yes, you can start modeling by talking all about food and drink and favorite TV shows, or other likes or dislikes at the dinner table. Just don’t make it work for them or for you. Don’t make it “say this right now”. Think of your goal less about “doing it right” and more about “getting comfortable with AAC”. I’ve seen fear of being wrong all too often lead to no modeling. And I promise some modeling, modeling with mistakes, modeling slowly, all of it is better than no modeling. 

Yes, there can be more to AAC. Yes, there are other things to think about, amount of modeling and vocabulary and recasting and probably some other fancy terms. I’m not denying that. But it all starts here. Don’t overwhelm yourself with dozens of articles and stress about doing it right. This is the foundation. This is what everything else is built upon. Make this strong. Become so reliable about having the device that you feel naked the one time you forget it for 5 minutes. Get so comfortable with responding and modeling with AAC that your child or student never, never, not for one second, ever doubts how important you see their system and how valued you see their words. Everything else comes later. 

How We Do It: Visual Schedules

yellow clipboard with velcro picture symbols showing a student's day (circle time, art, tech, eat)

I tend to write about the philosophy behind my teaching and the culture more than the practical. This is because nothing else matters until our classroom cultures shift. Visual schedules are a fantastic example of what I mean.

There are plenty of people who use visual schedules as a compliance system. This is on your schedule. You must do this. Or they use visual schedules because someone once said they should, but they sort of just sit around and have little meaning for the students using them. If that’s how they are being used, then it’s not a student accommodation. It’s a teacher tool.

We use visual schedules to increase predictability, visual supports for conversation about our day, and to assist students to know where they are going and when they are going there. They are a support system. I understand this deeply because I need a schedule.

How do we do this?

yellow folder on top of a yellow clipboard

We design the schedule to be easily accessed.

I often see schedules on walls. I’ve made this mistake in the past. But it’s not very useful on a wall if you’re in the cafeteria, on the playground, or even on the other side of the room. Asking a student to leave a preferred activity to go across the room to check their schedule to come back across the room seems like a lot of response effort for a time that may already be challenging. Transitioning, shifting attention, and now moving too? We keep our schedules on our clipboards. The front has a folder for data, notes, or individual student items. The back is the schedule. We also bring the schedule to our students. Older students could carry their schedules with them by placing them in their binders or backpacks.

We design the schedule for understanding.

We currently use primarily picture symbols, but not only picture symbols. We have used songs, objects, photographs, and written text, all dependent on the child’s needs. We’ve also mixed them all up — maybe a student uses a picture schedule for all of their work activities, but uses a spoon to transition to meal time. We currently don’t use times on our schedule as we are in preschool but I’ve used them with older students. It’s not about the tool. It’s about matching the tool to the student needs. Ask your students: will this lead to more or less understanding? More or less frustration? If they cannot tell you with speech, watch their nonverbal language. We always want to decrease frustration.

We use visual systems to support their use for transitions.

image of a filing cabinet with an "art" picture attached to the side, with 8 velcro dots below

One thing that has invariably helps my students when learning routines and schedules is to have a match in another location. They don’t just have a random picture of a table that means “work time”. There is a matching picture on the actual work time table as well. If we’re using a space that serves multiple purposes, that picture is attached by velcro. I don’t like spaces to have multiple visible pictures showing; it gets confusing. We know what the schedule says because we can read text. If our students are not yet able to read, how do we make sure they understand? This matching system helps so much.

We refer to the schedule throughout the day.

The schedule is not just a decoration or a transition cue. It’s something we talk about throughout the day. We talk about changes to the schedule in our morning meetings. When students go to their backpacks during the day, we show them their schedule to help them know when we go home. If a student asks for a snack or iPad or some other item that we cannot access right now, we use the schedule to tell them when they can have it.

We don’t care about compliance.

Repeat after me: the schedule is not about compliance. It is about understanding. Not compliance. Not compliance. It has to be said so many times. One of our assistants is brilliant at being about cooperation instead of compliance, especially with schedules. When a student puts a picture schedule piece in the wrong place or on the floor, she says, “That’s one place you could try. But let me show you where I would put it.” If a student just won’t take their picture symbol to transition, then we say, “Oh I’d love to help you. Let me show you where we are going.” If a student needs to finish their current activity, because they’re mid-alphabet, we let them finish their current activity. If a student runs across the room to the next activity, ignoring their schedule, that’s fine. If they are already sitting and waiting at the table, that’s fine too. Because it’s not about “checking the schedule”. It’s about feeling safe, knowing what’s happening in your day, and having a way to help you get from place to place. That’s why we use them. That’s why we adapt them. That’s why they work.

We don’t need to get physical.

white background with black text reading "no means no"... the o is a red "not" sign.
Bear with me, because what I am about to say cause you to feel defensive or want to click away. Please keep reading.

We overuse physical prompts and support in special education, and we are setting up our students to be hurt in their lives.

Whatttttt? Hurt?

Yes. Hurt.

One in three children who receive special education services are victims of neglect, physical abuse, or sexual abuse — compared to one in 10 non-disabled peers. They are 3.44 times more likely to be the victim of abuse compared to children without disabilities (Sullivan & Knutson, 2000). 3.44 times! And it is likely that these are underestimates, as children with disabilities may have difficulty reporting (or having their reports believed).

How does physical prompting play into this?

We are teaching our students that it is okay for someone to manipulate their body. We often teach something even more significant — that they cannot say no. When they fall on the floor and we force them up, we are teaching them that they cannot say no. When we force their hands under the running water in the sink, we are teaching them that they cannot say no. When they say “cookie” but we make them say “eat”, we are teaching them that they cannot say no and that their voice doesn’t matter.

I know it’s not the intention. But it is the impact.

I get it. I’ve made this mistake in the past. I’ve had moments that make me cringe as I’ve grown and matured in my understanding of teaching and supporting the kids I so adore. We think that we’re helping. We’re taught this in graduate school. We’re taught this by our children’s therapists. We didn’t know.

Now we do — and now we can do better.

It is possible, I promise. I teach ten preschoolers with disabilities every day with minimal physical prompting. I parent two children with disabilities every day with minimal physical prompting. It’s a journey, but it’s a journey that is absolutely worth it as you teach some of the most important life lessons: autonomy and consent.

How do we start?

Start by noticing. Notice the little ways that you use touch throughout the day. Notice when your child or student might be pulling away. Notice when you accidentally speak over instead of working with. It’s not about shame. It’s about mindfulness. It’s about noticing the ways that we, too, have been indoctrinated by a culture that expects compliance from children (and especially from children with disabilities). Notice when your hands begin to move before your brain even notices.

And then start to do things differently. Below are some steps to moving away from physical prompts and towards a different way of interacting. Your children and students will appreciate the respect for their individuality. They will thrive on having their voice heard and recognized. And you will uncover so much more learning, so much more personality, so much more of THEM when you take the chance to step back. I think you’ll like the change.

Ask yourself: what is this child communicating to me?

  • This is too easy / hard / boring.
  • I am not ready / I need more time / I need a break from this.
  • I don’t understand the expectation.
  • I don’t feel well.

When we find the same scenario popping up multiple times a day or week, we need to do some problem solving with the child or student. We can often minimize the need for prompting when we determine what the child is communicating through their actions, whether it’s disengaging from an activity or refusing a transition. There’s always a reason. When we address the reason, we often find that our students no longer need to complain or protest with their bodies.

Ask yourself: is this necessary?

It’s amazing how many times we think we need to do more — but we don’t. I think here about the student who has exercised their right to protest by laying on the floor instead of transitioning. The instinct by most is to pick this student up and force them to walk to the next location. But why? Are they being hurt? Are they hurting someone else? Is there absolutely no way to create safety by relocating peers / furniture / adults? That is the only time where I find it absolutely necessary to intervene in some sort of physical way (such as blocking a student from hitting themselves in the head). There’s a dozen other ways to respond — first and foremost, wait.

Yep, wait. We can wait for our students to re-regulate, offering supports or strategies for regulation when appropriate. We can make sure we stay regulated! And then address the situation together. Maybe we use one of the strategies below. Maybe we all just needed to offer more time to regulate. Maybe we can talk through it together when we are both calm and regulated, such as reminding a student that we take the bus to see mama.

Offer choices.

We all want choices in our lives. We all want to feel in control. There’s a difference between a lunch someone orders for you, and a lunch that you choose for yourself. Going to a party because you want to, or because someone else dragged you. Think of all the choices that you make on a daily basis. Think about the number of real, meaningful choices that your students or child gets to make on a daily basis. It’s often pretty insignificant. We need to offer more choices all day long. But we especially need to offer more choices before activities that have frequently served as triggers in the past.

An example: I once had a student who disliked the transition to the bus. It’s a hard transition. There’s a lot happening, and the bus ride can feel very long when all you want is your mama. We’ve struggled with making it out the door in the past. We didn’t really know what to do. We didn’t want to force him through the door, even if it was just through an adult holding each hand. It’s a bit much. But we also know that he needed to be on the bus and that, for once, there was a time limit. We can’t wait for the bus for 45 minutes. You’d be amazed at the simple solution that made all the difference: asking this student if he would like to wear his backpack, carry his backpack, or have help with his backpack. This small choice gave him a sense of control. It also meant that he could tell us what his sensory system could handle each day. Some days the feel of the heavy backpack helped him feel grounded. Other days, it was just too much. That tiny change has meant no tears and eagerly hurrying to get to the bus (and eventually mama).

Moral of the story: notice where you can offer choices, instead of telling what to do, how to do, when to do. Don’t be afraid about sharing control with your students. It’s often one of those antithetical ideas: the more you give away, the more you have.

Use other prompts.

There is a whole TON of other prompts available for teaching. We can use facial expressions, such as the “expectant waiting” face. We can talk to students. We can ask questions. We can give directions. We can show pictures. We can use video. We can point to different elements. We can use pointers and lasers and visual cover-ups. We can do it ourselves while they watch. We can start the process and then hand it over to them. Basically: don’t forget about all the other prompts that are available to you. Physical prompting is fast and it is easy, but that doesn’t mean it’s best. It’s rarely best.

Use assistive technology.

We are so lucky to live and teach in the 21st century. There are so many ways to accommodate our students. The one that most often comes to mind is the use of visual supports. We can use visuals to show each step of the process to complete an activity. We can use visuals to tell students what is happening, when it is happening, and where it is happening. We can use video to capture students doing the task, or showing their peers doing the task.

We can also use accommodations to create alternatives to the task, or modifying the task in some way. If a student regularly needs physical prompting to pull up their pants, maybe a different style of pants is going to allow them to be independent. If a student has difficulty locating a button on their talker, maybe a keyguard or even just a little sticker on the screen protector will guide them. If a student cannot touch one item at a time to count with cars and blocks, maybe they practice their counting with touch screens or focus on subitizing. This is an opportunity for endless creativity — and teamwork. Call on your instructional assistants, assistive tech teams, and related service providers! It’s amazing what we can come up with when we work together.

Emphasize consent. 

Always, always remember that a student has a right to say no.

There are still times when we use physical prompting in our class, primarily when teaching a new motor skill. Please remember that many — most — students do not need that physical support even with these skills. But some students struggle significantly with apraxia or other motor difficulties that benefit from some support. I think about my daughter, who benefits from physical support to find words on her talker the first few times she tries them. She cannot see the words very clearly, nor can she see our modeling. She needs us to show her.

But we do so cautiously. We ask — “Can I help you?” Yes, I literally ask my daughter this. I ask my students this. I give them the chance to give consent, or to say no. Even if they cannot verbalize consent, I hold my hand out without grabbing them. Do they put their hand on mine? Do they pull away? And they always should be allowed to pull away.

If they agree to have support, then I offer that support by hand-under-hand. It’s less intrusive, because they can more easily pull away at any moment. Because that’s the thing about consent — it’s an ongoing process. It’s not one and done. By placing my hand under theirs, it is easy for them to pull up and away. It is easy for them to decide to hit a different button on their talker. And they always should be allowed to.

(I know I sound like a skipping CD, stuck on repeat. But it’s a lesson that simply isn’t emphasized enough for our kids, and one that needs to be drilled into our heads. They are allowed to say no. They are allowed to refuse. They are allowed to pull away, walk away, however they convey the idea of NO. They are allowed to say no.)

I think of it as if I was taking lessons to swing a golf club. The trainer may assist me by providing physical support to feel what a swing should be. But notice: the trainer is going to ask me if they can support me. And if I decide, mid-swing, this isn’t working for me and walk away — they are going to let me. The trainer is not going to chase me around the golf course, trying to grab my hands and arms. It sounds ridiculous, yet so often we do exactly that.

Really, though, that’s what it comes down to… How would we want to be taught? What would we want for our own children, or for ourselves? We are caretakers of our children and our student’s trust. We must continuously live up to that. This is one of the most important ways.

 

 

Sullivan, P. & Knutson, J. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse & Neglect, 24 (10), 1257-1273.

Switch It Up: Meet Kids’ Needs to Solve “Behaviors”

We’ve had a couple of little “problem behaviors” pop up that have occurred across multiple students pop up in my class. Going into closets. Climbing on the counters. Dumping everything in the toilet. The instinct from grown-ups tends to be that whole “no means no” — repeat, day after day, ad nauseam. And we say, “Why aren’t they getting it?”

But we can look at it another way — these behaviors are the best tools that the students currently have to meet their needs. These students are telling us: I don’t yet have the skills to handle this exact situation on my own. I need supports; I need instruction. If we want the behaviors to cease, we can’t just say no. We need to create environments that support students to use the skills they have, while we teach the skills they don’t.

So that’s what we did this week.

Photo Mar 19, 2 51 48 PM (1)Situation 1: Climbing on the Counter

Above the counter are shelves — filled with all the things that we don’t allow free access to. Not because we are controlling and keep a “sanitized environment”, but things like Cheerios, Cheetos, glue, scissors… Things that just can’t be free access. They also tend to be things our preschoolers really, really want. Thus the climbing on the counter. All of our students have a way to ask for help or ask for those items. But in the moment, the impulse control, attention shift, and emerging communication skills just don’t line up for them to do so. Because they’re in preschool.

We added a Big Mac switch to the counter that says “I need help”. It’s LOUD. It’s easy — even our most emergent communicators can use it. Just leaning in to the counter as they think about climbing it often activates it, so that they can quickly learn the association. It also serves as a big visual support — a “STOP AND THINK” kind of moment. And it worked. Within just a few hours, multiple students were running to the button, asking for help, and then telling us what they need when we brought their talkers to them. Climbing fell off dramatically — and fast. So much faster than any “no means no” instruction could have done. Because we met the students need.

 

Situation #2 – Potty!

The toilet is a tempting playground. My own son went through the same phase; we hadPhoto Mar 19, 2 49 18 PM to call the plumber multiple times for all the things that were flushed down the toilet. It doesn’t matter that we have lots of sensory fun available throughout the room. It’s the TOILET. It flushes! It’s loud! It makes noise! The best way to help our students stay out of trouble is to help them stay out of the toilet.

We also have students who are just recently potty trained, who need to be able to run to the bathroom and gain access quickly. We needed to balance all of the competing needs.

Enter switch #2… It sits right above the door handle, and says “POTTY!” We can keep the door shut, because we are allowing students to have a quick and easy way to meet their need. Just like our counter switch, we positioned it for the easiest access for this particular group of kids. Like with help, they all have the ability to ask for potty on their talkers. But it’s hard. It’s new. We need a bridge until we get there, and this is it.

And once again, it works. We have students requesting the potty that I had under-estimated, that I had not been sure they were yet able to request. It’s not that I did’t think they ever could, but I wasn’t sure they were “ready yet”. But they have an awesome way of continually reminding me that “readiness” can be an arbitrary concept, one that is primarily used to limit them. Readiness is about accommodations as much as instruction. It’s about what I am doing  more than anything they are doing.

Meeting needs works. Again and again.