AAC: But where do we begin?

Photo May 15, 9 39 43 AM
“drink drink drink need need need” with LAMP on an iPad

But how can we introduce so much language when we do not yet recognize the child’s communicative attempts?

You use all that language to build a mutually understandable language.

Whhhaaaatt??

Yes. Lots of language. Even when they are not yet using any.

It starts with modeling (aided language input). And then we watch, carefully. Look for any signs that can be taught to the child’s entire team, or shaped into something recognizable and functional for that child. Notice their body language. Notice the sounds they make. Notice all the different ways that communication occurs, outside of words. Notice it even if it doesn’t fit the neurotypical model, because communication doesn’t need to fit into that box. It really, truly doesn’t. It doesn’t have to look the same, sound the same, be the same. It just needs to be something that allows this child to communicate the full range of their thoughts and feelings in a way that can be understood. Part of the work is on us — to do the understanding. 

From there, we build. That building might look different depending on where the child is, what the child is interested in, what body movements and vocalizations the child may have. But there’s a starting place for everyone. 

My student does not yet look at or notice me or the talker. 

That’s okay. I mean it. It really is okay. You can still start here. Join your student in the things that are fun for them, whatever they might be. And don’t do it to manipulate them into doing something else. Do it because it’s enjoyable for them and you want to share that experience. Be enthusiastic, be warm, be someone that your students love to be around. Model language here because all of us, every single one of us, like to talk about what we value, what we enjoy. 

And start to notice: are there words that seem to draw your student’s attention? Do they pause, look towards you, look towards the talker? Do they make more or less sounds when you say certain things? Assume these movements are intentional. As Kate Ahern says, “we teach intention by assuming intention.” Ascribe meaning and then act on it. If your student glanced at you for one split second when you modeled “go”, then make that car / swing / toy GO. If they start jumping up and down when you model “happy”, then comment on this: “Yes! You are HAPPY! When you smile, I think you are happy.” 

These body movements don’t need to be huge. They don’t need to be frequent. We just need to recognize them and show our students why it’s worth repeating. How many times, I wonder, have our students tried to communicate with us, but we didn’t hear them? We are showing them the power of words, yes, but we are also showing them that we are listening. We are finally listening. The thing is: when you start to look for these small signs — noticing, reinforcing, ascribing meaning, making it worthwhile — they are going to start showing up more and more and more. 

My student does not yet engage with the talker. 

Maybe this student is really observant. You see that they are often watching you model, but yet they haven’t initiated using the talker to communicate. 

First, I would troubleshoot to ensure that 1) the child is able to physically access the device, 2) the vocabulary available is powerful to this student, 3) that we have enough vocabulary available for the student, and 4) that we are doing engaging and fun activities, things where the student has a reason to communicate. 

Once you’re sure that these four hurdles have been met, then continue to treat as above. Accept any small action that could be a step towards initiating with the device down the road. I have a student where we are currently very excited about reaching for the device. We reinforce reaching for the device by confirming his selection, continuing the activity, responding as we are in a conversation. One day, he’ll start touching it — and then we will be just as excited about that. Reaching, touching it, activating any button, and so on… It’s all part of the journey, just as infants begin with noises and then “ma” and then “mama”.

My student babbles (sometimes labeled as “stims”) on the talker.

Let them. We so easily forget about how important babbling is for young children. They are stimming with their voices. They make repetitive noises. They say words because they sound funny. They blow raspberries and whisper and act ridiculous. It’s part of learning to speak. It’s also one of the most important ways that our students can learn where all the words are, especially if they are not yet readers. They need to be able to do this. 

Besides — children who love to babble on their talkers are giving you a really easy way to teach communicative intent. Respond to what they are saying. If they say “sleep”, pretend to go to sleep. If they say “mom”, talk about when you will see their mom. If they say “avocado banana ice cream pudding worms”, you say “Ew! That sounds yucky! I would much rather have chocolate pudding.” Provide context. Teach that when they say something, it matters to you. It’s part of an exchange. But you have to return their exchange for that to be true. How often are we the ones dropping the ball, writing off something as “he didn’t mean that”? Just act as if they do. It makes a difference.

My student presses buttons but doesn’t direct it to me. I wasn’t even nearby!

First off, let’s get this straight. You’re in the kitchen, and you spilll something. Your husband / wife / partner / child is in the living room. Have you ever just yelled out, “I need a towel!”

Yeah, exactly. 

Our kids have the right to just yell things out too. It’s actually one of the perks of high-tech AAC over sign language, low-tech, etc, when high-tech AAC is possible. They get to yell out from across the room. They get to, quite literally, be heard. 

If you’re worried that they won’t understand someone has to be able to hear them, that the message has to be received, I would just give that time. Keep receiving their messages. It’ll build. And there are ways to teach how to get attention with a device, whether high-tech or low-tech. We can work on that. Right now, in the beginning, we just want to teach our children that their voice matters. We want to respond to anything and everything. Not just for the vocabulary that we teach, the interaction that we strengthen, but so they know that they matter. That we will no longer intentionally or unintentionally ignore them. It’s important. It might be some of the most important work we do. 

 

Next week, we’ll build on this by discussing ways we can build communicative intent — and, really, communicative exchange — through multimodal means. We all communicate in many ways: gestures, facial expressions, words… We can support our students by ensuring they have multiple ways to express themselves as well. 

See previous posts in the communicative intent series here.

Language mapping with AAC

image of a preschooler holding a Thomas train and touching "up" on their iPad with Speak for Yourself, AAC app
all the words, all the time

A common question comes up when people ask about AAC and children with autism: “But what if they don’t have communicative intent?”

First and foremost, yes, if a child truly does not yet have communicative intent, you can still introduce AAC. You can do all the things we’re talking about in this series, wherever a child is in their communication. But I also feel like we need to break down this concept a little bit, because it can be confusing. Communicative intent is when we convey a message through the use of expressions, noises, sounds, gestures — all of the ways that we communicate. Notice that it’s not limited to words, it’s not limited to speech sounds, it’s not limited to pointing. It’s not even limited to intentional messages; non-intentional messages count. Non-intentional messages are where we all began. 

A baby is hungry. The baby cries. 

An adult says, “It’s time to leave the playground.” The toddler screams and pushes an adult away.

A girl’s sister takes her train. She bites her sister.

The teenager pulls her mom to the kitchen.

A preschooler stacks blocks in a tower and watches them fall. He flaps and jumps with excitement. 

All of these are messages. Some may be intentional. Some may be non-intentional. Some may be directed to others. Some may not yet be. But all of these children are using their bodies to create messages about their inner experiences. 

My guess is that when most people say “he doesn’t have communicative intent”, they may mean one of any number of things. They could be missing the child’s messages. They could only be referring to “appropriate behavior” — but challenging behavior is still communicative. Or they mean getting up and approaching an adult to share a specific and deliberate message. Each of these are separate problems that we can work through while using AAC. We only need to be open to examining the ways our philosophies and practices may be influencing what we see and expect in our children. I’ll address getting up and approaching adults in a future blog, but today we’re focusing on seeing a child’s message and mapping language on to that message. And you need to have access to robust language to do so. 

Seeing Messages

Every student is conveying messages. They may use their bodies. They may use unsafe ways to share their messages. But they are sharing messages, dozens and dozens of them every day. All of these messages are important, even when they don’t conform to a neurotypical way of communicating our needs, likes, or dislikes. 

We must become careful observers of the people we serve, whether it’s our children, our students, or our very best friends. What happens when our students are hungry? What happens when they are tired? How do we know when they like something? Do they do it over and over? Does their facial expression change? Do they move their bodies? What about when they are angry, overwhelmed, or frustrated? For a while, my daughter’s biggest message cue was when she heard anyone in the room say a relevant word, her head would tilt slightly. It wasn’t 100%, but it was a start. A start is all you need. Watch across daily routines and activities for several days. Make notes if you need to. Ask their families, their classmates, or a favorite staff person. 

If your student has a complex body, this might be more difficult. They may not flap or wave, run away or run towards. Watch their eye gaze. Do they look towards one item longer than another item? Do they turn their head towards or away? Is there a pattern to their vocalizations, more, less, faster, slower? Watch for subtle signs — a head tilt, a lift of the chin, eye movements, small shifts in their body. I once taught a student who simply closed her eyes when she did not wish to talk to us or engage in the activity. Every time. Art? Closed eyes. If I cancelled art and said we were headed to the playground, BAM! Eyes wide open, one hand waving, let’s go go go. If you’re not sure what a movement means, make a note of the time, activity, or communication partner that is present each time it occurs. Can you detect a pattern? Can you create situations where this message is more likely to be conveyed?

(Note of caution: do not deliberately create frustrating, overwhelming, or angering situations in order to test your hypotheses. Use observation only for those emotions. I am specifically referring to pulling out favorite toys, people, songs, activities, and looking for signs of interest, excitement, happiness, engagement.)

Language Mapping

Better understanding our students’ messages means that we can be better communication partners. One of the most important jobs that we have is to provide aided language input — as much as possible through as many routines of the day as we can. Aided language input refers to communication partners’ (that’s you and me!) modeling use of an individual’s AAC system. 

With our very early communicators — the students who are mistakenly labeled as lacking “communicative intent” — this modeling often begins by mapping language from their AAC system onto their actions. We translate the messages that our students share with their bodies into language that can be said on their AAC system. This is why it’s important to spend some time as Sherlock Holmes. We have to know what these messages are! Let’s look at some examples of language mapping in action. 

Jane 

Jane is a three year old student who often plays by lining up her Thomas the Train toys. Her teacher has been watching her play for the past few days and thinks that Jane is really happy when she lines up her trains. After she places the last one, she may smile to herself. She sometimes wiggles her fingers back and forth or runs around the table in a circle. Jane can do this many times in a row. Sometimes other students want to play with the trains and may take Thomas or Percy. Jane may start crying, pulling on her hair, or even fall to the ground. Jane does not seek out an adult for help or try to get her Thomas back. 

Jane’s teacher introduces an iPad with a dynamic display app. Notice that the teacher continues to map language onto Jane’s actions even if Jane does not appear to be paying attention at the time. We don’t stop talking to toddlers because they have their own interests to pursue. We don’t stop talking to our students just because they may not be looking at us — especially if we may be using neurotypical standards to judge attention and learning. We model, model, model, model. All day every day. Uppercase words are words that she models on the talker while speaking out loud. 

  • Jane lines up trains 
  • Teacher: “I think you LIKE this.” 
  • T: “That’s THOMAS! You LIKE Thomas!”
  • Jane takes them apart. She starts again.
  • T: “AGAIN! I wonder if you are HAPPY! You are doing it AGAIN.”
  • T: “LOOK! THOMAS is at the front.”
  • Jane’s peer picks up Percy, who was laying on the side.
  • Jane starts to whine.
  • T: “I think you WANT Percy. Maybe you are saying MINE MINE MINE.”
  • Before the teacher can help Jane get Percy back, Jane falls to the ground and kicks.
  • T: “You seem MAD! IT’S NOT FAIR! Sharing can be so FRUSTRATING.”
  • T: “I would love to HELP you get PERCY.”
  • Jane turns to teacher and looks at her for the first time.
  • T: “Let’s DO it. Let’s go ask Johnny for PERCY. You were PLAYing with PERCY.”

Robust AAC Matters

You can start to see why it’s much easier to model when we have access to a robust language system. A robust language system is one that has a lot of different words. It has nouns, verbs, actions, pronouns, adjectives, and all the little words that those who speak take for granted. Maybe you don’t have all the words open right away, but the options are there. They can be added at any time. 

Imagine Jane if her teams had been focused solely on functional communication training that was limited to requesting? How would we have to teach? Would we have to simply block Thomas and have Jane request Thomas over and over? What social interactions would we have missed? What language learning opportunities? What social-emotional regulation skills could we have taught? 

It starts to become obvious why — even with our earliest communicators — we need to be able to access all the words. When we limit our students to fringe/nouns or 10-15 words, it becomes difficult to say frustrated, angry, mad, this is too easy, happy, excited, don’t like, don’t want to, or give me more sprinkles on my cupcake! And all of those words are important. Especially about cupcakes.

Do you want more examples? Do you have a situation where you’re struggling to find the message? Or the right words to map? Leave your questions & feedback in the comments.

Last week: all means all, all the words, all the time, for all the people.

Next week: teaching communication as interaction — without limiting our student’s communication access, part 1. 

All means all.

image of white teen with brown eyes and short hair in a sea green top against a blue backdrop
This is my daughter, Lexy. She is persistent and fierce and hilarious. Her favorite things in the world are dance parties, playing ball, and having more dance parties.

I am going to break my typical way of thinking about Lexy to talk about her through the eyes of the world. I’ve gotten her permission to do this. We talked about how I wanted to share the ways some misjudged her so that we can help more children get access to talkers. This isn’t news to her. She’s lived this experience. She still lives it every day — fighting to be seen, heard, and respected. I am only talking this way now because a voice for everyone means everyone. Unfortunately, kids like Lexy often tend to be thought of as “the exception”. The “PECS does have a place for some” kids. The “well, are we sure they would benefit from that?” kids.

  • Lexy has a long list of diagnoses: autism, intellectual disability, orthopedic impairments, apraxia, visual impairments, and chronic health conditions.
  • Lexy does not identify any pictures when asked.
  • Lexy does not follow one step directions.
  • Lexy does not often respond to questions or comments from others.
  • Lexy may not direct any communication to others for extended periods.
  • Lexy’s communication can be subtle and difficult to recognize.
  • Lexy has had many teachers who felt that she “lacked communicative intent”. She was originally recommended a 2 button switch when an assistive technology evaluation was completed.
  • In subsequent AT evaluations, we were repeatedly told that X would be too many words, too many options, on and on and on. And let’s be clear — even just sixteen words. There are people who thought sixteen words were too many words.
Lexy is also a high-tech AAC user, because we believed that all meant all.
 
  • All people have the right to communicate.
  • All people have the right to as many words as we can provide access to.
  • All people do communicate.
 

Lexy currently uses a communication system that has a vocabulary of hundreds of words. She uses at least 75 of those words regularly. This includes core words. That’s right! Lexy, who was often taught under the assumption that core was “too abstract” most frequently uses core words. Words like different, go, bad, eat, drink, play… She loves to tell us mad and “you won’t let me do what I want.” All these words would have been unavailable to her in the single switch or fringe-focused picture exchange systems recommended for “kids like her”.

I’ve been doing this for a while — always working with the students who are most underestimated. I have never yet met a single child who did not need and deserve and have the right to robust language. Yet our profession continues to harm these children, to set arbitrary benchmarks that must be met before we give children what should be their fundamental right: a voice.

And that is why I listed all the things that Lexy cannot do. It is quick aPhoto Nov 20, 11 14 44 PMnd easy for people to see Lexy now and say “that’s great for her, but it won’t work for Adam!” She is Adam. She is the student being blocked. She is the student who has spent years on the same stage of PECS. She is the student who is still working on that Big Mack switch. The only difference? We shifted. She didn’t change. She’s always been neurodivergent and bold and silly and fierce. We changed. We stopped blocking her and started encouraging her.  This can be true for Adam, or Jane, or whatever student you have in your mind right now. It takes a fundamental shift — remembering and grounding your work in the fact that all means all.

In the spirit of that, I’ll be posting a series over the next month that showcases how we can use robust language systems to teach many of these “fundamental” skills. It has never needed to be “this skill or that system”. It can be both. It must be both.