AAC 101: Who Should Use AAC and Why? - Part 5

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This is part 5 of a six part series on AAC 101:  A Primer for Supporting an Augmentative and Alternative Communication (AAC) User. Look for part 6 coming up later this week.

People who use AAC are those individuals whose current mode of communication does not meet all their communication needs; restricts the quality and quantity of interactions with others.  

All individuals are considered potential candidates for AAC; ASHA and the Joint Commission for Persons with Disabilities have a “zero exclusion” criterion and consider not whether an individual is eligible for services, but rather consider where along the continuum they are currently operating as a starting point .  As long as there is a discrepancy between needs and abilities, an individual qualifies for services in AAC.  

Best practices also dictate that, while there is a relationship between cognitive and linguistic skills, this is not a causal relationship.  Language skills are just as likely to affect cognition as vice versa.

There is no such thing as the typical or average AAC user.  You will find individuals who need access to AAC from all age groups and a wide range of diagnostic categories.  There is almost no group of clients or students you will work with where you will not find some need for AAC.  Many congenital and acquired disabilities will require the use of AAC.  You will find users who have a communication disorder due to a congenital disorder, and those for whom it is acquired; such as aphasia, traumatic brain injury, and ALS.

Children who do not have speech or whose speech is not meeting their communication needs need to be considered as candidates for AAC intervention.   Among children cerebral palsy, Autism Spectrum Disorder and other developmental disabilities probably are the largest groups of AAC users; however, there are a variety of other disabilities or disorders that will require you to think about AAC access.  Children with Angelman’s Syndrome, girls with Rett syndrome, developmental apraxia of speech and a host of less common or low-incidence disorders can show up on the SLP’s caseload.

Among adults, cerebral palsy  and developmental disabilities continue to be a large group of AAC users.  Also adults with ALS, MS, and those who have suffered a stroke/ CVA or spinal cord injury.  

In both adults and children traumatic brain injury (TBI) also accounts for too many AAC users.  

Not all of these users require high technology AAC systems to communicate.  But they do require a robust system that allows them to be effective communicators.  The “…ultimate goal of an AAC intervention is not to find a technological solution to the communication problem, but to enable the individual to efficiently and effectively engage in a variety of interactions.” (Beukelman and Mirenda, 1998)

They all also require that there be partners who keep them motivated and stimulated, who provide opportunities for them to communicate, who assess their AAC systems on an on-going bases, and who provided the aided input and modeling needed for them to learn how to use their AAC system and language.   These partners also need to know the wide range of communication functions that need to be represented in the users’ toolbox.

As we continue to talk about AAC systems, bear in mind that a functional AAC system is a compilation of strategies that allow the individual to communicate effectively a variety of intents in a variety of contexts, with a variety of partners.  

All of us use a variety of modes to communicate.  Different modes are useful in different contexts.  I cringe when a user has pointed to the item in front of him or used a single word response, in response to the question, “What do you want?” and the adult demands he used his AAC system to construct a complete sentence.  When my husband asks me what I want to drink, I don’t think I have ever responded, “I want an iced tea, please.”  All of us use gestures and single word responses quite often.  This is important to remember in intervention.

Also bear in mind that communication needs a purpose - an intent.  The individual must have something that he wishes to communicate - impart - to someone else.  It is important to make situations motivating and meaningful in order to create an environment in which an individual who is just learning to communicate has something he wants to say and the means to say it.

A case in point: I was called in to consult a district regarding a boy of 10 with autism.  

He had been using a PECS board with symbols for favorite foods and activities.  

Pictures were also used during specific activities in the class.  These velcro’d pictures were only available during the specific activity, and were limited to symbols required for that activity.  They were also limited to nouns, with a few activity-associated verbs.  

They told me he had been successful for a while with pictures, and was great at using them to request food (he was always hungry), but wasn’t using them for other activities and so they did not think he was “ready” for a more complex system. 

When I observed in his classroom, I saw him first during an art activity where he was required to cut and paste, then color.  This was a boy who had poor fine motor skills and did not like or ever want to do cutting and coloring.  But the symbols for the activity required to him say that he wanted scissors, he wanted glue, he wanted the red crayon, etc.  He most clearly did Not Want any of these things – and “Not” was not available among the symbols.  

Given an activity he enjoyed and appropriate symbols to use, he was clearly able to use them.  His vocabulary was limited, as he had always been restricted to a noun-based vocabulary, but he clearly knew what the pictures were for and how to use them.

Lessons learned:

1. Verbal communicators are able to tell you when they don’t want something or don’t want to say what you want them to.  Nonverbal communicators have the same right to say “I don’t want to” as everyone else.

2. Only giving the individual the words to say specific, limited messages does not give them the ability to communicate.  

3. As Gayle Porter says, “…a child who uses speech will independently select the words she wishes from the vast array she hears/uses every day.  A child who uses AAC will independently select the words she wishes to use from the vocabulary other people have chosen to model and, for aided symbols, made available for her to use.” (Porter & Kirkland, 1995)   And a child who uses a limited AAC system will sometimes NOT choose to select words that do not say what he wants them to.

Susan Berkowitz, MS CCC-SLP, MEd., has been a speech-language pathologist for 40 years. She has worked mostly with children and adults with Autism, Cerebral Palsy, and other developmental disabilities, as well as 8 years in the language-based classrooms in a school district. Susan has worked in public and non-public schools, residential settings, and nonprofit community agencies. She has written for peer-reviewed professional journals and presented at international conferences. Visit her website  and blog for additional resources. For her complete resume, click here.

References
Beukelman, D., & Mirenda, P. (1998). Augmentative and alternative communication: management of severe communication disorders in children and adults. Baltimore, MD: Paul H. Brookes Publishing Co.

Porter, G. and Kirkland, J. (1995). Integrating augmentative and alternative communication into group programs: Utilising the principles of conductive education. Melb: Spastic Society of Victoria.