The Dos and Don'ts of Using AAC with Toddlers

The use of AAC, or augmentative and alternative communication, occurs whenever a person communicates through a form other than spoken language. AAC use with toddlers typically involves teaching our little friends to use sign language, pictures, or an AAC app or device to communicate. Importantly, using AAC with toddlers doesn’t mean that we believe that they are never going to talk; instead, it often means that we believe that they need a form of communication to serve as a bridge to spoken language.  When we think about using AAC with toddlers, the specific type of the AAC often isn’t quite as important as knowing some of the “dos” and “don’ts” of AAC use.  That being said, here are my top “dos” and “don’t” of using AAC with toddlers:

DO use AAC with toddlers who aren’t yet communicating verbally! In my experience as a pediatric speech-language pathologist, AAC is very often a powerful way to work toward spoken language. Using AAC can be very helpful when a toddler is beginning to use gestures, eye contact or sounds to communicate messages to others, but isn’t yet using spoken language and doesn’t yet respond to requests to imitate spoken words. Toddlers who fall into this category are often very frustrated that they can’t clearly communicate specific messages; the adults in their lives are often very frustrated that their toddler won’t imitate words. Once we show these toddlers the power of language through the use of signs, pictures, or other AAC devices/apps, they begin to understand that they can use specific words to make requests and talk about the world around them. Everyone is less frustrated! And, the vast majority of the time, toddlers then learn to use spoken sounds for that very same purpose - in other words, they start talking! In this way, AAC can serve as a bridge between early communication skills and spoken language.

DON’T worry that using AAC will prevent a child from talking. Research has repeatedly demonstrated that AAC actually helps children learn to talk, rather than preventing them from doing so. For example, Dunst, Meter, and Hamby (2011), completed a meta-analysis (a study that analyzes the results of a bunch of smaller studies) to look into the impact of sign language on spoken language.  They found that when intervention focused on sign language, children made significant gains in spoken language! Baumann Leech and Cress (2011) found a similar result when they followed the progress of a late talker who was taught to use pictures to communicate.  Although the child was never required to imitate words, he made significant progress with spoken language. Romski, Sevcik, Barton-Hulsey & Whitmore (2015) completed an extensive review of studies that looked at the use of AAC in early intervention and found that “the evidence strongly indicates that AAC does not hinder the development of speech at the very beginning stages of language acquisition” (pg. 194).  These are just some of the many research articles that support what early intervention speech-language pathologists know to be true:  Using AAC helps children learn to talk; it doesn’t prevent it!

DO use AAC with toddlers who are very hard to understand. All children deserve to be able to communicate effectively with others.  Some children, though, struggle to use speech sounds accurately.  These children can benefit from AAC use while they work on using speech sounds more accurately at the very same time.  Once speech becomes more effective, they will stop using AAC and rely on spoken language.

DON’T expect the toddler to be the only one using AAC. Instead, surround toddlers with lots of examples of AAC use in their environment. This means that the adults in a child’s life should use AAC, too! Just like children learn spoken language by hearing it, they learn to use AAC by watching others use it (Sennott, Light, & McNaughton, 2016).  We know that strategies such as self-talk and parallel talk help to grow a child’s spoken language; these strategies involve talking about what we are doing, what the child is doing, and what we are seeing.  When using AAC with a toddler, adults should continue to use self-talk and parallel talk. In addition to saying the words out loud, though, adults should also use the signs or pictures that match the words that are being said.  Not only does this help children to use AAC, it also provides a visual example of the words being said, which helps children to understand, and later use, those words.

DON’T use drill work to teach a child to use AAC. Instead, set up opportunities for a child to communicate meaningfully during his/her daily routine and favorite activities.  We know that communication temptations can be a fabulous way to create learning opportunities during a toddler’s day. Communication temptations occur when we get a child involved in something he loves and then, at a critical moment, we stop the activity. Within that crucial moment in which we know a child wants to communicate a message, we show the child how to use a sign, or a picture, or an AAC app to request more of the activity.  If he allows us to do so, we help him to use the sign, or the picture or the AAC device/app.  If he doesn’t, that’s okay! In that case, we just say the word for him while using the sign, picture, or AAC device/app and we continue with the activity. Eventually, when this procedure is repeated across time, children start to use AAC, too!  

DO give toddlers lots of opportunities to make comments and participate in social activities using AAC.  Although we might start by teaching a child to use AAC to make requests, we don’t want to stop there! Children communicate for a variety of purposes - to make comments about what they see, to greet others, to sing songs, to get attention, to take turns in a game...the list goes on and on! When we use AAC with toddlers, we want to give them opportunities to use AAC in a variety of ways (Davidoff, 2017).

DON’T only use AAC when the speech-language therapist is around!  In their review of the information on AAC use in early intervention, Romski, Sevcik, Barton-Hulsey & Whitmore (2015) found that families play crucial roles in the development of communication and language skills of toddlers and that parents and other communication partners can be taught to use AAC strategies with their young children. Everyone in a child’s life should climb aboard the AAC train!

DO seek out additional resources to learn more about AAC use with toddlers, such as: http://aackids.psu.edu

And…DO celebrate when a toddler starts to use AAC. There’s nothing better than watching a toddler learn the power of communication!

Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist and a Clinical Instructor at UW- Eau Claire.  You can find more of her blog posts at www.talkingkids.org.

References
Baumann Leech, E.R. & Cress, C.J. (2011). Indirect facilitation of speech in a late talking child by prompted production of picture symbols or signs.  AAC: Augmentative and Alternative Communication, 27 (1), 40-52.

Davidoff, B.  (2017). AAC with Energy – Earlier. The ASHA Leader, 22 (1), 50-53.

Dunst, C.J.,  Meter, D.  & Hamby, D.  (2011). Influences of sign and oral language interventions on the speech and oral language production of young children with disabilities. CELLreviews, 4 (4), 1-20.

Romski, M., Sevcik, R.,  Barton-Hulsey, A. & Whitmore, A. (2015). Early intervention and AAC: What a difference 30 years makes. Augmentative and Alternative Communication, 31 (3), 181-202.

Sennott, S., Light, J., & McNaughton, D. (2016). AAC modeling intervention research review. Research and Practice for Persons  with Severe Disabilities, 41(2), 101-115

Playing With Purpose: Bubble Blowing

Playing With Purpose: Outdoor Play