What is Augmentative and Alternative Communication?

Technology’s changing our lives and has given us the means to do what was thought to be impossible - to give voice to others. 

In this video, Stephen Hawking, discusses his new communication system with a BBC journalist.

Stephen Hawking is an AAC user. 

So,  what is AAC?

ASHA’s definition: "Augmentative and Alternative Communication is  Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write."

Smiling when talking to a friend, inserting an emoticon when sending a message, raising shoulders to express uncertainty are all examples of AAC. 

Who benefits from AAC

AAC systems are designed for individuals who are not able to use functional speech temporarily or permanently. For example, a child might use a low tech system while his/her speech and language is developing. When an AAC system is put in place permanently, it is seen as the individual’s primary method of communication throughout his/ her life. 

Additionally, AAC systems are sometimes appropriate to supplement individuals whose speech is difficult to understand. In these cases, verbal speech remains the main method of communication, and AAC system is only used as a means to clarify communicative breakdowns.  

Most often, Augmentative and Alternative Communication is prescribed for children with acquired communication disorders such as Autism Spectrum Disorders, Cerebral Palsy, Down Syndrome, Developmental delay, Apraxia of Speech, which result in significantly compromised communication skills. 

Some individuals with acquired conditions, like stroke for example, result in loss of communication skills later in life, and may also be candidates for AAC. 

Individuals suffering from progressive disorders (e.g., Amyotrophic Lateral Sclerosis, Huntington’s Disease) may also benefit from AAC.  

Selection

The process of selection of communication system is the combined effort of a team of professionals: a speech-language pathologist, an occupational therapist, a physiotherapist, a physician, an engineer, a vision specialist, a learning specialist as well as the AAC user and her/ his family.  

AAC systems

Unaided Communication Systems - rely only on the individual’s body to convey the message. Gestures, sign language, and nonverbal communication are all examples of unaided systems.  

Aided Communication Systems - rely on additional materials and/ or equipment to convey the message and involves visuals, communication books, and speech-generating devices. 

The biggest advantage aided communication systems have over the unaided ones is in the transparency of their messages. Everyone knows that a red stop sign means we have to stop, whereas only a limited number of people know sign language and understand the meaning each sign represents. 

The benefits of using AAC systems

Social Interaction

Studies show 30-50% of all children with ASD don’t develop functional speech. Many children with developmental delay also rely on AAC to communicate. AAC provides a way for individuals to participate in routines, games, and learning. 

Behaviour

The relationship between behaviour and communication has been well documented in the research literature. Therefore, it should not be surprising that the implementation of AAC systems often leads a decrease in maladaptive behaviours (e.g., screaming, hitting, pinching, etc).  

Communication

AAC systems support the development of expressive, receptive language, and speech production skills. 

Universal

AAC systems can be adapted to match each child’s cognitive and language level. There is no expectation that children would need a certain set of skills in order for AAC to be introduced.

Literacy

Through AAC systems, children severe expressive language delays can be introduced to grammar and literacy at the same age their peers learn these skills. 

Recommended readings: 

Millar, D., Light, J., & Schlosser, R. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech Language Hearing Research, 49, 248-264.

Beukelman D. , Mirenda P. (2005). Augmentative and alternative communication: Supporting children and adults with complex communication needs. (3rd Ed.)

Denitsa Getsova

Denitsa graduated from the Master’s program in Speech-Language Pathology at Sofia University, Bulgaria. In her practice, she has worked with preschool and school-aged children with a wide range of communication difficulties – speech (articulation, phonology, motor speech), fluency (stuttering), language, preliteracy and literacy skills, cognitive-communication (social communication, executive functions). Denitsa has completed the It Takes Two to Talk®and More Than Words®family-focused intervention programs designed for parents of children with language delays and social communication difficulties/Autism Spectrum Disoders (ASD). Additionally, Denitsa has received training in the PROMPT system(for motor speech disorders), DIR®Floortime Model (child-centered approach for children with ASD) and PECS (augmentative/alternative communication program for nonverbal or minimally verbal children). Denitsa incorporates new technology and uses an iPad in her sessions both as a way to support her clients’ communication needs and a tool for language learning. She provides assistance to parents in the process of selection of educational iPad applications for home practice.

Indirect Language Stimulation Techniques

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Indirect language stimulation techniques are powerful, child-centered strategies to use with your kids to help them learn language. They are appropriate for ALL children (typically developing and those with communicative impairments), and can be used in many different environments. The focus is on the child’s interest and what he/ she is doing, seeing, and feeling. 

Indirect language stimulation does not pressure the child to provide a response. Instead, the adult uses simple, short phrases to describe each action or object while interacting with the child. This helps the child learn the language she/ he will need later to participating in the same or similar game. 

There are a number of  indirect language stimulation techniques, and they are all interesting and worth mentioning. In this post, I will review self-talk, parallel talk, expansion, expansion plus, and recasting. 

Self-talk

In self-talk, you talk about what you are doing as you are performing an action. The focus is on the action you are in the midst of doing. 

Example: 

         Adult:”I am taking my shoes off. My shoes are wet. Where did my umbrella go? Oh, here it is. I found it. It was behind my purse.” 

          “I am washing the dishes. I am using soap. ” 

Essentially, you are pairing your words with the actions, thus providing an excellent model for your little one(s) to learn language. 

These strategies can be used in many different settings: at the grocery store, at the park, at home (e.g., cooking, playing together, doing chores together).   

It is important to use short, grammatically correct sentences when you talk to your toddler. 

Parallel Talk

The difference between self-talk and parallel talk is that in the latter you take the perspective of the child.  

Example:
         
         “You are playing with the cars. The cars crashed.” 

How to use: Use on its own or pair up with another indirect language stimulation technique. In my speech therapy sessions, I often use self-talk and parallel talk in the same activity. 

Expansion

With this strategy, you add to what the child is already saying, making it sound more like how you would have said it. 

Example:
         
         Child: "Baby cry." 
         Adult: "The baby is crying." 

How to use: Expansion works great for toddlers who are learning to combine words. This is a technique I use every day in my practice. It does wonders!

Expansion plus

 Like in the indirect language stimulation technique which was described previously,  the child’s utterance is expanded to make it sound like the adult model. What is different here is that we also add additional information. 

Example: 

         Child: “Baby cry"
         Adult: “The baby is crying. He looks tired.” 

Description

The focus is on the objects the child's engaging with. Take a moment to observe and listen. What does she/he seems interested in at the moment? Use short phrases to describe what the child is seeing. 

Example:           

             Adult:  “Cookies are delicious.” 
                          "This is a big ball."  
                          "This car is fast."

How to use: I usually use description with kids who already have a fairly good vocabulary. What I like about it is that it provides opportunities to teach a bit more advanced words: e.g., feelings, adjectives, etc. 
               
Recast

Recasting helps correct grammatical mistakes in a noninvasive way. Instead of pointing out what the child is doing wrong, we provide a model of what he/ she should be saying. 

Example: 

            Child: “The dog barking.” 
            Adult: “The dog is barking.” 

How to use: I recommend recasting if your children have difficulties using grammatical markers (e.g., if you hear phrases such as “The dog sleeping”, “I goed to the park”, etc.)

I am sure you are already using some of these strategies when playing with your toddler. Which ones do you think would be most beneficial for your child?

Planning to see the indirect language stimulation techniques in action? Remember: there is no need to bombard your child! Choose  one or two of the strategies and spend some time in preparing they will be implemented in play. It might help to jot down some phrases before you start using them with your child. 

Example: Parallel talk ( play activity - playdough)

            Adult: “You are squishing the playdough. Now you are cutting the playdough. ”
                        “You made a horse. Wow!”
            
In order for the “teaching” process to be effective, you will have to dedicate some time to it. Spend 10-15 minutes each day playing while using the strategy. It might take a few weeks to see the effects, but it’s all worth it!  

Happy playing!

Adapted from: Oh Say What They See:  An Introduction To Indirect Language Stimulation (1984). Educational Productions, Portland, Oregon

Photo credit: www.flickr.com/photos/ameriswede/

Denitsa Getsova

Denitsa graduated from the Master’s program in Speech-Language Pathology at Sofia University, Bulgaria. In her practice, she has worked with preschool and school-aged children with a wide range of communication difficulties – speech (articulation, phonology, motor speech), fluency (stuttering), language, preliteracy and literacy skills, cognitive-communication (social communication, executive functions). Denitsa has completed the It Takes Two to Talk®and More Than Words®family-focused intervention programs designed for parents of children with language delays and social communication difficulties/Autism Spectrum Disoders (ASD). Additionally, Denitsa has received training in the PROMPT system(for motor speech disorders), DIR®Floortime Model (child-centered approach for children with ASD) and PECS (augmentative/alternative communication program for nonverbal or minimally verbal children). Denitsa incorporates new technology and uses an iPad in her sessions both as a way to support her clients’ communication needs and a tool for language learning. She provides assistance to parents in the process of selection of educational iPad applications for home practice.