By Kari Jaehnert, Assistive Technology Specialist
PACER Simon Technology Center
The ability to express oneself affects behavior, learning, and sociability. When disorders prevent individuals from speaking, they often become frustrated and overwhelmed. A toddler's anger when his parents cannot understand what he wants illustrates the situation.
Fortunately, technology such as augmentative and alternative communication (AAC) offers individuals other ways to interact. AAC refers to all forms of communication that enhance or supplement speech and writing. AAC tries to compensate, temporarily or permanently, for significant disabilities affecting speech, language, and writing.
Typically, children who cannot express themselves verbally will use an alternative method such as a communication board or book. Communication displays can be made of symbols from one of several symbol set libraries, actual objects, photographs of objects or people around them, or even drawings. The child communicates by pointing to the pictures or objects placed on the display. Although the method may seem very basic, it is a very powerful method of communication. By giving a child the ability to make choices, it reduces frustration and offers a way for the youngster to express him- or herself to others.
Parents and teachers have long used low or "light" technology to help children express themselves. Examples of low-tech methods include 1) gestures or signing, or 2) pointing to or looking at pictures on communication displays such as a board or book. These basic forms of communication can have a major impact on the lives of children with speech and language impairments.
The next step in AAC may include using voice output communication aids (VOCA). VOCAs are typically battery powered and operate like a simplified tape recorder. Most are the size of a notebook or smaller and have buttons or target areas for recorded words or short phrases. Most VOCAs use digitized speech, a human voice recorded into the device.
A symbol or communication overlay (a page of symbols) is placed over the button area. When the user presses or activates the message button, the VOCA plays a spoken message. If a child wants a cookie, she touches the symbol for cookie and the pre-recorded phrase "I'd like a cookie" comes from the device. Essentially, the device acts as the individual's voice.
Research shows that instead of replacing speech, communication devices actually encourage children to develop speech. Voice output devices reinforce language through visual, auditory, and motor techniques, encouraging those who are able, to develop language and communication.
A study conducted by Diane Millar, Janice Light and Rolf Schlosser, three speech-language pathologists, reported in 1999:
"…among those who are able, not only was natural speech not inhibited by the use of AAC systems, but natural speech was more likely to increase through the use of AAC devices."
Selecting the appropriate AAC device is a process. It is important to select a device based on each person's communication needs and desires. Some key items to consider when assessing a child for a communication device include: the method of access, language system, durability and portability, and the flexibility of the device.
Method of access. Determining the method of access needed for the child is crucial. An individual who cannot point with fingers might use eye gazing or directing light at symbols. Another individual might press a switch to advance a dial on a clock-like device, thus pointing to his or her choice of messages. The method an individual uses to communicate is unique to his or her specific needs and affects the use of assistive technology.
Language systems. There are many different language systems to consider for a communication device. Many newer or beginning users use picture communication symbols, Mayer-Johnson's Picture Communication Symbols (PCS) is one of the most commonly used picture symbol sets. For those who are literate, there are devices that use letters and words instead of pictures and come with utilities to make typing faster.
Durability and portability. Since early childhood classrooms have active children, hard floors, and sand tables, devices used by young children must have exceptional durability. Portability should also be considered for people who move from one space to another for various activities. It may be necessary to mount a device on a wheelchair or walker. Remember that the individual needs to take their "voice" wherever they go.
Flexibility. As the child becomes more proficient in using the device, it may be necessary to increase the number of choices he or she is able to make with it. It is sometimes possible to upgrade a device instead of buying another. The ability to upgrade saves money and saves the user from having to adjust to and learn another device.
Strategies for Implementing an AAC Device
Developing a strategy to implement an AAC device into the user's environment is another integral part of the selection process. Once the device is chosen, the individual must learn how to use it in her day-to-day activities. Parents and professionals should be trained and allowed sufficient time to learn the new device so they can assist the child. The following is a list of strategies used for implementation.
Provide a supportive environment.
Children and young adults need a safe place to learn, practice, and experiment with language-a place where all forms of communication are welcomed and encouraged. Teachers, service providers, and parents should work together to develop new ways to communicate with the children. The adults need to evaluate regularly the child's needs, capabilities, interests, and experiences so the goals they set will help the child's communication progress. Parents, teachers, and service providers are communication partners. They need to "listen" patiently for the child to locate and press (or point to) a desired message.
Challenge the child.
Because caregivers and educators sincerely wish to help the child, they frequently meet the child's needs before the child has an opportunity to communicate with them. Parents are the first and most consistent communication partners for their children. Many times parents or caregivers say that they "just know" what their child needs, and often this is true. But many parents also admit that they frequently have to play "20 Questions" to pinpoint exactly what the child is trying to say. Unfortunately, the effort to be accommodating and helpful eliminates the child's opportunity to use their AAC device in an effective manner. It is important that adults challenge their children to use their device. A strategy of "pretending to misunderstand" can be consistently practiced to encourage appropriate communication. By using strategies such as this, the child will learn to use their AAC device to convey their thoughts and needs through gentle reinforcement.
Keep communication open among team members.
Maintaining teamwork among parents and school personnel is vital to the success of the child. The team must develop common goals and consistent strategies to implement the AAC device successfully in both the child's home and classroom environments. The team members must frequently communicate and cooperate so that the home and school goals complement one another.
Take an active role.
All team members, or people involved in the child's life, must be skilled in whatever communication system the child uses. For example, if a child uses a VOCA, the parent or guardian should be able to use it with the child and know how to program it. Everyone in the child's life needs to take an active role to ensure success.
Check IEP/IFSP language.
It is important that goals and strategies for the AAC device are clearly written into the Individualized Education Program (IEP) or Individual Family Service Plan (IFSP) of a child with disabilities. Language in the IFSP or IEP must be concise enough to guide the process, but broad enough to allow for a variety of strategies and devices as the child develops greater communication skills. Assistive technology services such as professional and parent training must be addressed. The IEP or IFSP should also document a back-up plan and process if the AAC device should develop technical problems.
Try simple strategies first.
Teams may begin to help a child develop communication by using low-tech or inexpensive strategies. Later, as the child's skill develops, more sophisticated tools may become necessary. Repetitive phrases, sound effects, songs and jokes can be recorded into a device so the child can interact with his or her peers in various activities. District technology centers or other organizations may loan such devices for trial periods. If the child shows improvement with the borrowed equipment, document it. Such data can help the team acquire funding for a long-term solution for effective communication.
Source: Family Center on Technology and Disability