|
Inspire AAC Blog
To communicate, we need roots. This is our foundation, our family, friends and community. We need to cultivate pathways that allow children to grow, to stand tall, to blossom. We need to seek out new ideas to help us better support each other and the children we serve.
|
|
I have heard that establishing new routines takes at least 30 days of doing that thing every day. Building new habits takes time. Those of us who live and breathe AAC in our profession need to slow down and consider that family life is busy. Here are some tips to support families:
We are a small community of AAC providers and we love what we do! I know many speech language pathologists who love providing therapy with children who require AAC to support their communication growth. Finding an SLP who will perform AAC evaluations can be more difficult. To add to this, not all SLPs who do AAC evaluations will also then support families with obtaining funding for the recommended AAC system. Here is a list of AAC providers in the greater Seattle area who, to the best of my knowledge, perform AAC evaluations AND support the funding process:
What are some of the differences between these providers:
Other local resources:
I hope this list supports you in finding the best services to support your child or student. You can reach out to me directly from my website, www.inspireaac.com, with any questions and certainly let me know if I need to add anyone to this list. For the past few years, I’ve been thinking about the term Complex Communication Needs or CCN. In the field of AAC, we have been using this term to describe individuals who benefit from AAC. I am concerned that the term, which does not have any validation in our literature, is not the best term to use.
My way of looking at this is that for persons who use AAC, the need to communicate is not complex. The need to communicate is foundational and a right. There is an urgency in finding ways for individuals who use AAC to express their needs, not a complexity. By putting complex communication together, this suggests that the person who is using AAC, is using complex communication. This pairing is also not accurate since we all use different ways to communicate and we all experience communication breakdown. Sometimes communication is simple. Sometimes it is hard to express oneself. So, it is neither communication that is complex nor is it needs that are complex. Why then are we using the term complex? I suspect the word complex was used to describe either an individual’s access mode or that the AAC systems, the hardware and software, the strategies, can seem complex or difficult to learn and use. Another challenge with using the word complex is that I think this sets up the field of AAC in the wrong light. Using AAC may be perceived as complex to learn for both the AAC user and other stakeholders. There may be other perceived complexities such as the upkeep to the hardware and software, positioning, choosing the best vocabulary for the individual, etc. Those of us in the field take on these “complexities” with determination. I don’t perceive them as complexities. This is a part of what we do to support AAC users. This is what we do when we feature match. This is what we do when we work with individuals and their families to find the AAC “best fit” for who that person is, where they live, who they interact with and their future goals. Let’s look at an SLP who is required to differentially diagnose Velopharyngeal Incompetence, Velopharyngeal Insufficiency or Velopharyngeal Mislearning in the context of speech challenges. The knowledge, the assessment and differential diagnosis is complex. Acquiring intervention strategies to treat these disorders takes time and experience. What might work with one individual may not work for another. We don’t call the knowledge and skills to treat these disorders complex. Nor do we say that these individuals have CCN. What about SLPs in our graduate programs or just starting out? Hearing the term CCN can feel overwhelming. A new SLP may feel they don’t yet have the knowledge or skills to address individuals who have CCN and may defer or decline to work with them. The term complex may give pause to our graduate students who already feel overwhelmed during their graduate studies. What about AAC users themselves? How do they feel about the term CCN? Does it describe their communication needs? What does the term complex mean to them? Lyle Lloyd posted a useful narrative to SIG 12 on ASHA several years ago. He stated that the term CCN has been used by ISAAC for its official papers though ISAAC maintains using CCN is not required for their research and professional publications. In the past, there have been other terms used such as Person Who Uses AAC (PWUAAC), Aided Communicators and Non-speaking Persons. More recently, the term AAC User was mentioned on SIG 12. Since writing out “a person who uses Augmentative Alternative Communication” is incredibly wordy, it makes sense to find an acronym that is universally agreed on. Let’s brainstorm and discuss what might be a better term. I think it is helpful in our literature to understand there are individuals who benefit from AAC, who have a need to use AAC for their communication. Why not just use this then – individuals with AACN? Let’s continue the discussion.  From time to time, we SLPs may encounter a child with communication challenges who is also blind, low vision or has a cortical vision impairment. I was fortunate early in my career to have my first job co-teaching with a wonderful teacher who trained at Perkins School for the Blind, in Watertown, Massachusetts. We worked together at a private school for children ages 3-21 years and many of these students had some form of vision impairment. I quickly became familiar with tangible symbols, tactile sign language and AAC strategies for this population. Prior to using symbols for communication, a child with a vision impairment has to learn to trust and reach out with their hands to explore their environment. This is where hand under hand support comes in.
What is hand under hand support? The strategy of hand under hand is useful for different populations, who may not be able to see you or your hands well (https://www.wsdsonline.org/hand-under-hand/). Hand under hand support helps a child experience how others hands move independent or together, including direction, speed and tempo. Hand under hand use helps a child learn to reach out and explore what is around them. If your hands are on top, you are in control and the child follows passively. Hand under hand use helps the child be more active and promotes their own hand use to reach out and explore their environment. This strategy also prepares the child for using tactile signing. The child learns to reach out to another’s hands to seek information. I invite you to scroll through this presentation. It has great short video clips for what hand under hand support looks like: https://docs.google.com/presentation/d/1ARNrneuu10gelg9iP8Ds032ZK9wcZJWkbV4Z4iRAZ7c/edit#slide=id.p28 Why do SLPs need to know this? A child with a vision impairment who is also not developing speech may require AAC strategies. Hand under hand support sets up the foundation for learning tactile sign language. In some cases, a child who learns to reach out and explore their environment can then learn to reach out to explore an AAC system such as a tangible symbol system or use of tangible symbols on a voice output device.  Why is answering yes or no to a yes/no question so challenging for some children? There are many reasons. A child with complex communication needs may have any combination of speech, language cognitive, motor, hearing and/or vision challenges. How do we teach this skill? Let’s start by considering when yes/no responding develops typically. Most 12 months old can stop doing what they are doing when they hear the word no. By 30 months or 2 ½ years of age, most children can say yes or no to simple questions. To teach a child how to respond to a yes/no question, there are two elements.
First, they have to understand the question. So, the solution to start is to make the question very simple with visuals. For example, you hold up a toy and say “do you want this?”. I often think about the concept that researcher Cynthia Cress PhD calls “too many hard things” (https://cehs.unl.edu/secd/faculty/cynthia-cress/). For some children, actually have both a visual and an auditory prompt can be “too many hard things” and so you may need to use only one prompt, either hold up the toy and gaze at it with a questioning look or ask a question “do you want x” without a visual. Second, the child has to have a way to respond. Again, thinking about the concept of “too many hard things, I never start with yes/no symbols because this adds a layer of complexity. I try to start with the child’s own natural responses, such as a smile for yes or a pout or look away for no. When working with children with cerebral palsy who are developing cognitively at age level, I often see that these children have figured out what motor responses they can do consistently, extending the body for yes or dropping the head for no, as an example. For another group of young children with mild-moderate motor delays, I sometimes see a trunk movement up/down for yes (as if they can’t get their head to isolate but can get their whole body to move up/down) or a very subtle head shake. For eye gaze responses, a child can look at you for yes or look away for no. The recommendation is to try and find one consistent and reliable natural response that the child can perform. A few extra thoughts. I often recommend communication partners model BIG motions for yes (head up/down) and no (head side to side). For some children, the silliness of this is enough of a motivator to help them imitate what they see. I encourage families and the team to agree on a single response for yes and a single response for no. This sets up the expectation that the child will respond in the same way across settings. Pay attention to the environment. One of my patients with a vision impairment is so tuned into the auditory environment, that responding is best when the environment is absolutely quiet (no small feat in a busy classroom or home setting). Teaching yes/no to children on the autism spectrum requires some additional thoughts as these children sometimes struggle with sensory challenges that interfere with their ability to listen and understand a yes/no question as well as to orchestrate a response. Additionally, I believe there is a social communication element that is challenging yes/no responses. For children with ASD, they may need to develop sensory integration strategies to be able to listen and respond. They may need to learn the social communication rules regarding yes/no responding before they can accurately answer yes/no questions. In summary, once the child is showing a consistent natural gesture or response to being asked “do you want x”, then bringing in symbols, switches or attempting harder questions can be pursued. We all encounter children who require AAC supports but have not yet shown consistent symbolic understanding or use. In other words, these children are not yet using spoken words, word approximations, sign language, picture symbols or text-based communication. As therapists, we struggle to find the needed AAC system or strategy that will support communication growth. Parents are critical as partners in this exploration. Not only is the AAC system or strategy need to be well matched to the child but the parents as communication partners need to be able to understand and use these strategies as part of family routines. Over the next several months, I will be posting some ideas for how to address communication for this population. Let me know if you have any questions about how best to serve these kids. And let me know what you think!
 Welcome! 2021 is finally the year I'm launching a website. This has been a fun project and, hopefully, the site will guide you in your search for services for your child or student. Communication is at the heart of what I do and communication is so much more than talking (or reading emails or blogs). It is being eye to eye with someone or sitting next to them. It is listening and relating. There is a wonderful book called Communication by Aliki, published in 1993. It is a children's book and a great resource for teachers or parents to help children learn about all the different ways we communicate. At the end, the author writes "Communication is the back and forth of telling and listening and responding, so you know you are not alone." If you would like more information related to any of the services listed on this site, please call or email. Let's have a conversation about what types of services and supports you are looking for. And again, welcome!
|
