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AAC Options for Students with Autism

Author-Avatar betsy@augcomsolutions.com

5/29/2016 3:31 PM

The discussion topic I am submitting for this week is the implementation of Augmentative and Alternative Communication (AAC) tools and strategies in the schools for students with Autism Spectrum Disorders (ASD). In the Autism programs I visit across Northern California, I am seeing a critical lack of communication options available to the students. AAC choices are typically limited to the Picture Exchange Communication System (PECS) or a high-tech device, usually consisting of an iPad with a sophisticated communication app such as Proloquo2Go or TouchChat. I see PECS used primarily for requesting food during snack, and iPad AAC devices used for social communication such as answering questions or sharing personal information. The latter is usually accomplished with maximum prompting (sometimes hand over hand) by an adult.

Recently, I observed a nonverbal student with autism using his PECS book at snack. He asked for “sausage” several times, only to be told that it was not available. He then asked for goldfish crackers, which were also unavailable. As his frustration became apparent, he was shown the two choices available to him: cheese and grapes. The icons for these two food items were then moved to the front of his book and he received grapes after creating an “I want___” sentence strip. After snack was over, he was instructed to put his PECS book on a shelf at the back of the room. When I asked the teacher why he was putting his PECS book away, I was told that it was distracting and only got in the way during classroom activities. I then posed the obvious question; “How does he communicate without his PECS book?” and was distressed by the teacher’s response; “He doesn’t”. And even more distressing, she didn’t seem to think that was a problem! Unfortunately, I witness scenarios like this far too often.

The iPad is one of my favorite devices for students with ASD! It can serve as not only a functional communication system, but also an engaging learning tool. Too often, however, I see it used solely as a reward for good behavior or completion of tasks. The iPad becomes nothing more than a source of entertainment for the student, who uses it to play games or watch movies. Attempts to implement it as an AAC device are met with extreme resistance, and eventually the whole notion is abandoned. Again, this is a scenario I witness far too often.

So if PECS or the iPad aren’t implemented successfully, what other AAC options are available to students with ASD? Of course there are countless alternatives, but in my experience they are seldom considered. I frequently see students with ASD as old as 18 who have no functional means of communication! I am anxious to hear from others of you who serve this population:

  • -Are you experiencing similar frustrations?
  • -What are some of the barriers to successful implementation of AAC for students with ASD?
  • -What are kinds of AAC strategies are you seeing implemented successfully?
  • -Who is making decisions regarding AAC for students with ASD?

I look forward to a lively discussion on this topic!

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Betsy, You and the other responses have hit on so many of the issues/frustrations that I care about so deeply in AAC. 1) the overuse or misuse of AAC strategies; 2) underestimation of children's communication potential; 3) choosing a tool based upon a child's label versus what's needed in that individual child's environment, their unique, natural communication abilities and what is truly needed to be supplemented or augmented through AAC.

It is so easy for people, whether that is professional staff or family members, to look at AAC as a very medical or clinical science model type of prescribing an item. You have this (insert label/diagnosis here), so you get this (insert name of device/app/printed book here). Oh how easy it would all be. And there are people that look at it that way, and will tell you that it is just that easy. There are also those that want it all to be in the hands of the clinician with complicated formulas and a mystery of complex decision making. That there is an "art" if you will, to AAC. Well, I've been a part of that for a long time too. And unfortunately, as we look so much at it as just an "art" to the feature matching part, this has often left out the consumer and the people closest to the consumer.

So quite possibly can a better marrying of choosing AAC systems be closer to more of a mixture of art and science? The iPad has led us in that direction, There's much that families have found out that their child with complex communication needs can do and can "say" with that iPad - even if "saying" is telling people what their favorite parts of movies are by skipping through the fastforward sequence of a movie to get to that good part. So, isn't that communication? when a little boy can make his grandpa laugh and laugh at the same parts in a cartoon that he does?

Now, don't think I'm the first person to come up with this idea. A whole group of people got together and look at the influence of what iPads and other mobile technologies have done to AAC and wrote a White Paper about it a couple of years ago. And it has made some impact upon how and who and what the decision making process looks like for many of the teams that I'm involved with now.

We all have to be better observers of how people with complex communication needs communicate. We also have to look at practices that we use to get people started, such as PECS, which can be really effective at getting someone connected to a request for an item - but once that starts happening - you need to move on. And that's what we don't do, especially in schools. We tend to underestimate and over-test abilities and we don't realize that we've satiated a kid to boredom with certain items that they don't want to ask for that "blue dog" anymore, they don't care if you every "pop" another bubble every again, so they don't ask for "more". And what do we do? We say, "oh, she forgot". "He doesn't have it at 80% 3 times a week... blah, blah, blah. and really, the kid doesn't care about "more" of that item. He really wants to say "throw that thing away!" and "get me something different".

This is why it is so important to have more vocabulary that one or two items, Vocabulary that provides options for children to tell you what they really do want to say, such as adding a "something different" to every set of choices, if you must have a predetermined, limited set of choices; when asking instructional questions, add an "I don't know", to their set of responses; and some other option to a "yes", "no", such as a "maybe". Or "ask me later" or "you choose".

Of course, now I've gone way past your discussion points and on to my own frustrations....

Kelly Fonner - 6/8/2016

Kelly,

Thank you for your comments! Yes, we certainly do need to observe and honor the unique ways in which people with complex communication needs communicate. We tend to be far too data driven and task oriented while ignoring essential communication needs when serving this population. I appreciate you including the White Paper; well worth reading!

Betsy

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I have found that using ipads that also have youtube or other fun activities on it very difficult. Usually, the child with autism knows easily how to get out of the communication app and into a fun game...even with guided access (in some cases.) Also when using proloquo or touch chat, for example, it is only the requesting or refusal functions being used. Would love ideas on how to engage kiddos like this to move beyond requesting or refusing. Perhaps infusing activities with more literacy would help, using their preferred topics... so I am looking forward to more responses! :)

Karen Natoci - 6/5/2016

Karen,

I think the key to successful implementation of any type of AAC (high or low tech) is providing engaging, meaningful activities which inherently elicit communication, especially during the "training" phases when AAC strategies are being introduced. One of the first questions I ask a parent or teacher when doing an AAC assessment is "what are some of his/her favorite activities?" I then create communication boards with vocabulary specific to each activity, either on a speech generating device or a static board, and model it's use for requesting, commenting, labeling, and answering (or asking) questions.

Karen,

I think the key to successful implementation of any type of AAC (high or low tech) is providing engaging, meaningful activities which inherently elicit communication, especially during the "training" phases when AAC strategies are being introduced. One of the first questions I ask a parent or teacher when doing an AAC assessment is "what are some of his/her favorite activities?" I then create communication boards with vocabulary specific to each activity, either on a speech generating device or a static board, and model it's use for requesting, commenting, labeling, and answering (or asking) questions.

Karen,

I think the key to successful implementation of any type of AAC (high or low tech) is providing engaging, meaningful activities which inherently elicit communication, especially during the "training" phases when AAC strategies are being introduced. One of the first questions I ask a parent or teacher when doing an AAC assessment is "what are some of his/her favorite activities?" I then create communication boards with vocabulary specific to each activity, either on a speech generating device or a static board, and model it's use for requesting, commenting, labeling, and answering (or asking) questions.

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Dear,

It's my first time here. I'm somewhat short of time, but the issue is too compelling for me. So I'll just make a few considerations and we may go on some other time. ;-)

- I see AAC as a combination of symbols, aids, techniques and strategies (This is from ASHA Technical Report on AAC). I see PECS alone, I mean, the protocol, as an strategy intended for requesting/functional communication mostly. Ipad, on the other hand, is just an aid, maybe a combination of symbols and aid. They are both incomplete on their own. PECS is likely to lead to the accomplishment of few communicative functions if implemented the way you described above.

- "It takes two to tango" - this concept is largely overlooked in the cases you presented. It takes engagement for real communication to go on and progress (on all sides). We learn from the Communication Matrix there are four reasons to communicate. We must explore all of them and guide children/people with autism to more complex communication.

I have experienced similar frustrations with PECS. I do not have an Ipad (I'm from Brazil - I haven't tried high tech AAC yet, but I intend to do so soon).

For more successful possibilities with AAC I recommend looking at other directions.

Take a look at http://www.joannecafiero.com/. Her book is really insightful.

And https://www.amazon.com/Enhancing-Communication-Ind...

I follow this blog http://praacticalaac.org/

I hope that it's some good food for thought.

Best regards,

Renata

Re Bonotto - 6/1/2016

Thank you for sharing your insight and perspectives Renata! Thank you also for providing links to three very useful and practical resources. I would love to learn more about the frustrations you are having with PECS, and hear about the AAC strategies you are using with this population. I look forward to hearing from you again in a future post to continue this discussion!

Betsy

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