Quality AAC Implementation
What about it?
• it takes a long time
• the agreement of a team helps, but one dedicated stakeholder can still do a lot
• develop a long term vision for your AAC user
• pick a robust language system that your user can access and attach with it
• focus on immersion overexpression at any moment
• it's normal to have periods of growth and periods that feel like a tableland
• identify barriers and figure out how to manage them
Implementing AAC at home
Implementing AAC at home is essential. Here are some tips on how you can do it.
Implement the AAC system during a daily routine
Every child's everyday things to do are morning routine, nighttime routine, mealtime routine.
These moments would be a great place to implement AAC! For example, "get up" or "wake up" for the morning routine. "Put on a shirt," "choose shoes," "make breakfast." Choose a few words or phrases to target at each time of day. Write them down, put a reminder on your phone, memorize their location on the device. Model each day during routines and ask questions that would help them to express those messages.
Create a second version of their AAC system
If your child uses an AAC app on an iPad, download that same app on a second iPad and let a sibling use it while playing or speaking with the child who uses AAC. You can also make a low-tech (paper-based) system: a binder with all of the pages in the device printed out and laminated. These should be accessible to members of the family.
Take the images from your child's system and print and post relevant vocabulary in different areas of your home. For example, having a laminated paper-based copy would help places where a high-tech device may be dangerous. Moreover, having low-tech systems enables you to model frequently without needing a high-tech device.
Choose a word of the week
Choose a word or phrase you want to target that week and post it to the fridge, or wherever else you will see it and remember to use it. Adding words to your child's emerging vocabulary is extremely important! I would suggest targeting core vocabulary terms at first, which are made up of pronouns, some adjectives, and mostly verbs.
If you're expecting quick results with AAC, you're likely to be disappointed. Remember that it will take a long time, but it's so worth it.
How to stimulate the AAC user to start communicating?
You may begin with words that describe the AAC user's favorite things and activities. (eg. chocolate)
For example, if the AAC user loves chocolate, then "chocolate" might be a good word to program into the app.
You need to motivate your AAC user to use the device. How will you do it? By leveraging the fact that your child wants chocolate.
Give him/her the chocolate just if he/she asks for it using the device.
Ways to include AAC users in conversation
Pause, wait, and allow time for the AAC user to form a sentence.
An AAC user can't provide the typical nonverbal cues while using their device.
Ask the AAC user to show you photos of what they are talking about. While you explore the pictures, the AAC user can form their message.
It is often more efficient for them to use visual supports to set topics, such as photos or line drawings.
Ask others in the conversation to wait while the AAC user is trying to deliver their message.
Core words are part of the list of the words we use the most in our daily life (80% of what we communicate). So the words we use every day are called core words. Core words are represented by verbs, prepositions, conjunctions, articles, adjectives, pronouns. Nouns are rare.
Core vocabulary is a small set of simple words, that are used frequently and across contexts.
AAC devices have these core words which give the chance to a non-verbal user to communicate.
Having core word vocabularies is necessary
Core word vocabularies represent the base of what you are going to build. These types of vocabularies are easy to find in the AAC apps, such as in the Fluent AAC app. We have estimated that a core word vocabulary includes the majority of words a user needs to be able to communicate, express feelings, and be understood by those around him.
Provide access to core vocabulary
Before we start teaching core vocabulary, we have to give our patients
AAC devices that have a variety of core vocabulary. That can be done if you set up the AAC devices for core language. The goal of utilizing core vocabulary is to give our non-verbal AAC users the ability to express themselves independently.
If we are giving access to the core words to AAC users, we offer them a great device that enables them to say everything they want. They have the chance to choose from a nearly small set of words to create their sentences. This way, they can express many ideas and thoughts.
What words should you begin with?
Remember that when you teach core words you have to pay more attention to what the user needs.
Managing which words, to begin with, can be challenging. If you search on Google for core vocabulary lists, you’ll find lots of articles and other already finished word lists. Honestly, this is kind of overwhelming. You’ll notice that there is typically a lot of overlap in words from a list to another list. You may notice a high percentage of the same words on many lists.
Here is our list of the words that we have selected to begin with when implementing core vocabulary guidance:
"I" "eat" "go" "more"
"You" "drink" "like"
"help" "done" "stop"
"want" "no" "that"
"need" "yes" "it"
Tips for beginning with Core Words vocabulary
The goal is not for the child to master the use of full sentences in the beginning but to form simple grammatical structures like "want water"
Communication is more than just words. Body language is crucial and expresses so much so you need to accept that as a form of communication.
For example, the patient can communicate with you by pointing to the bathroom. You can then model the "bathroom" word on the AAC device so the AAC user will make a connection between its needs (expressed through body language) and the device.
You can’t just show an AAC user a set of words and expect the user to learn them. You need to MODEL and show the patient what those words mean and what happens when they use them. Encourage them!
Why teaching core words is seen as a difficult challenge?
At first, many people struggle with teaching core words. We've detected that core words are less picturable. For example, conjunctions, adjectives, and prepositions are harder to be described in images, and also, some of these core words can have multiple meanings. Another difficulty is when you present to the user a core word board. The core word board may make patients feel overwhelmed because of the variety of words on a single page.
How to teach core words?
To model, you have to be the one who uses the AAC app the most. Every time you say any word on the app, point to the word. You can talk in full sentences but you have to give meaning to the words and images and refer to them
while you speak.
Example: How to teach the word "DO"?
The word “do” is one of the most versatile and common core words in our vocabulary and can be applied in almost any activity.
The word "do" can be used to manage other people’s behavior, ask questions, describe actions.
The word “do” is an easy word an AAC user can use in the position of other verbs he/she hasn’t learned. When it is another user’s turn to perform a gross motor or fine motor task, let your student say “do it” or “you do it.”
Many patients enjoy having others imitate their behavior. You can model for them “I do it,” and “you do it” during social activities like making faces, pretending to sleep, or be sick.
Let your patient use the word “do” to ask for help. When clothing, or opening food containers, your child can direct you to “do” it. You can also teach "don't" at the same time.
Knowing the words and making changes in a patient's communication style are two different things. An AAC user learning new vocabulary may need anywhere from 50 - 350 repetitions before mastering the word. It takes a lot to get to 350 repetitions. If it’s just you and you alone, then it will take longer to get to mastery. Get your team (family members, speech-language pathologists) in for this one!
Core words teaching strategies
Choosing words based on different communication functions can be an efficient place to start.
Consider all the different reasons we communicate. This can help us find core words that will support an AAC user to build language.
Requesting: want, want that, want more, I want
Directing: get, get it, get that, I get that, put it in, take it out, do it, I do it, give me that
Ask for information: what?, where?, where go?, who?, who go?
Give opinions: like, I like that, not like, good, bad, that good, that bad
You can select core words that are used to communicate during a specific, frequent activity.
Cooking: make this, get more put in, put in there help, need help like this, not like this
Puzzle: look, what?, where? where goes?, I do help, need help put in, take out
Music: turn on, off, turn up, what next?, want more, do it again like, not like, good, bad
Another way to structure the process of teaching and modeling core words is to target WORDS OF THE WEEK.
-sticky note the ‘target words’.
-use a word wall and let learners add pictures, text that define, categorize, or relate to the target words.
-create Word of the Week books. These can be physical books, folders with pockets.
-you can also create Word of the Week boxes. AAC users can put items in a box, decorate the box, move the box.
Activity ideas which may help you teach core words
➊ Words of the week
- highlight or sticky note the ‘target words’.
-use a word wall and let learners add pictures, objects, text that define, categorize, or relate to the target words.
-the word wall can become an important part of vocabulary instruction and learners are familiar with it, add some visual labels for where different items would be placed.
-create Word of the Week books. These can be physical books, folders with pockets, talking PowerPoint books, talking photo albums.
-you can also create Word of the Week boxes. Patients can put items in a box, close the box, decorate the box, move the box.
➋ Treasure Hunts
The game consists of searching for items that compare to the core vocabulary. Also, you can hide written words and go searching for them. To make it fun for learners, you can dress up as treasure hunters, give clues, or have a treasure map.
➌ Word PARTY
At the end of every week/month, you can organize a party with the purpose of learning and revising the core words. In order for the child to assimilate information, you have to make the activity of learning really fun.
Arrange a special party room and decorate it with confetti, balloons, bring food and juice. Make everything possible for the patient to feel comfortable and motivated.
Fringe words are more situation-specific. Their importance changes from context to context and from person to person. (e.g.evaporation, museum, funny). Fringe words are nouns, verbs, and more special adjectives.
Fringe words are very specific words. They have a more narrow meaning than core words and they describe particular things.
Fringe words are often easier to teach because you can picture them and explain them through images. However, core words are more flexible to use with communication partners. We can't just speak using fringe vocabulary so we must focus on teaching the core words first.
Differences between core vocabulary and fringe vocabulary
Some people may not be informed about the differences between these two. They correlate very well because we need them together to be able to form full sentences.
Let's imagine a common conversation between a person and an AAC user:
"What do you want to eat?"
Child: "I don't know."
"Do you want cheese or yogurt?"
Child: "I want cheese."
13 of those words are core words (want, do, don't, I, you etc.). The other 5 are fringe words (eat, know, or, cheese, yogurt).
Core vocabulary is represented by those words used with high frequency. Core vocabulary is usually the main part of all AAC devices because it is the most important in every situation we encounter.
80% of the words we use every day, can be used regularly for interactions in many different situations. Most of the core words are pronouns, verbs, adjectives, and prepositions. As you may already know, core words are often more difficult to be pictured. The difficulties come from the fact that there isn't a picture or object that represents words like "want", or "put."
Even if we have to put more accent on core words, we also use fringe vocabulary 20% of our time. Fringe vocabulary is used in fewer situations and at a particular time (e.g. ‘mountain’, 'road ', ‘hole’).
Fringe words are more specific to a subject, or individual. They represent approximately 20% of our vocabulary. Fringe vocabulary isn't made of general words and can not be used beyond many different situations. In the conversation example above, the fringe word "cheese" can not be used in a variety of situations and topics.
Why you're struggling to implement AAC?
It's never the learners' fault! Nothing about them makes them unable to learn AAC. If you hear people saying that a child isn't ready for AAC, they blame the learner. That kind of thinking gets us nowhere. Our learners are doing their best. It's our mission to figure out how to support them to be successful. No one said AAC was going to be easy.
Can the AAC system be one of the problems?
There may be things about the system that could be improved. You need to have a robust AAC system.
What should be done?
Implementation is the field that needs attention most of the time. Focus all of your time and attention on improving performance.
Stop using "high functioning" and "low functioning" terms
We need to stop using these two terms: "high functioning" and "low functioning".
But why do we have to do that? Because the language we use to talk about the AAC users impacts our thinking about them.
Why are these terms problematic?
-They don't inform our teaching.
-They provide no real information.
-They don't consider the impact of the environment or context on an individual's ability to function.
-They don't encourage an understanding of a user's unique profile and needs.
-They can minimize an individual's strengths.
They suggest a functional level that doesn't change, which can negatively impact expectations for growth.
-They can become barriers to supports.