AAC and Communication options for Non-Verbal Children
AAC (Alternative and Augmentative Communication) This name sounds a bit funny but it actually tells you a lot about what AAC is and isn’t. AAC serves two different but sometimes related purposes. Firstly as an alternative form of communication for people who can’t access traditional spoken communication. Secondly, to augment, supplement or support the use and development of verbal communication. When we are looking at communication options for someone who is non-verbal or has significant barriers to successful verbal communication we can use AAC to help these individuals communicate their wants and needs and engage more socially with those around them. There are many different types of AAC but they can all be divided into 3 main categories. There are unaided methods which do not require any additional items or equipment such as facial expressions, gestures and signing. Aided communication does require additional items and can be divided again into low technology (no batteries/power required) and high technology (communication devices). Here are some further details about each of these 3 types of AAC.
Unaided AAC Body Language and Gestures Body movements and facial expressions including frowning, smiling and simple actions such as reaching are all types of unaided AAC. Gestures include natural actions such as waving, shaking hands, and pointing. Gestures are interpreted differently according to the situation in which they are used. For example, waving may be interpreted to mean “hi” or may be used to gain someone‘s attention. Signing Signs Key Word Sign (formerly known as Makaton) is a widely used system that promotes communication. It uses manual signs (i.e. your hands) with speech. Key Word Sign uses signs for just the keywords in sentences to convey meaning. For example, in the sentence ―”I feel hungry” only the words “I” and “hungry” would be signed. Key Word Sign is not a language like Auslan – which is the language of the Australian Deaf Community. Auslan is a whole different language with its own grammar rules but is also another form of unaided AAC. Key Word Sign uses Auslan signs but with speech and follows spoken English grammar. Key word signs may help adults and children who need more than speech to communicate. For some people signs make it easier to express themselves and be understood by others, by supporting their understanding of what others say to them, and by helping to develop their own communication skills. Low Tech AAC
Objects Objects are usually used to support a child‘s understanding and in choice-making. For example, the teacher says, “Now it’s storytime.” whilst holding up a book, or a caregiver holds up the juice bottle and a tin of milo and asks, “What do you want?” The child can then indicate by pointing or looking at the one they want. This allows all children to make choices and have some control in their lives whatever their communication level.
Object Symbols Object Symbols are items used to represent larger objects, events or activities. For example, keys can be used to indicate that it is time to go in the car. They are particularly useful for people with sensory impairments (eg both visual and hearing impairment). Object symbols can also be used for people who are learning to progress from objects to pictures/symbols.
Photographs Photographs can be used to represent objects and activities and are usually used in a similar way as objects/object symbols. They are less “real” than objects, but not as abstract as drawings or symbols. Pictures/symbols Pictures and symbols provide a way for individuals with limited verbal skills to request, comment and answer a communication partner’s questions. PECS (Picture Exchange Communication System) is a commonly used method to systematically introduces the “exchange” of pictures to communicate. Communication Boards/Books A communication board is a single sheet that contains the picture symbols of everyday language or it may contain language specific to an activity (such as cooking or bathtime). A communication book is a way of organising more vocabulary for a person who uses AAC. Vocabulary can be organised in different ways, but there is generally an index page at the beginning of the book and tabs on the edges of the pages, so the owner of the communication book and his listener can quickly move to other topics/pages. A PODD (Pragmatic Organisation Dynamic Display) book is one example of a communication book. High Tech AAC Communication Devices Communication devices (also known as voice output communication aids [VOCAs] or speech-generating devices [SGDs]) are items of equipment that generate spoken words using synthesised speech (artificial voice) or digitised speech (recorded human voice). There are a HUGE range of different communication devices with varying complexity, display and access options and they change constantly as technology advances. iPads & Apps In recent years iPads and different Apps (Software Applications) have become an extremely popular option for AAC users because they are portable, socially acceptable and relatively affordable when compared to many communication devices. Proloquo2Go is possibly the most widely recognised and used iPad communication app but is definitely not a “one size fits all” for AAC users. Thinking AAC might be useful? Before you rush out and buy a device, start signing or start laminating symbols to help someone communicate it is ESSENTIAL that you do the following:
- Get a proper assessment by a qualified Speech Pathologist to evaluate current communication skills and needs to identify AAC options that might be a good fit.
- Trial and evaluate each of the potential options under the supervision of a qualified Speech Pathologist.
- Learn how to make AAC part of everyday life for the individual from a qualified Speech Pathologist.
We’ve heard horror stories of children who are verbal being “made” to use AAC to communicate or AAC being used that is completely inappropriate for a specific client’s needs. These sorts of things not only waste valuable time and money but most importantly they limit the communication potential of an individual. If you are interested in learning more about AAC or consulting with one of our Speech Pathologists to determine whether AAC would be beneficial and how best to select and learn to use AAC give us a call on 1300 66 1945.
– by Rachel Tosh
Rachel is a Certified Practicing Speech Pathologist (CPSP) with a wide variety of clinical experience in inpatient and outpatient paediatric care in both Australia and the UK which enables her to translate theory into real life application across diverse clinical contexts. Her latest adventure, Speech Parent is changing the face of paediatric speech pathology internationally by empowering and educating parents of children with communication and feeding difficulties. She describes herself as a recovering work-a-holic (we all know she isn’t actually recovering – seriously who else sends emails at 4:30am!?). Rachel is passionate about: business leadership; literacy and feeding difficulties; educating and empowering others; and optimising therapy outcomes. Although these interests may seem diverse, the recurring theme through them all is a love for facilitating growth and development in others so they can achieve their own unique potential. Things I like: “Lamb roast, reading, helping others and creating systems that work…I may or may not enjoy these together!” Things I don’t like: “People not respecting each other and children missing out because of bad care or broken systems.” Favourite colour: “Can I have the whole rainbow?” How the TAG team describe Rachel: “Passionate”; “Hard working”; “Creative”.
“Be there for others but never leave yourself behind” -Dodinski