Designing No Tech Augmentative Alternative Communication (AAC) Devices

My new job involves working with kids ages 2-5 who have been diagnosed with autism or other neurological disorders. The range of abilities I have worked with in the last 6 months has been challenging but exciting. One of the biggest challenges for me is trying to develop no-tech AAC options for my non-verbal clients. The clinic I work at is unique because it is considered a "kick-start" into therapy. Most of our clients are recently diagnosed. Our program offers them and their parents an intensive 3 month introduction to treatment. Having only 3 months with each client is the greatest challenge to this new position. It's hard to so frequently start over. And it really requires me to think through the most essential ways I can help them in the short time before we transition them to their more permanent therapy approaches.

Right now I don't have access to any high tech augmentative alternative communication (AAC) devices. I am hoping to find a dedicated AAC team here in the state of Washington that might be able to come in and consult with us, but I have yet to find one. In the mean time, I'm trying to design simple, functional communication boards or binders for those clients who need them.

Here are a few of the issues I have to deal with in designing these simple communication devices. I am going to put a big disclaimer out there that I am definitely not an expert in AAC. These are just the lesson's I've had to learn during the process.
  • SIZE: In order for the communication book or board to be truly functional it needs to go with the client everywhere. That means they need to be able to carry it. I have experimented with a lot of options and a lot of times it just depends on the individual kid which thing will work best. Here are a few ideas I considered. 
    • mini 3 ring binders
    • business card holders
    • laminated file folders or mini file folders (if you have a small laminator like me)
    • 3 x 5 index card binders
    • simple durably laminated pages or half pages hooked together with book rings
    • small wristband communication board (velcro wristband with small laminated sheets, or a hand sewn insertable option)
    • spiral bound flip books
    • in all honesty after all the experimenting and trial and error I have settled mostly on making small laminated file folders for ease and cost effectiveness purposes. At the clinic the file folder follows the kid wherever they are going so they always have access to it. Once the kid has mastered it at the clinic we make a copy for them to use at home with their family. The child needs access to their communication folder at all times in order for it to be effective. 
  • CORE VOCABULARY: Holy smokes this is a daunting task for me. Deciding which words will be the most functional for each child is really overwhelming. I have read so many websites and books and still haven't found that dream one-size-fits all core vocabulary. But there's gotta be a good solid core to the initial steps of English. I'm still teasing that out while swimming through all the info out there and trying to maintain balance in my life. I'm still so new to this process and I'm learning a lot. But each time I design a new system, I have to to remind myself to START SIMPLE. You are likely going to spend a lot of time teaching each word and concept. So start small and basic. Here are some things that are really important to keep in mind.
    • DO NOT use only nouns for things the kid likes. The purpose of communication isn't just to ask for something we want. Communication has many purposes (Light 1998): 
      • to communicate wants/needs
      • transfer information
      • establish social closeness
      • fulfill social etiquette
      • develop internal dialogue (Beukleman & Miranda)
    • Make it individual. It's a lot of work to make a new communication board for each kid, but I'm getting faster at it each time. And honestly in the past when I've tried to use another kids communication board, it is usually awkward and I have to make changes immediately.  
    • Basic core vocab suggestions: these are the core words I've used most often
      • greetings: hello, goodbye 
      • pronouns: I, You
      • verbs: want, see, feel, hear, smell
      • adjectives: like, don't like, fun,
      • commands: yes, no, go, stop, again, wait, my turn, your turn, more, done
      • familiar/favored nouns/verbs core board: activities, games, objects, people that the child frequently wants (e.g. coloring, blocks, balls, cars, book, singing, swing, jump)
      • feelings core board: happy, sad, mad, tired, silly
    • Make core phrases: for many of my kiddos they are just learning the function of communication. We try to keep things very simple for them. With one kiddo I'm currently working on core phrases of:
      • I want...  I hear...  I see... I feel...  I like.... I don't like...
    • Make an easy to access place for the most important core phrases. Here are some things I've used in the past for this section.
      • I need a break (this is only used if the kid needs a break from a learning task, it doesn't mean they get to go play. If they ask for a break from a task, the task is removed for a short period of time.)
      • I need to go Potty
      • I need to Eat
      • I need a Drink
      • I need Help
      • I want a New Toy
  • FRINGE VOCABULARY: The fringe vocabulary is additional vocabulary that is more specific to certain activities or situations. For example if you are playing with a toy house you might pull out a fringe board that has different toys that go with the toy house (e.g. boy, girl, bed, table, chairs, pot, plate etc). For my kids who have mastered the use of the basic core board, I try to introduce a new fringe board every week, or every day, depending on the child's skill level. Keep in mind that you might want to start simple with only 3 or 4 fringe vocab words for each activity. If your client does well with the fringe boards and learns quickly you can do more. 
    • fringe board examples I've used in the past, I put the different activities I've used with the fringe boards in parentheses:
      • Descriptors: colors (with coloring, play doh, etc)
      • numbers (with number puzzles, or counting activities)
      • shapes (with shape sorter, matching games, art projects from cut out shapes)
      • sizes (with mommy and baby animals, objects of various sizes, etc)
      • Farm Animals (with I went walking book, farm animals game, barn toys, Old Macdonald song, little blue truck book)
      • Toy House Accessories (with naturalistic functional play)
      • Mr Potato head parts
      • Body Parts (with head shoulders knees and toes, simon says games, do as I'm doing song)
      • Textures with sensory play toys
      • Art Supplies
      • Cookie decorating supplies
      • Play doh accessories
      • the options are limitless!!!
  • Organization:
    • It needs to be chunked into groups that make sense. It needs to be easy for the child to navigate, otherwise they will not use it. And if they don't use it, well, it's useless. It might be the most beautifully thought out communication board, but if it isn't easy to quickly pick out necessary vocab, it will not work for them. I'll put a few suggestions I've found useful in the past 9 months of experimenting.
      • Have a visual schedule on the front or back. Somewhere that is easily accesible.
      • Have quick social greetings on the front or back. For those times when they are quickly passing by.
      • For our little autism kiddos having a removable first, then board velcroed to the back has been very helpful. If their system has removable pictures it's easy to place those pictures on the first, then board.
      • Put Basic Core Vocab at the top or on one side, chunked in specific groups like: 
        • greetings (hello, goodbye), 
        • commands (go, stop, again, wait, my turn, your turn, more, done), 
        • yes and no in a well defined separate space that is easy for the child to find.
        • carrier phrases (I want, I see, I hear, I feel)
        • essential needs phrases: (help, break, potty, eat, drink)
      • Put Core Vocab Boards in a specific space: I usually place mine directly below the basic core vocab listed just above.
        • feelings core board
        • preferred toys/activities core board
        • familiar people core board
      • Put Fringe boards on the other side in an insertable, flipable or easily removable way. Here's some idea on how to make it easily changeable
        • cheap photo albums 
        • baseball card pages
        • Velcro 
        • business card holders
        • those photo insert things they put in wallets (anyone know what that's called)
  • Speech Generation: Ideally this no-tech AAC system is a step toward more functional communication, like speech itself, or a high tech communication system. Consistent modeling of the spoken words for each selected vocabulary item is really important so the client can pair the spoken word with the visual symbol and what it represents. Here are some important things to keep in mind.
      • Write out the exact words you'd like all communication partners to say when the client selects that symbol. The words need to be on the picture symbol. 
      • don't say good job right after they select a symbol. I know it's so hard to resist! But believe me this is important. You want to pair the picture symbol with a consistent spoken word for each picture. When they select a symbol, say the word that is written on the symbol, fulfill the communication request, and then you are welcome to praise the heck out of that awesome communication.
      • Adjust the number of words to the child's level. Modeling one word for each picture is usually appropriate but for some of my higher functioning kiddos two or more words can be appropriate. You will have to gage this individually. For example one kid's break symbol will just say "break" another kid's might say "Need break" and another kid's might say "I need a break".
      • Train communication partners to say the words that are written on the picture symbol whenever the child selects that symbol.
      • Immediately refer to the actual object, activity or task that the symbol represents. This will help the child learn the spoken words and picture symbols represent specific things in the world around them. This immediate reference is really important when the child is first learning the new picture symbols. Note: Once they solidly know what the picture symbol represents there is a little more wiggle room in response time. 
  • Physical considerations: You need to consider what the child will be able to handle phsycially.
    • movable picture symbols usually secured  to a base with velcro. This is particularly important if you are going to teach symbols in a picture exchange protocol like PECS. Or build individual picture sentences. So far, in my limited experience, my autism kids LOVE ripping the moveable pictures off and dropping them on the ground. so if you have a kid like that there are other options. If you do moveable symbols it's important to consider the child's motor skills. Are they going to be able to pull off the symbol effectively and place it in the right spot for communication? Do you need to make the symbol bigger or smaller based on their visual needs, etc.
    • pointing! teaching a distal point is such a great skill to start off with. Let's be honest. Printing, laminating, and cutting out pictures is time consuming! but then you add cutting and attaching the dang velcro? Goodness, that is a lot of work! It is so much easier to prepare a communication system for a child who can point at individual symbols instead of having to physically pull them off and move them. The only issue with that is that the communication partner has to be watching and the phrase that the child built is not visible later. And the child needs to be able to navigate multiple symbols on a page.
    • view finder system. So far this is my favorite system. It was one of those ideas that came, mid session, while I was trying to problem solve with a kid who couldn't quite grasp the distal point. It is a movable window that helps the child highlight the picture symbol they are selecting from a board of printed pictures. My view finders are usually a bright yellow rectangle or square frame that the child can place over the selected picture symbol. This way there is still a lasting sentence structure, but there is a lot less prep time involved. I place reusable stick dots on the view finder. That way the viewfinder stays in place. Reusable stick dots are great cause you can just wash them once they get dirty and then they are magically stick again! 
  • USE in all contexts: I can't stress enough the importance of using the communication system in all contexts of the child's life. They need it at home, school, at the store, at the park.... WHEREVER they go! 
One last note, for the picture symbols themselves, I often use LessonPix which is a web-based picture library. It's an online picture symbol library. It is a really great resource that I would highly recommend. I might have to write an article about how much I love Lesson Pix someday. You can also use board maker, or a simple google image search.

Phew....That was a long winded post. Believe me it has been a learning curve with this new job. But I am loving this new insight into the world of augmentative alternative communication. What lessons have you learned about low-tech, or no tech AAC? What has worked for you? What hasn't? Please share!

Here are some pictures of a communication board for a higher functioning kiddo.


New City. New Job. New Insights.

Hello long lost blog. You have been sorely neglected these past few years. It's been 6 months since I went back to work. After 2 years of full time mommyhood, I decided I had to dip my foot back in. I only work 10 hours per week so I still consider myself full-time mom with a little bit of SLP spice on the side.

I'm so happy to be back in the speech language pathology world, but I tell you what, it was a rude awakening. Once again I'm reminded of the incredible juggling act all speech language pathologists engage in. So just FYI you are all the coolest. Seriously, SLPs are an incredible breed. In my new job I don't get to work with other SLPs which is kind of a bummer. But I'm learning to love the opportunities in my new position to collaborate with other professionals in their fields, and there is just nothing, NOTHING as cool as watching a child gain confidence in communication. It is amazing.

My new position has me researching aspects of our field such as autism, early language development and augmentative alternative communication in much more depth than my past experiences. I am excited to write down a few things I have learned this year. However, I have to admit, the more I learn the more I realize that I have so much to learn. When I was freshly out of my graduate program I was so excited and I thought I had all the answers. Now, my eyes are more fully open to the fact that I will always have so much more to learn. I have my education and experience to thank for a good base knowledge, but there is just so much to learn. It's something I really love about our profession.

I will attempt to keep track of some of the lessons I am learning professionally on this little webspace. But I will not claim to know it all.

I will also make a promise to not push you to buy my latest super pricey product. I'm seeing a lot of that out there lately and it's totally killed my interest in blogging all together. If I make something cool I will try to share it. I try to keep all pricing below a $1. But that is not the purpose of this blog. I think there is something really amazing about writing down lessons learned in our profession. That's what this blog is for. So here we go friends, let's learn together. 


Searching for an SLP Job in a New City

SLPs I need your help! I will be looking for a part-time SLP position in a city that is brand new to me. Huh? Yeah...My life is crazy right now. Like insane. Here's the update.

My husband felt stagnant and unfulfilled in his job for a lot of years. But he is finally being recognized for his amazing skills and has been offered an opportunity that we can't pass up. The trouble is that opportunity involves completely uprooting our family.

So I need to...get everything ready for the first of the school year with my speech kiddos, hire a new SLP to take over my dream job (SAD!), sell the house (quite the feat in itself), pack (yuck!), find a house in a city I've only ever seen once (yikes!), go through all the mortgage fiasco to buy a house, then proceed to move everything 700 miles away from all of our family and friends. Overwhelming right? Wait it gets better. My husband has to start the job next week (2 weeks after they offered it to him). The company is flying him there for the week and then back on the weekends until we sell our house. It will be hard to be separated. It'll also be an adventure to chase around our 2 year old son and keep the house in perfect showing condition to sell by myself. Feeling the stress build? Wait it gets even better. I am 7 months pregnant. Yeah.... If we can sell the house, find a house, pack, move, unpack, and find a doctor before this kid comes kickin' it will be a full-blown miracle.

So there you have it. My life is crazy. But I love it so much. I'm so sad to leave behind my ideal SLP job, but I am hopeful that there are excellent opportunities in the city we are moving to.

Does anyone have any suggestions on how to find SLP positions in a brand new city? Are there any websites you've found helpful? Any sites to avoid?

I remember when I was fresh out of grad-school, the job search was a ridiculous maze of confusion. There were a lot of websites with what seemed to be "fake" jobs that were posted just to get you to sign up for their website. I'd really like to avoid that whole mess and just apply for legitimate openings.

What was your job-search like?


In Class Speech Work

One of the most fulfilling changes to my therapy format this year has been creating an in-class speech program for most of my students as a supplement to our direct therapy. While my unique school environment made it easier for me to begin this program, I think it could be introduced in a more traditional school environment.

What is an in-class speech program?
  • An opportunity for the student to practice their speech daily in school. Almost every school program has some flexible, independent working time for the students. My students practice  for 5 or 10 minutes during this time. Some of them work on their speech independently and some have gotten their friends involved. Some have even organized daily speech buddies.
What I LOVE about in-class speech works...
  • more opporuntities for the students to review the concepts gone over that week
  • practice in different contexts with different people
  • gets peers and teachers involved
  • work stays at the school (less chance of getting lost in transit)
Okay, Okay, I know what you are all saying...."When am I going to have time to make in-class speech tasks?" But it could be something as simple as reading a book out loud and finding their goal sounds. I like to encourage a lot of creativity and fun. Here are some examples of in-class speech programs we've done this year.
this is a cute R song that a student and her speech buddy wrote

a collection of speech works. I usually make them with the kids during our speech sessions and then send it with them in plastic baggies or envelopes.

this is an awesome rhyming R game

My students keep track of their in-class speech work with a chart like this

here is one that we've been working on for a while


My New School

In my new career ventures I have the opportunity of owning and operating my own business, but I still get the pleasure of working with students in their school environments. It's a perfect combination for me. Seriously, sometimes I have to pinch myself to make sure I'm not dreaming. Fortunately, because I was offered positions at a number of locations, I was able to hand pick the environment that I wanted to work in. The school that I work in has a completely different teaching philosophy and environment than the traditional schools that I have worked in.

What is my new school like and why did I choose it?
What really drew me in was this school's focus on the individual child. The philosophy lets students learn at their own pace. They teach in small groups instead of whole class lectures. They give their students a number of responsibilities that they must get done in a day, but allow them flexibility to choose when and in what order they are going to get them done, within the structure of the school day.

At our school the student's are required to get a number of "works" done in "work cycle". The "works" are set up in categories like "language" and "math" and "science". The student knows which level they most recently passed off and move on to the next work in progression. They are allowed flexibility and independence in how they approach getting work done. They keep track of their work with "work charts". If you walk into a classroom you expect to see kids spread all around the room working on different projects. There are desks but the students aren't required to sit at them, and they are free to move them around the room. Students often work on projects on the floor so they can spread out pieces of their "works" as needed. From what I have observed, the students can work independently or in groups. There are 2 teachers per classroom who monitor the works and give support to the children when needed. When teachers present lessons, it is in small groups of 6-10 children who are around the same level. There is always a constant hum of activity. The students are free to talk quietly but can't be too loud or crazy because it would disturb the other students who are working on their different projects. There's never a teacher standing at the front attempting to teach 30 kids at 30 different levels a one-size fits all lecture. It's a whole new fascinating world that I'm still trying to wrap my head around. It's dramatically different than any public school I've ever worked in but it is brilliant when executed correctly. The students have so much opportunity to become independent thinkers and problem solvers. It's that thinking outside of the box ideology that made me excited to work here.

Bringing Speech Therapy to the Classroom:
Another key reason I was excited to work at my school is the opportunity to easily work my therapy sessions into the classroom environment without disrupting the classroom dynamic. I have my schedule set up to do 2 sessions per week with my students. I do group sessions with 2 or 3 students on Tuesdays. And then I get to do individual sessions in the classroom with the students on Wednesdays. It's amazing! It gives me the ability to work with the students in multiple contexts.