Augmentative and alternative communication (AAC)
Written June 22, 2018
My name is Caitlin Calder and my daughter Della has Bainbridge-Ropers Syndrome (ASXL3 mutation). I am starting my last year of graduate school at the University of Houston to become a speech-language pathologist (SLP) specializing in augmentative and alternative communication (AAC). Although I am drawing from my own experience helping my daughter learn to use a speech generating device, all of the strategies that I am recommending are evidence based and considered best practice for speech-language pathologists.
Part I: What is AAC?
What is AAC?
Augmentative and alternative communication is any method of communication that isn’t speech. A few common methods of AAC are sign language, pointing, head nodding, writing, and speech generating devices.
Is AAC an option for my child?
I believe some form of AAC is an option for all children, we just need to find the right method.
If my child uses AAC, will they ever learn to talk?
YES! Research shows that using AAC facilitates speech. If the child learns how effective communication is, AAC will motivate them to use speech more often, if they are able.
How do I know if my child is ready for AAC?
The most important component of communication in general, is a basic understanding of cause and effect. If I do (A) then (B) will happen. If I cry, my mom will come. If I throw my toy, my dad will get it.
Pointing: If the child can point to something they want, they can point to a picture or push a button.
Signing: If the child has even one basic sign, they have connected the idea that two, seemingly unrelated things, go together. On the surface, the action of bringing your hand to your mouth is completely unrelated to crackers, but symbolically it can get the child their favorite snack.
If your child is not currently doing any of these things, an SLP can help teach basic communication skills.
Where do I start?
An SLP in a school or in a private setting can be a good resource on where to start with your child. If your child is in public school in the United States, the school district may provide a communication device. Ask your child’s teacher or SLP if this is an option.
AAC options range from free to expensive and low-tech to high-tech. A free, low-tech option is sign language. Signs can be adapted to your child’s abilities and can be whatever you want. There are plenty of resources to get you started. Another low-tech option is using laminated photos of your child’s favorite snack or toy.
A high-tech option is a communication app on an iPad. A refurbished model (what our family has purchased twice) is around $120. There are a variety of communication apps at a variety of prices. If the iPad is out of your price range, search “ipad grants” to find a number of charities and government funded programs that help cover costs for individuals with a speech impairment.
Part II: Getting started
I remember the day we put a speech device in front of our daughter. I genuinely thought she would pick it up and thank me for taking such good care of her. That turned out not to be true. In the beginning, using the device felt awkward and I interpreted that to mean I was doing it wrong. Now that I am helping other families to use speech devices, I always tell them that using the device is not going to come naturally at first. It’s going to feel weird because you and your child are learning to communicate using a completely different method than you are used to.
Step 1: Find a motivator. Della will not do anything unless she is motivated. If this sounds like your child, the key to using the device is to find something that they really want. A few ideas are bubbles, books, a special snack, or a certain toy.
Step 2: Start with one button. Show your child what you want them to do by pressing the button yourself. Next, take your child’s hand and help them press the button. Then act as if the child had asked for it all by themselves and offer them the item. We want to teach our children that an action (pushing a button) has an effect (getting what they want). You might have to repeat this process 200 times before they understand, so don’t give up!
Step 3: Start with 5 minutes a day. I don’t know about your child, but Della has an extremely short attention span and she wouldn’t want to sit and blow bubbles with me for longer than 5 minutes. We want to avoid frustrating our children when they use the communication device. I can’t emphasize enough the importance of modeling and showing our children what we want them to do. Get the whole family involved. Everyone who asks for bubbles, gets bubbles.
Step 4: Each button means something different. When your child seems to have a grasp of pressing the button to get what they want, it’s time to introduce a second button with another motivating item. Continuing with the previous example, let’s use bubbles for the first button and a book for the second button. With two buttons on the screen, go through steps 1-3 with the new book button. However, if your child pushes the bubbles button, honor their request and give them bubbles. They might get upset because they actually wanted the book, in which case you can say “Oh, you wanted the book.” Then take their hand and help them press the correct button. If they are happy with either item (as my child is), then make the second button something they don’t want like broccoli or a random object. I like to call this method sabotage because we are setting up the environment for our children to learn that being specific in their communication can get them what they want.
Part III: AAC Strategies and Tips
Concrete items are the easiest for our kids to learn. A quick way to figure out if something fits into this category is asking yourself if you can take a picture of it. If the answer is yes, then it’s a good starter item.
Stick to short periods of time to use the device. I thought my daughter had to be using the device all day everyday and it made me feel overwhelmed, and we ended up not using it at all. Start with 5 minutes a day - that’s it. When you’re ready, move to 5 minutes twice a day; maybe once in the afternoon and then once after dinner.
A special occasion can be highly motivating. One of the first times I remember AAC working for us was on Halloween. We made a button on Della’s device that said “Trick or Treat.” At every door I would put the device in front of her, she would push the button, and they would give her candy. Della was THRILLED (even though she couldn’t actually eat the candy). Visiting Santa and letting your child tell him what they want is another good motivator.
Choose things that are meaningful to you and your child. I know an SLP who put a button for glitter on a child’s device. I know she was well meaning but as a mom, glitter is the last thing I want my child around. If your SLP is teaching your child to use words on the device that are not meaningful to you, then you should speak up. The SLP doesn’t know what to include that is meaningful to your family and I’m sure he or she would love some input from you.
Be honest about what you (the parent/caregiver) need. Confession: I got so overwhelmed with the device that I let it sit on the shelf gathering dust and it stared back at me, judging my terrible mom skills. I lied to my SLP and told her we were using the device at home because I felt so guilty. I should have asked for help. I should have asked to watch the SLP work with my daughter, so I had some point of reference. I should have been honest and admitted that I didn’t know what I was doing. Don’t be like me! My daughter ultimately was the one who paid the price for my pride.
Medical disclaimer: This website does not provide medical advice. Our website contains general medical information about congenital ASXL mutations. This information is not medical advice and should not be treated as such. You should always talk to your or your family member’s health care professionals for diagnosis and treatment, including information regarding which drugs or treatment may be appropriate for you or your family member. We do not represent or warrant that any particular treatment is safe, appropriate or effective for you or your family member. In the event of a medical emergency, you should contact your doctor immediately or call 911.