Why use a voice output communication device?

For 50 years, voice output, or AAC, devices have been used to help those with developmental and acquired disabilities to communicate successfully.

AAC devices offer tremendous promise in helping nonverbal individuals with autism overcome their unique communication barriers.

How effective are AAC devices?

Some parents worry that giving an AAC system to their child will prohibit the development of verbal speech. However, research has repeatedly shown that this is not the case – in fact, the opposite is often true.

AAC systems provide an active means of communication, which tends to improve verbal speech. The process of learning the meaning of one word, then increasing their single word vocabulary, and then combining words together to make phrases and sentences helps children with autism reach the goal of independent, spontaneous communication.

The auditory output of AAC devices provide sensory feedback to help the child develop his receptive and expressive language skills.

Is my child ready?

There are no prerequisites to introducing AAC or using a speech generating device.

In fact, using a device with speech output and consistent motor patterns to say words is an easier cognitive task for nonverbal individuals. Learning can start at a cause/effect level, where the learner touches a button, hears a word, and experiences what happens.

Modifications can be made to accommodate the learner’s current level of language and motor skills by:

• Using a larger screen

• Using a keyguard

• Highlighting keys

• Limiting available choices

However, it’s important that the individual have quick access to a lot of language; if the communicator doesn’t have access to the words they would want to say, then why use the AAC system?

It’s also important to maintain consistency when beginning communication. Starting with one type of system with the intent of graduating to another system when the individual “proves” they’re ready means that individual will have to have to relearn how to communicate. The motor movements are different, words are in a different place, it may sound different, etc. Relearning places a greater burden on those with more cognitive challenges.

Source: The Center for AAC and Autism

One of the hardest parts about using alternative and augmentative communication or AAC devices with children, is knowing what to do with it once you have it. AAC devices are any device that allows a child to use language to communicate other than spoken speech. Some children use sign language, others use AAC devices that will speak when a button is pushed.

No matter what the child is using, it can be tricky to figure out how to incorporate it into a child’s everyday life, either at school or at home. Well here’s the trick, are you ready for it?

Teach a child to use AAC devices and systems in the same way you would teach them to speak.

Ok, I know it sounds simple but it’s much harder in practice than it sounds. Here are my ideas for how you can implement this at home or at school:

1) Have Someone Who Specializes in AAC Devices Find a Good Fit

Obviously, the first thing that needs to happen is for the child to get fitted for an AAC device. This is something that should be done by a good AAC evaluation team. These teams are usually made up of a speech-language pathologist who specializes in AAC as well as an occupational therapist who can give input about the motor components of using AAC devices. There are many ways for children to activate AAC devices and they will know which one is right for the child.

Some children will activate the device by pushing a button with their finger. This is the most common method. However, there are children who have significant motor problems and this may not be a reliable way to use their device. For these children, you will need an alternative means to activate the device, such as a switch that when pushed will stop a light that is scanning past the buttons. When the light is stopped, it will speak whichever message it is on. Other systems have the ability to track your child’s eye gaze and will speak whichever button the child looks at for a few seconds. There are other ways to activate the device as well so speak with the evaluation team about the best method for your child

2) Get Everyone Familiar with the Child’s AAC Device

How Typically-Developing Children Learn to Talk: Typically-developing children learn to talk by being around adults and older children who have a good mastery of their language. These adults and communication partners are familiar with their language and know how to use it. In other words, they are comfortable speaking and talking to the child.

How Children with AAC Learn to “Talk”: Each child should have gone through some sort of therapy or evaluation to determine what means of communication is best for him and his family. Regardless of what method that was chosen (sign language, picture communication, picture board, speech output device), the adults who are going to be communicating with the child need to be comfortable with it. Just as a family that speaks only Chinese would have a hard time teaching their children English, the child you’re working with will have a hard time learning to use his AAC device if you don’t know how to use it either.

Take some time to get familiar with the AAC device or system. If it is sign language, take time to learn as many signs as you can. If it is a device that speaks when buttons are pushed, take it home for a weekend and practice creating sentences with it. Can you hold a conversation with your partner or a friend using your child’s AAC device? You should definitely try.

3) Model Using the AAC Around the Child

How Typically-Developing Children Learn to Talk: Typically-developing children hear their native language being spoken around them constantly. They hear language being used for an entire year before they start to speak their own words. They hear adults use their language to communicate with them and with each other.

How Children with AAC Learn to “Talk”: Children need to see their AAC device being used around them. If they never see anyone communicating with the AAC device, why would they be motivated to use it themselves? If your child is using sign language, sign along when you speak to your child or to other adults when your child is around. You don’t have to sign every word (especially at first when you don’t know all of the signs), just sign the ones you know.

If your child is using pictures, show him the pictures as you say those words. For example, if you’re asking your child if he wants a cracker, show him the picture for cracker as you say it. If your child has a speech output device that talks when you push a button, push the buttons along with whatever you’re saying. Again, you don’t have to push a button for every word you say, just hit the important ones.

Just as children with typical speech need to hear their language A LOT before they are able to begin using it, the child you’re working with needs to see his AAC device being used a lot as well. Use the system when you are talking to the child, talking to other adults, talking to other children, etc. Just make sure that you are leaving the AAC device or system near the child (not taking it away) so that he or she can use it as well.

4) Encourage The Child’s Attempts to Use the AAC Device

How Typically-Developing Children Learn to Talk: As a parent of a baby, I can tell you that I am constantly praising my child when he does anything that could possibly be seen as intentional communication. If I’m walking out of the room and my baby says “ba”, I immediately smile at him and say “bye! Yes, I’m going bye bye!”. Now, as a SLP, I know my 7-month-old isn’t really saying “bye” and that was probably just a coincidence, but that’s what we do as parents. And it works! When we reinforce our children’s accidental speech acts, the child learns that communicating is powerful and will create meaningful interactions with the adults around him.

How Children with AAC Learn to “Talk”: At first, the child you’re working with will probably not be using his AAC device meaningfully. He may just push buttons randomly to hear what they sound like. But whatever you do, don’t say “he’s just playing with it” and take it away. You wouldn’t take away a baby’s voice box because he’s babbling instead of saying real words. This is all a part of the learning process.

If the child pushes a button, even if it’s accidental, you can still respond as though it was meaningful. If he pushes “potato” when you’re playing in the bedroom, you can say “Potato? We don’t have any potatoes in here. There may be some in the kitchen though.” This may seem silly, but it helps the child understand that the words he is creating using his AAC device have real meaning.

This phase of exploration won’t last forever. The child will eventually become more meaningful with his use of it. But for a while, you’re going to have to be ok with the child “playing” with it to see what it does, just like a baby playing with his voice.

5) Have the AAC Device Present at All Times

How Typically-Developing Children Learn to Talk: This one’s pretty straight-forward. A child always has his voice with him. He doesn’t turn his voice off or leave it at home on accident. It doesn’t run out of battery and need to be charged. The teacher doesn’t take it away when he’s talking over her. She just teaches him not to talk when she’s talking.

How Children with AAC Learn to “Talk”: Just like you shouldn’t (and can’t) take away a child’s voice, you shouldn’t take away a child’s AAC device. If the child is using sign language, you don’t need to worry about it because his hands are always there. However, if the child is using pictures or a device of some kind, you will want to make sure the device is with him and functioning at all times.

If the AAC device needs to be charged, charge it during times when he won’t need it, like while he’s sleeping. Or, get an extra battery and switch it out.

Even if you’re annoyed that the child is pushing buttons on the device instead of listening or paying attention, you still can’t take it away. Instead, do what you would do with any child and teach him that he has to have a quiet voice or quiet talker during ____ situation.

6) Set Up Opportunities for the Child to Use the AAC Device

How Typically-Developing Children Learn to Talk: As parents and educators, we tend to set up situations for our children to be successful at communicating. For example, we may sit our child down in his high chair and hold up some grapes and say “do you want grapes?” Then, we pause to see if he will say it on his own. We give him a situation to say what he wants. We are even more likely to provide these opportunities when we know it’s a word that our child is able to say. For example, we probably wouldn’t say “what’s that” when pointing to an animal that our child has never seen before, but we would probably ask him the same question when he sees a dog (or whatever his favorite animal is). We do that because we know he can say “dog” so we know he’ll be successful.

How Children with AAC Learn to “Talk”: Set up situations during the day that will allow the child to use his AAC device to communicate. In the classroom, this may be during a structured repetitive task like snack time. Present items that you know the child will be motivated to communicate for and that the child knows how to find or use with his AAC device. For example, have some snacks that the child knows the signs to or can find the buttons for on his device.

Show the child the item and then model the word using the child’s AAC device. Then, pause to see if he will use the AAC to communicate. If he’s having trouble, you can always take his hands and help him. Just make sure that the child is receptive to being touched and doesn’t seem upset by your help. Some children will be just fine with this and others will become very upset. You don’t want this to become a negative experience and you don’t want the child to feel like he has no control over what happens to his body. Be respectful of the child’s wishes if you decide to try helping him use the device and never force it.

7) Get All Adults On Board with the AAC Device Use

It is very important to make sure that everyone in the child’s life is approaching the AAC system or device the same way. Explain these methods to other adults in the child’s life.

Source: speechandlanguagekids.com