Level 1 - Fundamentals of AAC
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Three interlinking Components
There are three key concepts or components to remember when we talk about AAC. These are Speech, Language and Communication.
Language refers to a whole system of words and symbols—written, spoken or expressed with gestures and body language—that is used to communicate meaning.
Communication “is fundamental to children’s development; children need to be able to understand and be understood. Communication is the foundation of relationships and is essential for learning, play and social interaction.” Quote from 'All Together Now' (download PDF)
*Explore ideas from Scope. These show ways in which a parent can encourage the earlest social interactions and start to build communication skills.
Activity - Understanding Speech, Language and Communication
Drag the words to the appropriate column - You may find overlaps and you may not agree where a word should be placed! Some could be in two places, but only one position is allowed in this case.
Its not all about speech !
More tips to encourage language
When language does not develop during these times there are many professionals who can help with delayed communication skills and in a YouTube video a Speech and Language Therapist (also known as a Speech Therapist, Pathologist or Logopedist in some countries) provides five tips for encouraging a toddler's language. Which ones do you feel familiar with?
Activity - Encouraging communication
This activity is all about us! Think about how we make sure we are helping to make effective communication possible.
Sensory story telling
Sensory storytelling uses all of our senses to tell a story that is easy to follow and take part in
Even the most ordinary events can be made more exciting and interesting. Think about:
Summary
To develop a child's language and communication we need to:Communication does not have to be verbal and when it is augmented, or an alternative is used with those who have complex communication needs, it is known as Augmentative and Alternative Communication (AAC) in English. It can be hard to imagine not being able to speak or express ourselves.
Think how you feel when you cannot understand another language, such as when you travel alone. What sort of difficulties and anxieties arise?
We have to find other ways of making ourselves understood otherwise we become isolated and frustrated.
Children normally start to understand pictures, make
gestures, point and build eye contact, use body language as well as vocalise at a very young age. These forms of unaided communication remain very important throughout our lives. They continue to complement our verbal speech and language.
However, when we want to express our needs and wants or start to make requests, if these cannot be achieved by learning to speak symbols can become a form of aided communication.
Many young children start with pointing but can benefit from learning more gestures, alongside the use of pictures, when starting to communicate, especially if their receptive (understanding) and expressive language skills are delayed or they are non-verbal. This may be due to cognitive, physical or sensory disabilities which can be:
The range of different types of disability can be enormous, as can the varying degrees of speech and language difficulty, so it is important to understand the overall picture in order to learn how to help individuals overcome the barriers.
Symbol Iconicity
AAC Symbols, like many images can have different meanings depending on the context and can be used in different ways. They can represent people, objects and actions as well as be descriptive, but most importantly they need to feel familiar and guessable - not confusing or opaque. "Iconicity" can be important. This is the extent to which a symbol represents an intended meaning. This is not always easy. The symbol needs to make sense within the user's social setting, be part of the culture and represent all the various aspects of a user's life.
AAC and Culture
“Language is a cultural phenomenon” (Huer, 2000) and so it is important to consider this when developing an AAC system for a child with complex communication needs who may use symbols that might not have been designed with their community ot localisation in mind.
What is localisation in comparison to personalisation? Please add these concepts to your reflective journal.
There needs to be flexibility in the choice of symbols even though we require a consistency of design to make them easier to learn.
We also want symbols that encourage the child to feel comfortable using them.
Symbols need to reduce frustration and allow for making that all important request or sharing of an exciting moment.
Some children become very used to certain images and introducing alternatives can cause anxiety. Changes need to occur with care. Always introduce new symbols that are an appropriate match to the child, the setting and the task in hand allowing a sense of success when it has been chosen.
Symbols when created by local designers, who understand the context,
language and social setting can result in better outcomes. Research carried out by the Global Symbols team using the symbol voting system has demonstrated this
Getting Started with AAC
As you watch this video think about the number of ways Maya finds her Voice?
When you ask a very young child a question and they are just learning to talk they may reply with a gesture, point or make an attempt to say a word. Hopefully you will give them support and enhance what they have said, possibly by gently saying the word or phrase in the correct way or elaborating on what has been said. You encourage their communication skills and enhance their language - the same is true for symbol users.
In the Inroduction we mentioned the difference between communication
and language? Add some notes about these two concepts to your reflective journal.
Activity - Language and Communication
Symbols in Early Conversations
A vocabulary of frequently used symbols needs to be introduced across all communication environments, whether in the home, school or in other settings. This type of vocabulary has become known as a 'core vocabulary', thinking about personalisation and localisation.
Select the hotspots to see how you can help encourage communication. In this image you see a little boy using a PicSeePal communication device
If a structured approach is needed
for a few symbols being used in an interactive setting it might help to try the Picture Exchange Communication System, where symbols can be used to request an item. Training is
provided to follow a set pattern of symbol use that allows a child to learn to make choices and communicate needs when in the past they have found it hard to initiate communication. It has been found to help those children who have been diagnosed
on the autistic spectrum. However, it can be restrictive if the symbols are not to hand and it is not possible to provide a symbol immediately when a new idea comes to mind.
It may help to use the Pragmatic Organisation Dynamic Display (PODD) using natural language stimulation, where symbols are used alongside verbal language. The PODD book is similar to a grid display and can be used with an online app. The principle is all about modelling but the communication partner initially guides the conversation and observes the AAC user for reactions, if they are unable to indicate the symbols they wish to choose. Any interaction is interpreted and the communication continues with page or screen turning occurring by the communication partner.
A demonstration of PODD with Tasman and Regan
Different AAC Systems - Visual Scene Displays
Research has shown that when young chidren
are working with pictures they may find Visual Scene Displays (VSDs) easier to use. These can be a photograph or picture on a tablet that has
items for a conversation. It may be any scene such as a familiar room with favourite toys or the kitchen with food and drink, the car or outdoors with animals. You can see how hotspots can be used for text in the example below but usually
you would record sounds and speech, labelling items or asking questions to encourage interaction.
Activity - Getting started with VSD and Interaction
Try taking a photograph and pick out points that could initiate a conversation - How many open ended questions can you ask and how would you encourage your young AAC user to interact?
Did you find that the conversation tended to be initiated by you as a communication partner and the vocabulary was limited to what was available under your potential hotspots. Maybe you needed a collection of symbols to support the topic?
So in order to expand vocabulary and generate more language it is time to move on to a grid format with various layouts that allow for a more flexible approach to vocabulary building. This does not mean topics are lost, but those frequently used words are easier to reach. These are often called Core Boards.
Introduction to Core Vocabulary Communication Boards
Core Vocabulary boards offer some of the building blocks around which early communication can be built
This video provides a useful introduction to the topic of Core boards.Activity - Using a Core Vocabulary Board
CoughDrop provides several free sample AAC charts including core boards. These are built on a grid system that can be used online in a web browser, as an app on portable technologies or as a print out for
a paper based system.
Try using this English core vocabulary symbol chart from CoughDrop
AAC Progression
It is important that multiple AAC systems are used in line with
multimodal forms of communication or total communication. An electronic aid may be impossible to use in the bath and single communication board or small set of cards, such as a keyring of important symbols, may be more useful on occasions.
Different types of communication boards can be developed for a range of tasks, settings and be personalised to suit the user, the linguistic structures of a language as well as the topics being discussed.
Activity - Features for designing a board
You have been asked to build a communication chart for a particular child and you have been given the vocabulary list to use on a grid with a number of cells. Complete the crossword activity below, as a way of confirming some of the features you will need to
think about. You will be taken to another page and then return to this topic.
Direct Access Options
Communication systems can be adapted to be
accessed by children with physical impairments associated with complex physical disabilities such as cerebral palsy or muscular dystrophy. But is not just physical difficulties, changes can also be made for children with dyspraxia, which is
common amongst autistic children.
There are a range of access methods that can be applied to low-tech paper-based communication solutions such as activity boards and communication books. Remember throughout the course you may see the word board and chart being used interchangeably.
Most children will prefer to use a single finger to point to symbols on their communication aid But many children with complex communication needs will find this difficult due to the level of control required. Here are some of the solutions:
For accuracy you could try make the symbols larger. But be warned that bigger targets are not always easier for people who use large and uncoordinated movements. Larger symbols in a given area results in less symbols per page, which increases the navigation between pages which can be inefficient and tiring for the child.
Some children who find finger pointing difficult
will use fist-pointing, where an entire closed hand indicates the symbol required. In practice often the child will rotate their wrist and use different parts of their hand depending on the location of the symbol on the board.
It is also possible to use feet to select symbols, and some people even use their nose, although this can have postural implications.
Some children can grip a stylus which allows large movements with fine precision as does not require rotation of the wrist or extension of the finger. There are lots of different shapes and sizes of stylus available and they can also be custom made or 3D printed. The selection of stylus depends on the grip and orientation of the child’s arm and hand.
Activity - Practice Pointing
With a communication partner take the communication chart or board you created
in the AAC Systems and Devices topic and try some different pointing methods. Try using your fist to point and even your feet. Ask the communication partner what is easy and what is difficult for them. Make some notes in your reflective journal.
More Access Options
Some children use eye pointing, pointing to specific symbols with their eyes, to access paper-based communication aids. This requires communication partners who are good at watching eye movements while using specific skills to build messages and check that they’ve understood. It is possible to use eye pointing with standard communication boards or books, but often an E-Tran frame is used.
The e-Tran (Eye Transfer) frame is frequently used by children who
find it easier to communicate using their eyes rather than their hands or feet. The e-Tran frame is made up of rectangle of usually transparent plastic with a window cut in the centre. The symbols are arranged around the outside. By watching the child’s
eyes carefully it is possible for the communication partner to follow their gaze and confirm selections of symbols.
Both fist and eye pointing generally require larger, and therefore fewer, symbols on the communication board or page. This reduces the vocabulary on every page, which restricts the words the child is able to use. One way to solve this is to use colour encoding which divides the board into 2 or more colours. Small symbols are then grouped and each labelled with a colour. Using this method a child can point to the group and then to a colour. With six colours this permits six times as many symbols on any given page.
It is also possible to do this using numbers or shapes, something that should be considered for children who have visual difficulties.
Watch this video to discover the way colour is used to help with symbol choices. Transcript available.
Activity - Practice Eye Pointing
With a communication partner try using eye-pointing to
communicate using your communication board. How easy is this for the communication partner? How do you confirm with the partner that they have selected the correct symbol? What happens if they make a mistake? Write down your thoughts and experiences
in the reflective journal.
Partner Assisted Scanning
Some children will communicate most easily using partner assisted scanning (PAS), also known as mediated scanning. Sometimes this will be a ‘back-up’ method for when they are too tired or otherwise unable to take their usual approach to access the paper-based communication aid.
PAS involves the communication partner listing things that the child might want to say. The child indicates when they reach the right one, usually through a non-verbal ‘yes’ response. It is common practice for the communication partner to use a board or a book containing the vocabulary so that it is presented the same way each time. This helps the child learn the layout of the vocabulary and can predict when to prepare to give their ‘yes’ response. This is usually the least efficient way to access a communication aid but can be effective for children who find the other access methods difficult.
In this video you will see a demonstation of PAS from the ACE Centre. A YouTube transcript is available
PAS is sometimes combined with eye pointing as an alternative to coding. In these cases the child will look to a group of symbols and the communication partner will step through them one at a time until the child provides their ‘yes’ response.
Activity - combining elements of access methods
Return to your communication board. Can you find a
way to combine eyegaze and partner assisted scanning to make it as efficient as possible for a communication partner? Note down any ideas in your reflective journal.
Communication Partner Skills
With all paper-based communication aids there is a significant emphasis on the communication partner’s involvement in interpreting and supporting the AAC user. Learning to closely observe someone’s movements while checking that you have correctly interpreted
those movements take practice. Additionally it is often expected for you to make predictions of words and entire phrases (although this depends on the individual child and should be confirmed beforehand). Finally, it is vital that the communication
partner retains what has been said so that the entire sentence can be recapped and confirmed. This is easier than it sounds so many people choose to write down each letter or word as it is produced.
Activity
Reflective Journal
Presentation slides
The Progression Model
In the past it was often assumed that children will start their language journey using single message devices such as BIGMacks with photographs and eventually, through a series of new devices, work their way towards an electronic device with thousands
of symbols. Although BIGMacks and other single message devices have their role, it is no longer widely considered true that most children should start with them and then change their device often.
Read the content under the four tabs (headings) before completing the activity below.
There are problems with the old progression model. The issue being that these more simple devices or 'low tech' don’t provide space for children to grow into; to develop and explore new vocabulary and practice using a communication aid. If a device
is programmed with just 2 or 3 symbols then they can only say 2 or 3 things. This is fine until they have mastered the technique because unless somebody is ready to quickly replace the device, they can be stuck for the foreseeable future.
Starting with a ‘robust’ vocabulary. Often what is now considered ‘best practice’ is to start with a device with a big vocabulary, but hide (or ‘mask’) lots of the symbols that aren’t being used. Some apps such as CoughDrop support this vocabulary scaling automatically. While most symbols are hidden at first, the ones that are displayed retain their same location, even years later when the device is full of symbols. This draws on the benefit of muscle memory, or motor planning, whereby the location of the symbol is as important as the symbol itself. Learn more about what is meant when we talk about a robust vocabulary in AAC.
Too many symbols? If during the assessment or afterwards,
it is felt that there is too much vocabulary on the screen at any given time, contributing to inattention and lack of motivation, it is easy to be flexible. The typical way to deal with this situation is to hide or ‘mask’ symbols until you
feel that the child is ready. Thus we can start with two cells with symbols or buttons (just as one would with a low tech aid) such as ‘more’ and ‘stop’, before gradually adding new symbols as their language develops. Most AAC apps on tablets
and dedicated communication aids offer this option. It can also be easily achieved when using paper-based communication aids.
Masking is when we hide one or more symbols on a board
Using masking helps to:
But it is important not to remove words that could be useful and to be able to quickly unmask them and not to presume a certain level of competence. Look at the sample boards made by the TechOwl AAC Community.
Presuming competence
In order to provide a more complex communication
aid than you feel the child might be able to use involves the assumption that the child is more capable than you might think. When people encounter a child or adult with a communication disability we tend to assume that they have intellectual disabilities
as well, or that they have limited capacity to learn new things. Often it will take a long time for these AAC users to learn to use their system to its full extent, and sometimes the device may need to be made simpler. The important thing is that
they are given the opportunity to exceed expectations.
"Presuming competence for AAC users is based on two principles. These apply to all human beings, regardless of diagnosis or degree of difference.
However, there are some pitfalls regarding the presumption of competence which are covered very neatly in an article from the American Speech & Hearing Association (ASHA) which you can find in the further reading section.
Reflective Journal
Presentation slides
Summary
Further Reading
Baxter, S., Enderby, P., Evans, P. and Judge, S., 2012. Barriers and facilitators to the use of high‐technology augmentative and alternative communication devices: a systematic review and qualitative synthesis. International Journal of Language & Communication Disorders, 47(2),
pp.115-129.
De Geeter, K.I., Poppes, P. and Vlaskamp, C., 2002. Parents as experts: the position of parents of children with profound multiple disabilities. Child: care, health and development, 28(6),
pp.443-453.
Kranich, E.R., 2018. Parents' Perspective on Their Child's Use of Voice Output Communication Aids: Challenges, Benefits and Missing Pieces.
California State University, Long Beach.
Starble, A., Hutchins, T., Favro, M.A., Prelock, P. and Bitner, B., 2005. Family-centered intervention and satisfaction with AAC device training. Communication Disorders Quarterly, 27(1), pp.47-54.
Reflective Journal
Pointing at symbols with a Tablet
"This is Oliver, he is 3 years old. Oliver has suspected Childhood Apraxia of Speech which means he understands words spoken to him and knows the words he wants to say in his mind, but is unable to say them with his mouth. This video was taken on 4/2/15 and is his first attempt at using an electronic AAC (alternative and augmentative communication) device. He is using the Speak For Yourself app on the iPad for his AAC device."Direct Access to Devices
Direct Access (usually
through touch) is the most efficient way to access a communication aid but is also the most physically demanding. Many children with physical disabilities find it difficult to stick out a finger and accurately point to a small symbol.
There are lots of things we can do to help with this, such as providing the AAC user with a glove, a stylus, or putting a plastic or metal guard around the symbols. These all work by reducing the number of mistaken symbol presses. A glove usually has the end cut from one finger, so other parts of the hand can rest or touch the screen without making a selection. A stylus and keyguard work in much the same way.
The communication device usually has some options that can be used to ignore brief touches of the screen and other types of unwanted interaction.
Depending on the devices you have to hand try “touch & hold delay” for
Android users or “touch accommodations” for iOS devices. Follow the instructions online to enable these features and change the settings. How do you think these could benefit
children with physical disabilities? Note down your thoughts in your reflective
journal.
One access method supported by iOS devices, but not by Android at the time of writing, is the ‘Use Final Touch Location’ feature. This enables children to drag their finger on the screen, which stabilises their movement, until they reach the symbol they wish to select. Lifting the finger then selects the symbol.
The hold delay has also been found to help children with attention difficulties, or for those who might press the same button several times for the effect of the audio. This is known as ‘perseverating’ and is common amongst autistic children. One remedy for this is to set a hold delay to around 0.2 seconds so only very purposeful presses will be accepted by the device and converted into speech. Android Touch and Hold Delay settings
Head pointers are unusual in that there is no physical connection between the child and the access method, i.e. the child is not touching the computer or an input accessory at any point. A head pointer uses a camera tracks the movement of the child’s head which in turn moves the pointer around on the screen.
Here is very short video illustrating the use of headpointing with Spanish symbols and text to speech.
Activity - Access Methods
Indirect Access - other ways to access a device
We can consider pointer control for those children who really struggle with direct access. Usually this is recommended for children with cerebral palsy who may find targeting the symbols difficult, or for children with muscular dystrophy for whom the range of movement across a screen can be very fatiguing.
Pointer control, as a term, relates to using a standard
mouse to access a computer. Many children with physical impairments will use specialist joysticks, trackballs, and glide pads to access their computers and/or electronic AAC device. Most children will use their hands to operate these mouse alternatives,
while others may use their feet or even their mouths. Mouse alternatives always require some intentional movement from the child (such as moving a finger or an arm) but the accuracy and range required for each type does vary.
As with direct access, there are lots of accessibility options built into the devices to help ignore accidental button presses, or to assist with getting the mouse pointer onto the desired symbol. These are constantly changing and being updated, think about how you will stay up to date with these.
Using a Windows computer take a look at the ‘ease of access / mouse settings’ in the control panel. Find the pointer speed and try moving the slider to the fastest and slowest settings. You can also change pointer speed on an Android device.
What do you find? What are the advantages and disadvantages for someone with poor motor control when using one speed or the other? Make a note in your reflective journal.
Summary
Further Reading
Reflective Journal
Presentation slides
Thinking about AAC Interactions
As you watch this video, make a note in your reflective journal about the way AAC is being used in support of vocabulary, interaction, encouragement, modelling, responses and repetition. (No captions or transcript)
Communication ideas
The Ten Steps to Communication are explained in greater detail in the slides provided in the Presentation section at the end of this topic as we come to the end of Level 1 and review all we have learnt. At this stage we have been providing an overview of what is involved when we introduce alternative methods to support communication.
Let's pause again and just think about the conversations and interactions between a very young child and a communication partner. The amount of repetition, gesture and facial expressions. In English there are also games we play such as 'peek-a-boo' games, 'bye-bye' games, simple shared activities when reading books, singing songs and imaginative play with building blocks or playing with sand. water and toys like cars or dolls.
For those children using AAC it is even more important to allow time for turn taking, intentional reactions and generative language.
Always try to model (point to words on the AAC chart or device as you speak). Modelling is also called 'Aided Language Stimulation' or 'Aided Language Input'. Sometimes with
Watch this video where Aided Language Stimulation is explained by Christopher Bugaj
Transcript available"All language development theories assume that children are
surrounded by models of others using the language they are
learning in their daily environments" (CHAT Now Manual, p. 1)
The problem for the AAC user is that not everyone uses their language system, so they repeatedly need to see the way it should be used in many different situations. Daily routines are an ideal time and the involvement of the extended family and
all the AAC user's friends are very important.
Advantages of Modelling
Research has shown that modelling speeds the learning process and can be very motivating when used in all communication settings., It also helps the communication partner to slow down and the process is a collaborative effort when learning where symbols are to be found and how the AAC system works. The process is also multi modal as it can be visual and with touch, it is not just about hearing the word being said.
It is always important to aim just that bit higher,
to encourage progress from one word to combinations, whilst the communication partner is providing the complete phrase or sentence. Remember the next stage of language development and practise these phrases, not just ‘ball’ but perhaps ‘play ball’
or Do you ‘want the ball’? I want the ball etc.
Mistakes can happen but this gives both the AAC user and yourself a chance to sort out the problem as you wold in a spoken language situation. Find a new word / symbol, think aloud as you delete one word or add another that is needed to complete the conversation. You will learn more about modelling as we go through the levels.
Activity - Reviewing Typical Communication Development
If you do not have a chart to remind you of a typical child's communication development in the first 5 years consider adapting this example from the American Speech–Language–Hearing Association (ASHA) and "Look through a language development lens to set expectations and guide intervention for AAC Users" (Chickadee AAC)
Summary
Please remember to;
Further Reading
Binger, C., & Light, J. (2007) The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23, 30- 43.
Drager, K. D. (2009). Aided modeling interventions for children with autism spectrum disorders who require AAC. SIG 12 Perspectives on Augmentative and Alternative Communication, 18, 114- 120.
Burkhart, L.J. (2008) Key Concepts for Using Augmentative Communication with Children Who Have Complex Communication Needs (Download pdf) Easy to follow key points that add to what has been discussed in this topic.
Assistiveware Start Modelling - overview with more resources - blog
Reflective Journal
Presentation slides
Whilst we are thinking about encouraging interactions and communication we will be concentrating on the need for:
Consistency in AAC
Three important things to remember :
Fiona Age 2 needs the earliest type of communication
chart for gaining attention, interaction and early requesting perhaps using words such as more/stop - Download Fiona as a Case Study to learn more about her (Word
doc).
Let's see how these two symbols can be used and bear in mind they may be part of a larger chart where other symbols have been hidden. This is called 'masking' and can be useful to prevent confusion but also allow quick access to more words such as those found in the top most often used words for AAC in any language. The top 100 most frequently words in English have very few nouns!
Try these strategies
Steps | Technique | Examples |
---|---|---|
Prompt | Physcial cue | Move a hand to indicate what is wanted - points |
Verbal cue | "let's play with the rattle" | |
Gestural cue | Makes a gesture of shaking the rattle | |
Pause | wait for child's reaction - eye contact, sound, gesture | |
Model | Gesture model | Points to picture/symbol 'more' |
Verbal model | Word is spoken / text to speech 'more' | |
Outcome | Object / Activity provided | Child reacts positively, points, touches board or toy etc. |
Imitation | Copy child's reaction and provide positive feedback | |
Recast - repeat any error in a corrected and positive wat | Say the word again 'more' and point to the chart and praise. |
Activity - Create a simple board
Try out a free online chart creator Boardbuilder to develop your own simple chart for any activity with a wide choice of symbols rather than images. The chart can be printed out or downloaded as an open board format (obf) file to work on Cboard or Coughdrop communication apps. Possible labels, based on core words in English can be used when searching for symbols. These are seen in the table below and you can colour code by the parts of speech if you are aiming to support phrase or sentence building and later literacy skills. The blanks represent places where other symbols can be added as more vocabulary is learnt - remember 'masking'.The finished board when used in Cboard online
Language Acquisition through Motor Planning (LAMP)
This is an approach to building language with the use of symbols that encourages consistency of motor patterns to help with finding required words as quickly as possible. This is called "LAMP" and is developed by PRC-Saltillo. LAMP is based upon:In the example below you can see we have kept the original positions of the early choice of words and simply added more with some categories for charts that will be on the layers below the home board in a communication book or on a tablet.
The colour coding can be downloaded as a Word document and may be designed in many ways with higher contrast and different coloured borders rather a fill - learn more about Goosens' et al or the Fitzgerald Key from the PrAACtical AAC blog.
Activity - Further Case Studies
You have met Fiona, now meet Yola, Milo, Petra and Frederick who are our other Case Studies - Each one comes with a Strategic, Linguistic, Operational and Social Goal that guide you to the next stages of vocabulary building. To learn more about these goals download Pathways for Core First (for Windows) from Tobii Dynavox. We will be looking at the background research behind these goals later in the course. Use your reflective journal to jot down notes about the goals and whether you feel they will be useful in the future. Pathways for Core First is also available as an app for iOS or Windows.
AAC core word of the week
New vocabulary is important!
Finally watch this video to see how you can help to make a word for the week become part of a child's AAC journey.
Summary
Further Reading
Reflective Journal
Presentation slides
Download a case study, activity documents and presentations slides about pre-communication skills.