Level 2 - AAC Strategies and Assessment
Test your knowledge
Test your knowledge
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Activity - Understanding FamiliesTake a moment to consider some of the concerns parents may have before an AAC Assessment. The notes on the flip cards are based on research carried out with families of AAC users by David McNaughton and colleagues in 2008: “A child needs to be given a chance to succeed”: Parents of individuals who use AAC describe the benefits and challenges of learning AAC technologies.
Concerns about using other forms of communication
One concern some families have is around a myth that “AAC will stop a person from learning to speak” and yet all the research refutes this fact. AAC encourages communication when provided in the right format, settings and with fun in mind especially for young children. A therapist from the United States describes the "3 AAC Myths Preventing Children with Autism from Making Progress." Transcript available
How frameworks help assessment
There exists a very wide range of communication aids, language layouts, symbol representations, access methods and form factors (the actual shape and style of electronic devices and paper-based resources). Therefore it can become a bit bewildering when setting out to find the best fit for an individual child.
Following an assessment framework allows teams to work together in a systematic way in order to find the best solution for every child. Assessment frameworks also help by providing access to resources such as forms that guide thinking, activities to try
during assessment and ways of measuring success and progression.
You can follow the links to view and try the Communication Matters Matrix and the Participation Model and compare them to the SETT Framework which will be discussed in great detail. Different frameworks may be
needed in a range of settings.
A free website tool that can be used by profressionals and family members. It takes you through a series of questions that creates a chart that indicates a child’s current communication skills and challenges. It can also be used to monitor progress the child makes
This framework was initially developed by David Beukleman and Pat Mirenda in 1988 and was endorsed by the American Speech and Hearing Association (ASHA) in 2004. It provides a strong, systematic approach to AAC assessments and intervention.
The participation model is seen through a flow diagram that includes the following steps:
Assessing opportunity barriers
E.g. policy, attitude, skills of team who support the child
Assessing access barriers
E.g. current communication, potential to use AAC, potential to improve speech
Plan and implement interventions for today and tomorrow
E.g. providing training to the child and to the team
Is the person participating in their life using their AAC?
"SETT is an acronym for Student, Environments, Tasks and Tools. The SETT Framework is based on the premise that in order to develop an appropriate system of Tools (supports –devices, services, strategies, accommodations, modifications, etc.) teams must first develop a shared understanding of the student, the customary environments in which the student spends time, and the tasks that are required for the student to be able to do or learn to do to be an active participant in the teaching/learning processes that lead to educational success." Joy Smiley Zabala, Ed. D., ATP
"The goal of the SETT Framework is to help collaborative teams create Student-centered, (Self) Environmentally-useful, and Tasks-focused Tool systems that foster participation and achievement."
Activity - Planning for AAC
In order to understand why there are so many different types of assessment needed have a look at these resourcces as they will help you "Plan for AAC throughout the Day"
Project Core Universal Core Selection ToolIf you did not explore the Universal Core Selection Tool here are the decisions the Project Core team ask you to make before designing a symbol chart of core words. Start to think about all the other questions you might want to ask yourself as you build a symbol chart for a child. Add them to your reflective journal on the different types of assessments needed when considering AAC and be prepared to question further when you learn more about the SETT Framework in the next topic.
SETT overviewThis video provides a short overview of the framework. This will introduce you to SETT. A transcript is available.
SETT: The Student
We need to always be considering a range of factors about a student's body, cognition and behaviour when preparing for an assessment, observing the student and trialing equipment, Questions regarding their attitudes towards AAC and communication in general, their ability to attend to tasks, the things that they are interested in, how they express that interest, are examples of important things to note.
It is also important to ensure the AAC assessment team and all stakeholders including the family agree on the best possible solutions when the child is not able to indicate preferences.
The child’s physical abilities such as the way they move their hands and arms are going to have a very significant impact on the solutions you can trial and recommend.
Consider a child you know who has a physical disability. Then have a look at the International Classification of Functioning, Disability and Health (ICF) which provides a long list of ‘student factors’ that you can consider when completing an AAC assessment.
As you complete more assessments you will notice that some are more relevant than others, but nonetheless the document provides a very useful checklist to help ensure you have covered everything.
Activity - Introducing Stefan
Let's meet Stefan, a child with cerebral palsy, he needs an assessment so we will complete a SETT-style assessment using the scaffold documents provided by SETT’s author, Joy Zabala.
Read Stefan’s case study. Return to the ICF lists above. Which items in the lists could be seen as barriers for Stefan when using a communication aid? Where are his strengths?
SETT Scaffold Form - Consideration of Need
The SETT Scaffold form helps you to consider the challenges that Stefan faces. When completing this do bear in mind that Stefan has a lot of strengths, too, and we'll be using those strengths to find the best communication solution.
When completing an AAC assessment the environment often gets forgotten about. This is one reason why following a model such as SETT can help make sure it is at the forefront of the assessment process. The International Classification of Functioning, Disability and Health (ICF) provides examples as well. Drag the words listed to the appropriate category on the left.
Picture Stefan as a student in the place where you work.
Think about which of these environmental considerations are going to help him and which might be barriers to his success with AAC?
There are a number of documents, written in English, available to support AAC practitioners in the following areas:
Links and descriptions for these can be found in the further reading section.
The ICF can be downloaded from the World Health Organisation website:
Clinical Assessment Checklists- Partner Informed:
Hands-On AAC Assessment:
It is vital to have full awareness of the tasks that the child wishes, or needs, to accomplish using the solution recommended. This can have a significant effect on the choice of vocabulary (the words and phrases) that are used in the AAC solution. A young child may need words such as bubbles or sand, whereas an 8 year old may need some more advanced words to match more age-appropriate activities. These words may be added to core vocabulary or used in activity charts.
We need to consider that participating in activities is not the only important task for a young AAC user, but also the development of language generally, which is a longer-term task critical for long term life outcomes. This is an example of why a team approach needs to be taken for AAC assessment. Let’s consider our case study...
Stefan and the people close to him have been asked why Stefan needs a communication aid. These are their responses:
Stefan’s example covers three communication task areas:
Activity - Needs and TasksCan you match the type of questions asked about why Stefan needs a communication aid to the three communication task areas by flipping the cards?
Building Language for Tasks
When thinking how you can encourage the use of more language any regular evalutation session, it is worth considering using a schedule analysis tool in order to find the right vocabulary. An example of an AAC Implementation Worksheet has been provided by Vicki Clarke. The process involves observing the child’s environment and recording what is said by his or her peers, and the types of activities that the child engages in.
By carrying out this task you will be able to follow on with next part of SETT and we will be discussing the way to build communication charts and progress with language building in Level 3.
The most obvious tool is the communication aid itself, either a paper-based solution or an electronic device - often both! However, “Tool” in the language of SETT also applies to the people who are going to support the child. This includes those who will communicate with him or her on a daily basis such as the family, carers, teachers and therapists and other professionals, who might work with the child once a week to develop language, as well as the involvement of AAC specialists to provide training and support for the communication aid.
Now see how Atlas was able to communicate using an app for several tasks and use different tools for communication. We are not endorsing any particular app, but want to show how AAC can encourage the development of speech, language and literacy skills.
Atlas - 'Now we're Talking!' from AACORN on Vimeo.
Matching symbol set to user
Let's think about the flexibility needed in a communication book or application made up of symbols and listen to how Tamsin uses her symbol set to say that her brother is crazy! Also appreciate how her school are working to achieve an inclusive environment. ( Transcript download)
Activity - Describing symbol sets
Task - Comparing symbol sets
Many commercial symbol sets are available on certain AAC devices, Open licenced symbol sets (Creative Commons) can usually be added to any device (Sometimes they have to be adapted). Look at this comparison chart (developed by Spectronics) to compare symbol sets and our presentation slides on the subject. It might help you to start to make a chart of some of the considerations that we have touched on.
|Think about your user (more on this subject in the modules to come), environment, tasks and then iconicity, abstract representations. Look and feel across the whole symbol set not just individual symbols.
|Does the symbol set allow sufficient vocabulary coverage for the future?||✔|
|Are the core words that are most frequently used well represented?||✔|
|Are their clear rules that show how different parts of speech, actions, topics are depicted? e.g. a group has an outline cloud around it, prepositions represented by squares etc.||✔|
|How consistent are the representations?||✔|
|How complex are the symbols? Looking at backgrounds and amount of detail||✔|
|Can the symbols be adapted for poor vision - black and white, high contrast?||✔|
|Will the symbols be easily adapted to suit many different settings? e.g. walls, charts etc.||✔|
|Can the symbol set be used as a basis for developing literacy skills?||✔|
|Does the symbol set have a licence that allows independent adaptations and sharing?||✔|
Pictographic Symbol Sets
AAC systems are made up of all the items that go towards total communication, part of that collection may be an AAC symbol set.
A pictographic symbol set is usually:
Moving from single concepts to building language with symbolsHighly pictographic symbol sets may have easy to guess symbols, but may be less easy to apply in all contexts. A symbol for 'water' might not work when a child wants to tell you his eyes are watering.
Explore a range of symbol sets on Global Symbols and from other resources you may have found and develop your own ideas about the best symbol sets for the children you support. You could add the selection to your reflective journal.
Eyegaze isn't Perfect
Eyegaze does have some disadvantages. Until recently it was one of the most expensive options, with integrated eyegaze communication aids costing more than many people could afford. More recently cameras have become available that work with most Windows computers and tablets.
In addition, eyegaze systems are very dependent on the ambient light. While they work without issue indoors, they usually fail outdoors and in sunny indoor spaces, such as in bright classrooms. Children who use eyegaze for AAC need to be able to access a reasonable number of symbols displayed on the screen at any one time. This requires good voluntary eye movements, something which can be hard for children with physical disabilities such as cerebral palsy.
Another factor to consider when evaluating eyegaze is the position that it needs to be accessed in order to work. Typically this is directly in front of the child, at head height, mounted safely to the wheelchair. Any variance in this position can greatly affect accuracy. This position can be difficult to achieve, and even if it is possible, then the presence of the eyegaze affects view which in turn affects mobility and awareness, as well as the ability to maintain appropriate eye contact during conversation.
Activity - Reviewing eyegaze use
Watch the eyegaze video. How is Jason selecting the symbols he wishes to use? What are the advantages and disadvantages of this approach?
Can you think of any other approaches? Make a note of your thoughts in your reflective journal.
Assessing for Switch Access
Developing Switch Skills
Children learning language in the classroom
Never forget to remind yourself about the importance of language in developing confident young individuals. The role of the classroom with its complex interplay of social dynamics is vital for children to develop an understanding of language and the important pragmatic social skills that accompany it. Being part of this group, and the communication that is required for this, is vital for a child to develop confidence and a sense of agency. Children that can’t communicate do not learn to speak for themselves. Communication aids and effective classroom support can change this.
Of course this applies to children who communicate using AAC as well as for those who do not. So how do we set up a classroom to help children who use AAC to engage, learn and socialise?
Activity - Thinking about classroomsTake a moment to consider how changes to a classroom might improve the experience for a communication aid user.
Consider our case study, Fiona, or a child you are familiar with. Read how she is being encouraged to take part in the classroom activities. Note down your thoughts in your reflective journal.
The physical space
Some of the easiest problems to solve involve physical space for paper-based and electronic aids, places to securely store the aids and points to charge the high-tech devices. These can be seen as practical issues and are usually straightforward to correct. Ask yourself questions such as:
A supportive place to learn symbols
Many AAC users share classrooms with children who do not use AAC. Using communication symbols throughout the classroom helps everybody as they are picture labels that help children who are learning to read and write, as well as normalise the use of symbols for the AAC user. Examples of symbols in classrooms include now and next boards, visual timetables, storage labelling and social stories.
Making a visual timetable can be a matching game with different areas for the various activities.
The role of the people in the classroomHowever just as importantly, if not more so, is the human support from teachers, teaching assistants, and the AAC user’s peers in the classroom. One of the most important roles is that of the ‘communication partner’ - the people who communicate with the AAC user. Having an assistant or carer using the AAC system or device with a young child, learning to communication will help them to become more integrated into the daily routines as well as a more independent member of the class. The importance of the communication partner's role will become more apparent as we work through the levels.
Any activity that the child engages in can, and should, involve their symbol communication aid. Examples include:
Here is an example of Simon Says game using Avaz AAC app (YouTube Transcript available)
Activity - Reflecting on Using AAC
Have a look at this blog from PrAACtical AAC: How We Do It: AAC in the Special Education Classroom . You may
find some useful ideas.
Articles with ideas for using AAC in the classroom
You can make resources using software and websites such as:
You can also use Microsoft Word, making use of photos, online pictures and free symbols:
Building AAC Competencies
If a child learns to use their communication aid for 30 minutes twice a week with their speech and language therapist, then it would take 84 years for them to be exposed to as much language as a typical 18-month old. This statistic is intended to make the point that it is everyone’s responsibility to become good communication partners and to ensure that the communication aid is available in as many situations as possible for the child.
Janice Light has written about the four areas that a child needs to develop in order to become a competent AAC communicator. This is very useful when working with a child because you can consider how they might be learning in all these areas. Janice Light and David McNaughton revisited the ideas in 2014 (downlod PDF slides). You will recognise each competency as they have been mentioned and linked to the Tobii dynavox Pathways for Core First.
Each tab represents one of the four original competencies.
Linguistic competencies involve the following:
Operational competencies involve the following:
Strategic competencies relate, largely, to how to deal with the limitations of the communication aid, e.g.
Social competencies include a list of how the child uses the device in practical terms to:
Additional Information as a result of the updates to the four competencies include Changes to AAC Systems and Expectations for Participation, Demographics and the Scope of Communication Need
Whenever any classroom activity is being considered for an AAC user then an awareness of these four essential areas of AAC skill development is necessary. Such activities may fit to existing AAC teaching styles such as explicit instruction, incidental
teaching, mand-model or conversational coaching.
However, most linguistic, operational, strategic and social skills are developed through modelling, whereby the communication partner uses the AAC user’s device to talk to them. This is known to have a profound effect on the development of children who
Activity - Modelling
The importance of modelling has been mentioned at every level during this course. Point-Talking is a descriptive alternative term that you might also see being used for this AAC communication strategy. It simply involves the more competent communication partner pointing at symbols on the AAC user’s communication aid while they are talking with them.
Modelling is a way to expand the individual’s vocabulary while demonstrating how the device can be used in natural settings. It can be used to work on all four of Janice Light’s competencies because you can model turning the device on and off, using it
in social situations, combining existing symbols to overcome missing vocabulary and to teach
new symbols. Modeling also slows your speech down which makes it easier for the
AAC user to learn.
Types of Language
When people first start modelling they tend to use directive language. Although this comes from a good place it does not help the AAC user to become a good communicator as it tends to be "one sided"
Directive language involves commands, closed questions and questions that the communication partner already knows the answer. Examples include:
Broadly this strategy involves testing and not teaching. Using this technique results in children not gaining that sense of agency discussed in Unit 1 and it stops them from developing the ability to initiate conversations and coming up with novel utterances.
Parents, always with the best intentions, often use directive language and so when planning out implementation it is important to work with them on their ‘communication partner’ skills.
Video - It is sometimes hard to find ways to encourage children to initiate conversations...
Non-directive language is more similar to the natural communication you would expect peers and adults to have with children who use their speech to communicate.
Try this as a communication partner with a young child and see how much more language is generated by them, rather than yourself in the conversation! You may want to make a note in your reflective journal.