Course: Level 2

  • Level 2 - AAC Strategies and Assessment

    • child using a button switch_button_text-bottom">

      Level 2 offers a framework that can support a functional assessment for AAC user needs, identifying strategies for inclusion and highlighting key issues for implementation.

      The following topics will help you:
      • Assess for AAC needs
      • Build upon referral and screening assessments
      • Identify technologies and strategies for inclusion - Introducing the SETT Framework
      • Understand the needs of the AAC user.  Make symbol set choices
      • Decide which activities can enhance interactions. 

    • Test your knowledge

    • Please work through the topics below in the order they are provided, unless you feel confident that you know the subject.  

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    • Group of people meeting

      In this topic we will cover:

      • The relationship between family and practitioners
      • The importance of the family in relation to AAC assessment
      • Understanding needs and concerns
      • Environmental context and support

    • Understanding the potential AAC user's environment

      It can be extremely hard for a family to cope with all the demands that come with having a child who may have complex communication needs, usually alongside other disabilities impacting on sensory, physical and / or cognitive abilities.   

      The early years can be spent visiting hospitals, clinics and specialist centres, learning about possible outcomes from different professionals.  But nothing is more important than building a relationship with the family so there is mutual trust.  When there are siblings around it can be an overwhelming challenge for those in close contact with the non-verbal child, to make extensive use of all the aspects of AAC that need discussing.  

      It is vital that there is an understanding of the needs and concerns of parents and close carers, with an awareness of the environment in which the child is being brought up.  

    • Activity - Understanding Families

      thought bubbleTake 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. 

    • AAC Assessment and the Community

      Explaining how an AAC assessments works and what you hope to achieve with it is very important

      Here is an example of an American  Speech Pathologist telling her local community about an AAC Assessment. There is a transcript available


      Here are some ways that you could use to help your community understand AAC
      Ideas for spreading the word
      What Where How
      Leaflets Doctor's surgeries
      Family clinics
      Hospital waiting rooms
      Schools
      House departments      		 Simple paper based version with clear text and images - Make the electronic version available on a website - Make sure it is available in several different formats such as doc, pdf and html so it can be used by everyone. 
      Local Radio Organised by local station Get to know the journalists and offer an introduction and possible FAQ session. Try to find time to have a regular slot with a commentator so that you gather momentum over time.  Have different experts discussing the different topics. 
      Blog On your website Start generating interest by writing articles and linking to other blogs.  A good example is Carole Zangari's 'PrAACtical AAC'
      Use Social Media Use online collaborative tools e.g. Facebook accounts etc Share the burden of updating between colleagues and try to keep it all up to date with links to events etc. 
      Face to Face Local/National and International Nothing really beats face to face - making yourself available whenever possible to share your knowledge.  Local open days in schools, clinics and parents' meetings.  Taking a table at a local event with lots of simple activities on show - free ideas and easy to make games.  National and International conferences are harder to do and take more time, but can lead to grants and interesting knowledge building opportunities that you can share on your return with families and colleagues



    • Activity - sources of support to families

      There is a real need for families to have information and training on how to use AAC with their child and within their family: although families are experts regarding a child, families and caregivers are not always expert in the effective use of an AAC but who delivers this training?

      thinking bubbleIn your reflective journal name five individuals who might be needed to support the family when training is needed to use an AAC device and provide the reasons. 


    • Family members involvement

      family membersFamily members have been recognized as the most significant communication partners for children and credited with helping their children to achieve their communication potential (Huer &Lloyd 1990). However, it is important not to put pressure on siblings and to make it fun rather than a chore.  

      Let’s watch this video. Do you think that this sister needed any training to support her brother?  Is there too much expectation? Transcript available 

      It can be hard to implement AAC into family routines, hard to constantly teach everyone to model what is being said whilst dealing with everyday activities.    But it is important to try to encourage some planning before a parent asks questions similar to the ones below …

      • What am I expected to do?
      • How much am I expected to do?
      • How will I know when I’m finished?
      • What will I do next?

    • Summary 

      Working with families can include relevant effective early intervention practices. Here are some of the items we have covered in this topic:

      • Family - emotional well being and relationship effectiveness to encourage communication
      • Instructional  – aided modelling, requesting, prompts with careful language support.
      • Interactional  – flexible, responsive; recognising family strengths and vulnerabilities
      • Natural Environments -  at home and in school - working in the context of normal routines 
      • Positive Behaviour Supports - consider resources, routines and expectations of a setting, as well as AAC user skills, preferences and values of extended family 
      • Transitions – aiming for generalisation across settings e.g. outside school or with unfamiliar peers


    • Further Reading 


    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal - Offering support to the family

    • Presentation slides

    • url icon
      URL
      Understanding the needs of families: The role of the extended family URL
    • url icon
      URL
      Direct Access & Pointer Control URL
    Topic
    1

    • two girls using AAC

      In this topic we think about the referral process and the steps taken to prepare for the AAC assessment.

      • The essential information required when writing (or reading) a referral
      • The eligibility for AAC service acceptance
      • The impact of motivation on the assessment
      • Considering the child’s abilities
      • Do they already use AAC?


    • Activity - Starting out with referrals

      Most services that offer AAC assessments have some form of referral criteria. Some only work with children, others are just for adults.  Some require the potential AAC user to have a complex communication need and some will work with those who have a specific language impairment. It is important to familiarise yourself with the criteria of all the services available to you, in order to provide up-to-date advice to potential AAC users and their families.

      think bubbleWhat AAC assessment services do you feel you need in your area? 

      How would a family be able to get a referral? 

      How long is the wait?   Can you make a simple information sheet for your colleagues and add it to your reflective journal.  You may want to look for samples on the web or from local organisations in your area - they may not work in the field of speech and language, but have similar assessment information.

      The Barnsley Hospital AAC and Assistive Technology Team based in the UK  have put together many documents about referral criteria for AAC which may  be helpful. 

    • Understanding current communication

      In the preparation for the AAC assessment it is worth considering first how the child that has been referred for an assessment currently communicates. Is this information in the referral form or do you need to talk to someone to find out more? 

      This is important in that it allows you to prepare to communicate with them when you meet them, but also gives you an idea of their language skills, physical skills and the opportunities within their communication environments.  

      Managing expectations may also be important, especially if it is felt the child should be able to reach certain early learning goals before they are 5 years old.  Here are some examples of possible language and communication goals:

    • Preparing for the AAC Assessment

      AAC assessments don’t happen if the child isn’t motivated to engage! If they are not interested in playing with a particular doll  or train, then they are unlikely to go to the effort involved to try new equipment. While preparing the assessment always get an idea of the things the child will engage in.

      Understanding the child’s abilities and difficulties

      girl using AAC device

      It is also useful to know about a child’s performance skills - or at least those that affect his communication and activity participation the most. These include mental skills (memory, problem solving, language) and physical skills (arm and hand movements, seating stability) as well as sensory skills (vision, touch and hearing for example). Having an idea of what the child can do allows the AAC assessment team to select from a wide range of possible solutions before even meeting the child. 

      Who attends the assessment sessions?

      Finally, when  preparing for an assessment some time needs to be spent considering who might need to be there. The child will always be included, and hopefully someone from his or her family. Also it might be useful to have people who understand the child and the environments they communicate in, such as teachers and teaching assistants. Finally a Speech and Language Therapist and Occupational Therapist each play an important role in AAC assessments. 

      See how those in Thasya's inclusive school environment adapt support to work with her abilities and her love of music and then what happens when she is given an AAC device. 

      THASYA hi-res OPEN CAPTION from Dan Habib on Vimeo.

    • Summary 

      • Referrals for AAC assessment are prioritised based on the child and their environment
      • The assessment should be motivating and engaging for the child to perform well
      • Knowing about their current communication methods and previous AAC use helps you make the best decisions going forward


    • Further Reading 


    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal

    • Presentation slides

    • url icon
      URL
      Building upon referral and screening URL
    Topic
    2


    • girl smiling using AAC

      This topic builds on a referral and any screening tests to evaluate the needs of the young child who has complex communication needs. We are going to explore:

      • Who can AAC help and how does screening identify this?
      • The importance of the AAC assessment process
      • How each child needs a device that is bespoke for their needs
      • Thinking about today and tomorrow

    • Who benefits from AAC?

      There are two main groups of children who benefit from AAC, those with complex communication needs (CCN), and those with a specific language impairment (SLI),.

      AAC helps these children by providing an alternative to speech and language, or by augmenting existing speech and language. 

      Some children find it easier to use symbols as a way of communicating and may have undiagnosed reasons for not following typical speech and language developmental patterns, but still benefit from the use of AAC strategies. 

    • 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  

    • Activity - Who Needs AAC?

      Who is eligible for AAC?

      In the 1970s and 80s it was widely believed in the AAC field that children should only be ‘eligible’ for AAC once they have achieved certain cognitive and language milestones. This is now generally discredited, with a view that emergent communicators will learn through opportunities to participate using accessible communication aids in motivating activities and supportive environments. 

    • The AAC Assessment

      child with speech therapistOnce a child has been identified as being suitable for AAC how do we know what solutions will best meet their needs? 

      The most formal approach is an AAC assessment which often involves a team of people and a long wait. Many families opt to take a shortcut by purchasing AAC apps online and installing them onto iPads or Android tablets. However, these may not take into account all the complex needs of some children and may not be always be successful. 

      Considering the future

      Another reason why a communication aid might not be successful is because during the assessment, the immediate needs of the child may been accounted for, but future-proofing the device was not. Making considerations for tomorrow’s needs - both in the child’s language development and increasing opportunities to use the device in new situations - is vital to ensure that it continues to support them as they develop.

    • Bespoke Communication Aids

      "Not all of these users require high technology AAC systems to communicate. But they do require a robust system that allows them to be effective communicators. The “…ultimate goal of an AAC intervention is not to find a technological solution to the communication problem, but to enable the individual to efficiently and effectively engage in a variety of interactions.” (Beukelman and Mirenda, 1998)" (AAC 101: Who Should Use AAC and Why?)

      The goal of the assessment process is to find or develop a communication solution that fits the needs of the child and their environment. The three main features of the devices that are determined by this process can be seen under the three tabs:

      quick talker

      Are words and phrases represented by symbols, objects, or text? If symbols, which symbols?

      walking a dog

      Do symbols represent individual words or phrases? How are they arranged to promote communication growth?

      eye gaze tablet

      How is the device accessed by the user? Do they use touch, eye-gaze or switches or something else?


    • Summary 

      • Every child with a significant speech difficulty should be considered for AAC 
      • Remember that one size does not fit all! 
      • Planning for tomorrow is as important as planning for today


    • Further Reading 

    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal - Assessing for AAC

    • Presentation slides

    • url icon
      URL
      Assessing for AAC Needs URL
    Topic
    3


    • Boys with AAC

      In this topic we will explore some very useful AAC assessment frameworks such as:

      • Those that help AAC specialists to prepare and deliver assessments
      • The Participation Model approach to assessments
      • The Communication Matrix website
      • The SETT Framework, a framework that we shall focus on in more detail
      • Implmentation within the classroom. 

    • 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. 

      Communication matrix


      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

      Participation diagramThis 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

      Evaluate effectiveness

      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 

      SETT



      "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

      thinking bubble
      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"

      • Do's and Don'ts article on access to AAC in a day.



    •  Project Core Universal Core Selection Tool

      If 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. 

      Decision tree for how many symbols on a chart


    • Summary 

      • Many factors need to be made when recommending an AAC solution for a child - not just the level of speech and language. 
      • There are several frameworks available, some are free and offer resources to help you on the AAC journey - you may need a mix. 
      • SETT is a popular approach used by AAC services involving the use of technology in readiness for school and beyond.

    • Further Reading 


    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal for Different types of assessments

    • Presentation slides

    • url icon
      URL
      Understanding Needs and Assessment Frameworks URL
    Topic
    4


    • pointing on an AAC device

      This topic considers the SETT framework and how we address the STUDENT and ENVIRONMENT parts of the assessment framework.

      • Using the SETT framework helps us to consider the needs of the child and their environment
      • The usefulness of the International Classification of Functioning,Disability and Health (ICF) to consider things about the child and the environment you may to wish to consider in your assessment
      • Lots of free tools available to help you with these stages!


    • SETT overview

      This 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. 

      think bubbleConsider 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. 

      • Age, gender, lifestyle, habits, social background, education, religion, life events…

      • Body functions (Mental functions, sensory functions and pain, cardiovascular, neuro-musculoskeletal, movement-related…)

      • Body Structures (Joints, muscle power, tone, shoulder and upper limb, pelvis and lower limb, trunk, lips, tongue, pharynx, larynx, ears, eyes...)

      • Upper limb (Range of movement, joint stability, strength, endurance, tone, spasticity, flaccidity, bilateral integration, motor reflexes, tremors and perseveration.)

      • Sensory functions (Visual field, visual acuity, accommodation, oromotor movements, perception, visual neglect, control of pupil, pupil concentricity, strabismus, nystagmus, moisture of the eye... )

      • Mental Functions (Consciousness (arousal), orientation (times and place), intellectual (problem solving and learning), attention, memory, emotional functions, language, arithmetic, etc.)

    • Activity - Introducing Stefan

      child in a wheelchairLet'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.

      1. Print out the SETT Scaffold for Consideration of AT Need. 
      2. Thinking of Stefan, highlight any areas of concern in the list in Section 1 of the form as best you can (you may need to make up some details for this case study!)
      3. Now list these areas of concern in the first column of the table on page 2.
      4. When you have finished use the presentation slides to check some of your ideas and you can refer to the ICF to search for other information.


    • SETT: Environment

      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. 

       

      think bubble
      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:

      • Interviewing children, families and school staff
      • Observing children
      • Clinical assessment checklists
      • Hands-on assessment tools

      Links and descriptions for these can be found in the further reading section.

    • Summary 

      • SETT makes it easier to step-through a process to consider AAC for children
      • The ICF provides a list of useful things to consider when deciding on the best AAC solutions for children
      • The AAC solution that you choose should be dependent on the child and the environment that they communicate in
      • There are lots of useful tools available to help you every step of the way

    • Further Reading 

      The ICF can be downloaded from the World Health Organisation website:

      Interview Tools: 

      Observation Tools: 

      Clinical Assessment Checklists- Partner Informed: 

      Hands-On AAC Assessment: 


    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal

    • Presentation slides and Case Study

    • url icon
      URL
      Understanding the needs of the student The influence of environment on options URL
    • page icon
      Page
      Stefan - our Level 2 case study Page
    • page icon
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      Example - partially completed SETT Consideration of Need for Stefan Page
    • resource icon
      File
      SETT Scaffold Consideration Form Template File
    Topic
    5


    • boy with tablet

      This topic looks at the two remaining letters in the SETT framework, TASKS and TOOLS:

      • The tasks that the child needs to do – and how we consider these
      • The tools available to the child, the communication aids and the people and other resources

    • SETT: Tasks

      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.

      boy in wheelchairWe 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: 

      What is going to enable the child to be able to chat to their friends, inform their mum of their eating preferences, and stay calm when feeling frustrated?  
      The communication aid, configured well with a robust vocabulary, will help the young person to develop their language.
      One of the fundamental purposes of language is social closeness. Is the communication aid chosen going to increase social closeness, or possibly put up more barriers? If Stefan had been introduced to PECS (or any other symbol based dialogue system) woud he be able to use this independently to communicate with his peers and people unfamiliar to him?


    • Activity - Needs and Tasks 

      Can 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. 

      1. Take the 'SETT Scaffold for Consideration of AT Need'  
      2. Thinking of Stefan, list the specific tasks he is struggling with in the second column of the table on page 2.
      3. Use the  presentation slides on this topic to help you and refer to the ICF to search for other ideas.


    • Sett: Tools

      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. 

      1. Print out the tool consideration scaffold document and see if you can fill it in.
      2. Put the tasks in the ‘descriptors’ row and the possible AAC tools in the ‘tools’ column.
      3. You may need to think about a range of communication aids 
      4. Have a think about how each tool matches up to each task (“descriptor”).

      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.

    • Summary 

      • Considering the tasks that the child needs or wants to do is essential when deciding what AAC system should be recommended
      • The words and phrases in that system should enable the child to do lots of things, including learning new language
      • SETT provides a useful framework to work through these issues, and the forms can be used to help you identify how tools are likely to meet the needs of the student

    • Further Reading 

    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal

    • Presentation slides and Case Study forms

    • url icon
      URL
      What tasks and objectives do we want to address and what technology is available? URL
    • page icon
      Page
      Example - SETT Scaffold tool selection for Stefan Page
    • page icon
      Page
      Example - a completed SETT Scaffold Consideration of AT for Stefan Page
    Topic
    6


    • choosing sweets

      This topic is all about the need to think about AAC symbol set choices by:

      • Reviewing available symbols sets 
      • Identifying some key features of symbol sets 
      • Suggesting considerations when choosing a symbol set


    • 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

      group of dog symbols

      think bubble
      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. 


         Check Points to Consider for Symbol Set Selection
        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?  ✔
        More options...


    • 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:

      • Available as a collection of symbols.
      • Not standardised like road signs, icons or emojis (ISO).
      • Made up of concepts – symbols as referents – what they relate to.
      • Linked to labels that can be changed to suit the language and user. These are separate from the symbols (can be printed above the symbol so communication partners can see the meaning or below when focussing on literacy skills). 


    • Moving from single concepts to building language with symbols

      Highly 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.  

      selection of water symbols

      think bubble
      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. 

    • Summary 

      • There are many AAC symbol sets. 
      • Different sets have a different look and feel, grammar structures and categories.  There are no international standards
      • Don’t forget the needs and abilities of the AAC user and their family, setting, culture and language in choosing a set
      • Consider iconicity (how guessable), flexibility, consistency and how easy to generate language for progression.
      • Remember symbols are used in many different ways and situations. 


    • Further Reading 


    • Reflective Journal 

    • journal icon
      Journal
      Activity - Reflective Journal - Choosing a Symbol Set

    • Presentation slides

    • url icon
      URL
      Choosing a symbol set URL
    Topic
    7

    • Ulrich using Tobii eye gaze

      This topic starts with a discussion about eye gaze technology as it is often mentioned in AAC articles.  However, high tech eye-gaze does not work in all settings so alternatives such as switches may be used by children with the most complex physical disabilities.   We will explore:

      • The advantages and disadvantages of eyegaze technology
      • Types of switches
      • How to use switches with many links to resources in the Further Reading section
      • Switch scanning

    • High-Tech Eyegaze

      High-tech eyegaze is one of the most modern access methods available for AAC users. It is often used by children who are not efficient with direct access or pointer control. The technology is a useful alternative to low-tech eye pointing as it does not require the communication partner to be trained and able to observe small eye movements, such as when using an E-Tran frame.   The following key points are adapted from Vicki Clarke's article on PraacticalAAC (2016)

      What is required for eye gaze access:

      • Sufficient movement control - head and oculomotor. 
      • Sufficient visual acuity with at least one eye
      • Mounting equipment which allows for the device/camera to be positioned where it does not cause repetitive strain for the child (all axis movement on a mount is best, i.e. the device can be positioned higher/lower/left/right/tilted etc. to capture the reflection from the child’s eyes).
      • Cognitive and visual processing skills that allow a degree of attention to targets on the screen.  This can mean there needs to be a minimum of a .3 second pause on an image to begin to work on eye gaze.  This is a brief glance but contunually sustaining these pauses can be a strain for some children. 
      • Patience to calibrate the device, although settings are saved they may differ in various settings
      • Symbol sizes and targets that are comfortable at the distance between the device and the child - the distance from the screen may be from 53 plus cms (21 plus inches)

    •  Activity - Eye Gaze elements

      Drag the labels to the correct areas on the image.

    • 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 


      Thought bubbleWatch 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. 


    • Switches

      a selections of switchesSwitches are robust in the sense that they work in a wide variety of environments as they are not affected by light. Switches are also more accessible as they cost as little as £25 and it is possible to make them yourself.

      There are many types of switch available for children who use AAC. Most are mechanical and require a push from the hand or another part of the body to activate. Other types of switch include electromagnetic that can detect eye blinks, pneumatic switches for children using their breathing to make a selection, through to electrical switches that can pick up tiny signals from muscles and even the brain. 

      The type of switch chosen is decided by the type of movement that the child can consistently repeat in a timely manner. Usually this is arm or hand movement, but switches are often accessed by the knee, foot or through head movements. 

      In this video Elliot is using two switches with a game.  Transcript available

    • Switch Scanning

      Switch scanning is the term used to access symbols using switches. Each symbol on the screen is highlighted for a second or two, providing the user an opportunity to press their switch to select it. Switch scanning is typically far slower than eye gaze or any of the other methods described in this module. 

      Fortunately there are a number of ways to make switch scanning more efficient, such as through the use of alternative symbol layouts, scanning entire rows and columns, or using two (or more) switches instead of one.  Examples below taken from Wikipedia

      row scanning

      row scanning

      Scanning Example

      Imagine you have a grid of 60 symbols. A typical scan pattern would start at the top leftmost symbol and move right, one symbol at a time, with a dwell on each symbol of 2 seconds. Upon reaching the end of the line the highlight moves to the start of the next line, just like when reading text. If the symbol wanted is in the bottom right corner the user would need to wait for the computer to highlight 59 other symbols before they are able to select the one they want, taking two minutes. 

      60 symbols scanning

      To speed this up most users learn to scan in rows then columns, rather than each symbol individually. A grid of 60 symbols would typically have 6 rows and 10 columns.  Starting with the top row it would take 12 seconds to reach the bottom row. A selection (with the switch) is made to activate this row. Then each symbol is highlighted, from left to right, each taking 2 seconds. Since there are 9 symbols in the row before the one we want this will take 18 seconds. So using this method it would take 18+12=30 seconds to scan to the bottom right, four times faster than using the conventional approach. 

    • Summary 

      • Eyegaze can be as efficient as direct access (touch) if the child has good voluntary movement of the eye
      • Eyegaze doesn’t work in all environments, particularly bright sunlight
      • Switches are robust and reliable but can very slow compared to all other access methods

    • Further Reading 

      Eyegaze

      Assessing for Switch Access

      Developing Switch Skills

    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal - High Tech Access devices

    • Presentation slides

    • url icon
      URL
      Eyegaze & Switch Access URL
    Topic
    8

    • primary classroom

      This topic looks at:

      • The importance of communication on a child’s self-confidence
      • How to embed symbols into classroom activities
      • How to use symbols around the classroom to support comprehension

    • 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 classrooms

      thought bubbleTake 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:

      • For high-tech devices can it be heard by the teacher and peers? 
      • Is it safe to use high-tech devices during gym, music and art? 
      • Is there enough space on desks for low-tech devices such as communication books?
      • How far away is the charging point?
      • Where can a communication partner sit to help the AAC user during class time?


    • A supportive place to learn symbols

      AAC in a classroomMany 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 classroom

      However 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. 


    • Class Activities

      Any activity that the child engages in can, and should, involve their symbol communication aid. Examples include:

      • Symbols can be used everywhere, just like speech. Expect to use the communication aid with all activities, indoor and out.
      • Shared reading is a great way to introduce reading and increase symbol vocabulary through modelling.
      • Another effective activity is singing – again using the communication aid alongside your voice.
      • It can be very effective to get peers involved, for example the AAC user could direct a game of ‘Simon Says’ using his communication aid. 

      Here is an example of Simon Says game using Avaz AAC app (YouTube Transcript available)

    • Activity - Reflecting on Using AAC

      thought bubble

      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. 

    • Summary 

      • Learning to become a competent communicator using AAC gives the child the confidence to consider them self as an person with their own interests
      • Symbols used around the classroom helps AAC users understand more uses of symbols
      • Symbols used around the classroom also help AAC users to appreciate that symbols are an acceptable way to communicate
      • There are great online resources to help you get started.

    • Further Reading 

      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:

    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal

    • Presentation slides

    • url icon
      URL
      Using AAC in the Classroom URL
    Topic
    9

    • building lego

      In this topic we will look at activities which are used in classrooms to support children who are developing their language skills using a communication aid. You will find that:

      • Children need to be exposed to language to learn language and this applies to AAC users as well as speakers
      • Janice Light provides four things to think about when developing AAC competencies
      • Modelling is the most important way for AAC users to become competent communicators


    • Building AAC Competencies

      How often is the child learning language with their AAC device?

      girl with button switchIf 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. 

      The Four Competencies

      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:

      • The meanings of symbols  – The obvious one, such what does a symbol showing a stickman holding his hands in the air mean? 
      • Syntactic skills – How to combine symbols to create meaningful sentences

      Operational competencies involve the following:

      • The access method - Children with physical disabilities may have to learn to use switches or other methods to make selections on the device  including paper-based resources
      • Navigation between pages - Learning how all the language is laid out and categorised and how to turn the pages (for both electronic and paper-based communication aids)
      • Volume  - How to turn the volume up and down is an important skill that children who speak are taught! 
      • Clearing the message bar  - This ensures that multiple messages don’t run together – making for long utterances that are difficult to understand 

      Strategic competencies relate, largely, to how to deal with the limitations of the communication aid, e.g.

      • Volume - How to get your message across in a noisy classroom? 
      • Vocabulary - Symbols users will always have a limited vocabulary on their communication aids. An example heard recently is there is no word for ‘cruise’ on a communication aid so the child combined two words ‘hotel’ and ‘boats’ 
      • Environmental - What should the child do when they go outside when and their eyegaze does not work? 

      Social competencies include a list of how the child uses the device in practical terms to:

      • Take conversational turns
      • Start conversations 
      • Maintain topics of interest
      • Ask for information,
      • Tell people things    
      • Agree and confirm

      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

      communication competence

      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 use AAC. 

    • Activity - Modelling

      thought bubbleThe 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.

      Check the following statements as being true or false?


    • Types of Language

      Directive 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: 

      • “Point to ‘happy’” 
      • “Is your name Stefan?” 
      • “Where are we going this afternoon” (when both know they are going to the park) 

      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

      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.

      Examples include: 

      • “I think …” 
      • “I see you are …” 
      • “I am going to …” 

      conversation

      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.

    • Summary 

      • Consider all the ways in the classroom that can be used to help children become good communicators
      • Use Janice Light’s list of four areas of skill development to help you
      • When modelling, use non-directive language to elicit the best development of language skills


    • Further Reading 

    • Reflective Journal 

    • journal icon
      Journal
      Reflective Journal

    • Presentation slides

    • url icon
      URL
      Developing AAC Competencies URL
    Topic
    10
  • It is time to work through a few questions to refresh your memory about all you have learnt in Level 2. 
    Topic
    11