AAC implementation and building communicative competence

what drives AAC intervention

• addressing unmet communication and participation needs

• identifying priorities for the individual

• enhancing communication effectiveness

• increasing engagement

long term success of an intervention plan

• interventions that utilize environmental adaptations

• interventions designed to enhance natural capabilities

• skills and strategies that will have the greatest impact on real-life situations

• interventions that incorporate evidence0based strategies and techniques

all inclusive

communicative competency should be _____ ______

range

important for an AAC user to have access too vocab that represents a ______ of communicative function

constraints

be aware of _____ that might be created from a limited

vital components of a device

• robust vocab selection

• ongoing AAC availability

• training and support

• personalized AAC (last step)

5 AAC competencies

1. operational competence

2. social competence

3. linguistic competence

4. strategic competence

domains of communicative competence

• AAC users begin as novices and work to become competent with appropriate support, instruction, practice and encouragement

• an individual’s communicative competence may vary across contexts depending on partners and environments

operational competence

the technical skills required to use the AAC system or device. The includes powering the device on and off navigation between pages, volume control, etc

• promote accuracy and efficiency and reduce effort and fatigue as much as possible

• motor and technical skills required to use an AAC system

• interventions typically involve movements to demonstrate skills, as well as repeated performance

• approaches can involve explicit instruction or a cognitive developmental approach

social competence

pragmatic language skills, such as initiating, maintaining, and terminating communicative interactions in a socially, culturally, and contextually appropriate manner

• sociolinguistic skills

• sociorelational skills

linguistic competence

expressive and receptive language skills, including grammar, syntax, and the linguistic codes of AAC systems

• interventions should enhance communicators in conversation, narration, exposition, and textual genres in written and expressive modalities

• should be based on functional readiness and need

• provide frequent opportunities for modeling of grammatical targets and independent use

• immature AAC utterances are contrasted with more grammatically complete forms

strategic competence

adaptive strategies including unique to AAC-based communication, such as using device features to convey a message as quickly as possible, identifying and repairing communicative breakdowns and using compensatory skills

• use of compensatory strategies to overcome language, operational, and social challenges

emotional/psychosocial competence

motivation to communicate via AAC, resilience and persistence during communicative exchanges, the use of emotional vocabulary for empathy, self regulation, and self advocacy

• motivation

• attitude

• confidence

• resilience

mastery

communicative competence does not require _______

real-life, applicable

therefore, AAC interventions should focus on communication performance within _____, ______ contexts

linguistic competence targets

• range of vocab

• range of sentence structures

• morphology

• range of expressive skills

• code switch between languages

• literacy skills

• morphosyntactics

• linguistic conventions (content & form)

• fast mapping

• shared book reading

• written/typed expression

challenges to developing linguistic skills

• need to learn spoken words and corresponding AAC representations

• words in system may not reflect internal lexicon

• individuals who use AAC may not receive feedback about their vocabulary

• development compromised if only access to a limited range of concepts

• complicated to learn with symbols

• core vocabulary plus vocabulary to support language learning

operational domain targets

• body movements for unaided messages

• hand shape, position, orientation, and movement to form signs or gestures

• open book, turn pages, select target symbols

• locate target symbol, pick up, hand to partner

• use of pencil to draw/write

• use access technique for selection

• navigate to other AAC displays

• adjust volume of speech output

• access digital communication tools

• capture and upload photos and video

• navigate between apps/tools

• plug in/charge system

• power system off/on

strategic domain target examples

• partner assist in locating symbol to help with navigational demands

• prepare messages in advance to reduce partner waiting time (quick fire messages)

• introduction strategies

• humor to maintain a positive rapport

• regulatory phrases to manage interactions

• repair strategies for breakdowns

• digital media to bypass demands for face-toface interactions and increase social network

sociolinguistic skills

• discourse skills: taking turns, initiating conversation, maintaining conversation, etc.

• communicative functions: requesting attentions, requesting info providing info, confirming info in a social context

• “conversation skills”

sociorelational skills

• interpersonal aspects of communication that form the foundation of positive relationships

• active participation in interactions, demonstrating interest in communication partners, projecting a positive self-image

• more abstract

• based on exchange/relationship not language

• pragmatics

social domain targets

• range of functions

• personal care

• talking with healthcare providers

• emergency planning

• tell stories and share experiences

• exchange information

• explain concepts and describe procedures

• self advocate; report abuse, crime, or neglect

• contribute meaningfully during interactions

• social niceties

• manage conflict appropriately

challenges with development of social skills

• disability associated with specific impairment

• difficulty developing orientation skills

• difficulty with perceived focus on partner

• limited social circle

• may have few meaningful opportunities to interact with diverse range of partners

psychosocial domain targets

• celebrate success

• mentor programs

• describe the problem

• outline ways to solve the problem

• identify the best solution

• take action

factors to consider during goal making

• skills most important to the person who relies on AAC

• skills valued by the family, friends, and community

• skills used regularly in the real world

• skills most likely to result in communication success

mixing; competent

be aware of inadvertently ______ content and communication in the same goal, especially when the person is not yet a ____ communicators

data collection types not suited for AAC

• x/x trials

• % accuracy

• % of opportunities

data collection types best suited for AAC

times per __

__ times across __ context

__ communicative functions used per __

sentence length increased from baseline of ___ to __ across

intent

expressive communication is a function of a person’s ___

autonomous

communicative success depends on the individual’s ability to express an ______ message

strategies used to facilitate the achievements of goals

• access to a comprehensive language system

• trained communication partners who can model AAC and interact in a variety of natural contexts

• trained communication partners who can identify attempts at initiating communication and use expansion

• trained communication partners who can assist with operation of a communication system to support an autonomous message

• engineered communication opportunities within natural contexts

• training of communication partners about expectations for communication learning

• sufficient wait time without interrupting thought process

• strategic and natural feedback on attempts and successful communications

• environment of people who validate the use of AAC

building communicative competence

• no single best approach

• choosing effective instructional procedures depends on a range of factors

  • individual’s age, needs, capabilities

  • target strategy or skill

  • supports and demands within the environment

  • evidence that supports the effectiveness of the approach

• kind of like dynamic assessment

responsive social pragmatic intervention

• parents and other communication partners are taught to fulfill communicative attempts and to model target skills

• used in naturally occurring interactions

• direct elicitation of child language

  • read+provide an aided AAC model

  • ask a wh-question+provide an aided AAC model

  • answer the wh-question +provide an aided AAC model

explicit instruction

• based on principles of ABA

• structured stimulus presentation with expected student response

• occurs in less natural situation

• needs to address avoidance of prompt dependency

• can use % accuracy or tally marks for data collection

milieu/incidental teaching

• the approach is often paired with a milieu (person’s social environment) or incidental teaching to promote generalization of skills in a natural environment

• uses more facilitative strategies as opposed to direct elicitation of child language

• common elements include

  • manipulating the arrangement of the natural environment

  • targeting specific communication goals in a natural context

  • utilizing prompt techniques to elicit the target skills

  • responding to the individual’s communicative attempts

mand model

when a person with complex communication needs approached or is engages with a preferred item/activity, the communication partner asks a question

• if the individual does not respond with the target skills, the partner models the desired response

• overlaps with explicit teaching

• a partner points to a doll while a child is playing with it and asks “what is that?” if the child does not respond or response incorrectly, the parent models the sign DOLL

expectant time delay

a communication partner asks a question, models a symbol, or places a desired item in view and then provides an extended wait (pause) accompanied by an expectant facial expression and eye contact

• a parent points to a picture in a story book asks, who’s that? and then waits expectantly to provide an opportunities for the child to sign or point to a symbol to respond

missing/out of reach item

a item needed for an activity is missing

• a parent lays out salad ingredients but “forgets” to provide a bowl, so the individual needs to ask for it

incomplete presentation

an initial request is followed by an incomplete presentation of the requested item

• i.e. a request for toast with jam is responded with a piece of toast without jam forcing the child to request for jam

interrupted behavior chain

an ongoing activity is interrupted to create a need for requesting

• a child who relies on AAC who is proceeding through a cafeteria line must ask the attendant for certain items before proceeding to the next station

wrong-item format

the individual is provided with a wrong item following a request

• after asking for a cup of tea, a child is provided with a cup of coffee instead creating the need to use a repair strategy to clarify the original request

respond with natural consequences

communication partners respond immediately by providing the item selected, even if they think that the communicator made a mistake. the communication partner should immediately provide the selected item and let the natural consequence of the selection occur

strategy instruction

incorporates demonstration, explanation, and discussion of target skills, including the benefits of specific methods and techniques, the situations in which they are most appropriately used and feedback on performance

• showing a client how to access prestored phrase messages to reduce cognitive load and fatigue

coaching

• similar to strategy instruction by providing more formal opportunities for the individual to practice strategies or skills while giving feedback on the individual’s performance

• frequently used with individuals who have the cognitive and metalinguistic capabilities to understand the explanations provided and are motivated to practice the target strategy or skill

  • while a caregiver interacts with a client, clinician coaches the caregiver how to model in the moment

modeling

• the communication partner uses unaided and/or aided AAC in conjunction with spoken input

• most frequently referenced strategy in literature

• can vary on a continuum from more structured interventions to stimulation that is infused within daily activities

• research has shown that beginning AAC communicators benefit greatly from this without expectation

• not applying pressure has shown to be the strongest form of teaching

EAT CAKE layers of modeling engagement

1. Exposure: “putting it on the plate”

2. AcKnowledgement: “noticing the item on the plate”

3. Curiosity: “push it with the fork”

4. Try it: “touch it”

5. Acceptance: “no big deal, I have this all the time”

6. Exploration: “lets see what else I might like”

exposure

modeling even if seems inattentive; may not look but tolerates

acknowledgement

modeling with excitement occasionally curious when topic is interesting; not saying to look at device; convey positive and fun

curiosity

occasionally looks if interesting; no active exploration; aware of device and deciding if worth their attention

try it

seen device frequently and okay with interactions; attempts to activate for cause/effect; might look random/stimming but not; respond to what user says

acceptance

expects modeling and looks for language that’s useful; looking at message window

exploration

touches buttons and looks to adult for meaning; begin to use previous models’ purposeful intent more frequent and noticable

common modeling challenges

• getting stuck trying to model every word

• overcoming making mistakes when modeling

• thinking AAC users must be looking every time

• when AAC user does not respond

• getting stuck modeling requests

• making the AAC user copy you exactly

• modeling stops when the user makes progress

• modeling something only once