Saturday, October 5, 2013

The Break Down of AAC by Andrea Schario

Let’s start at the beginning!  I want to spend my first post on this blog explaining Augmentative & Alternative Communication (AAC) to those of you who are not familiar, or who need a quick-and-dirty refresher course. 

When I tell people that I am a Speech-Language Pathologist, they often reply: “Oh, so you help kids learn to say the ‘R’ sound?”  Here’s my typical response: smile and nod.   
If I’m feeling super-feisty that day, I shrug and say, “Well, that’s part of it…” 

Internally, I reply:  I work mostly with kids who are three years old or younger, and ‘R’ is not typically mastered until 4-6 years of age.  Also, the adult ear is so accustomed  to hearing ‘R’ errors that we hardly even notice them, so those pesky ‘R’ issues don’t even have much of a functional consequence for super-young kids.  Imagine, you’re at a park with your kid, who points to an animal with long ears hopping in the grass, and says “wabbit!”  You totally understand what she said, AMIRIGHT??  Oh, and by the way: many of the kids I work with don’t communicate verbally.   
That response would cause people’s heads to explode… so, I smile and nod.   

 And sometimes I tell people a story about how I couldn’t say my last name (Rabenold) when I was little.  My parents thought that was super-cute and put me on the answering machine.  You have weached the Wabenolds…

I digress.   My main point is this: many of the kids I work with don’t communicate verbally.    My little buddies have a variety of medical conditions that affect their ability to speak, and many of them need to either replace speech with some other form of communication, or supplement their verbal communication because it is not functional enough for them to communicate all of their wants and needs.   Welcome to the wonderful world of Augmentative and Alternative Communication (AAC)! 

Let’s start with a few important definitions.  There are 762 bajillion jargon-y terms in the field of AAC, so I’ve narrowed the field so you can focus on some important fundamentals: 


Aided AAC:  A group of AAC strategies that require some external aid or device.  These options include use of picture symbols, real objects (e.g., handing an apple to a caregiver to indicate hunger); writing or typing tools; and a wide range of voice-output devices (i.e., devices that allow a speaker to press a button or interact with a screen, and a spoken message results).

Augmentative & Alternative Communication (AAC):  The use of modes of communication other than speech to supplement or replace an individual’s spoken communication.

Effectiveness of communication: The ability to accurately construct the desired message and produce the intended result.  A child trying to order an ice cream cone needs the listener to hear the message, understand the message, and respond accordingly (give them their chocolate cone with sprinkles).

Efficiency of communication:  Producing the desired message while minimizing time and effort required for communication.  One of my most wonderful patients of all time had a degenerative condition that made it impossible for him to speak more than two or three words per minute.  He COULD speak, but it was so inefficient that he preferred to type most messages on his AAC device.

Expressive Language:  A person’s ability to effectively share wants, needs, thoughts, feelings, and ideas.  Expressive language includes all modes of communication, including speech, written communication, sign language, and use of AAC.

Intelligibility:  The “understandability” of a person’s speech.   Intelligibility can be affected by numerous factors, including: a speaker’s ability to produce speech sounds; his/her rate of speech; and vocal problems like hoarseness.   Background noise is also a major consideration – some children are fairly intelligible in a quiet environment, but cannot be understood in a noisy classroom.

Multimodal communication:  Use of more than one type of communication (e.g., a child who uses AAC, sign language, a low-tech picture communication book and facial expressions to communicate).   Often, multimodal communicators will switch between modes depending on their communication partner (e.g., Aunt Shirley, who doesn’t know sign language), or the communication environment (e.g., Bobby can’t use his iPad outside when it is raining).

Receptive Language:  A person’s understanding of verbal, signed or written communication.   In young children, basic assessments of receptive language determine whether a child can follow directions, identify pictures and objects on command, understand questions, etc.

Unaided AAC:  A group of AAC strategies that require no external aids or devices.  Unaided AAC can include use of gestures (e.g., pointing; waving; shrugging), sign language, and facial expressions (e.g., raising the eyebrows to indicate that you’re asking a question).

My friend Timmy will be our guide here.  Words in bold are key AAC terms, and are defined in the box above.
Timmy is five years old and was born with Cerebral Palsy.  Timmy has excellent receptive language; he comprehends everything a typical five year old does.  However, his intelligibility is poor, and most people have a very hard time understanding what Timmy has said.   In most settings, it is more efficient and effective for Timmy to communicate using a mixture of unaided AAC (in Timmy’s case, gestures and facial expressions) and aided AAC (an app on his iPad, which he uses to quickly access thousands of words and pre-stored phrases and sentences).    Here’s what a conversation with Timmy might look like:

This conversation illustrates a common situation: Timmy is using multimodal communication.  He combines speech, unaided AAC and aided AAC to maximize his ability to quickly communicate with his mother.   AAC is very rarely the only mode of communication available to a child; it is simply one tool in the toolbox.

I hope that this post has sparked your interest in the amazing, astounding, and sometimes overwhelming field of AAC.  In future posts, I will delve further into specific AAC options, who can benefit from AAC, how to get your hands on an AAC device, and more!   What do YOU want to learn about?  Please leave me a comment!

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