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Strategies to Increase Effective use of Aided Communication
by Susan Berkowitz, M.S.,M.Ed., C.C.C.,SLPChildren who use augmentative communication do not have models from whom to learn their mode of communicating like verbal children do. But children do not spontaneously learn a skill that isn't ever observed. Those who interact with these children need to not only tell them to use their system, we need also to model its use. For that to happen, those who interact closely with the child need to be comfortable and familiar with the system. When speaking to the child, one needs to use the system to communicate your message, too. Show the child how to use the system, how to communicate, and how to use a mode other than speech.
Sometimes, a child doesn't know how to construct their message or find the vocabulary they need to effectively convey their message. We support a child's language acquisition when we actively engage in problem-solving with the child; figuring out what they are trying to convey, assisting them with finding ways to say it, suggesting strategies, co-constructing messages as needed.
Use all of the information the child is giving you; verbally, gesturally, contextually, with their body language. Focus on the child's attention and interest rather than yours. As you work out what the child's meaning is and model strategies, the child will gradually shape their behaviors to yours and their actions will become clearer.
Explicitly tell the child what they can do to better express themselves; suggesting what method of communication they should use (gestural, verbal, sgd - such as "look at me if you want a turn," or "use your device to find the word for what you want"), telling them what they can do to be more clear (i.e. "cookie...what about a cookie? tell me more."), suggest what words might work to communicate the message better ("it's snack time; do you want cookies? Tell me want eat cookie" "I see you're not eating that cookie. Do you want a different kind of cookie? Tell me different") Natural Aided Language is a strategy in which environmentally specific symbols or words are placed on a communication board or page to facilitate participation in a specific activity. Every person who interacts with the child is responsible for using the aac system and appropriate language. The child is exposed to intensive receptive language stimulation without pressure, with the expectation that expression will eventually occur. Adults use the system to "talk" to the child, reinforcing and shaping all attempts to communicate.
Negotiate meaning. If the message is unclear, you may need to suggest various meanings (see above: do you see a cookie,do you want a cookie, did you bake cookies with mom...). Just like we "guess" what a young child is saying when their articulation is not fully developed for speech to be clear, so we have to interpret what the new aac communicator is saying sometimes, then work with them to make sure we have "guessed" correctly, and provided a clearer model for them to use.
Provide feedback - you can repeat the child's message, check for clarification, or recap what has been said, as needed. Use correct syntax when you do, then you can provide an expanded message that gives the child a model of a more elaborated version of the message. Watch the child for clues, movements, etc., as well as watching direct responses. Confirm verbally what you think they intend. Then, enhance or expand on what they provided. Be careful not to interrupt.
You also need to make sure there is sufficient vocabulary available on the system. Children can't use vocabulary that isn't there. A child's language development will ultimately be either limited or enhanced by what others determine to provide on their system. Make sure that there is a basic, core vocabulary available that matches the child's age. The average toddler uses about 25 words in more than 90% of their utterances. Most of these words can be used repeatedly in multiple contexts. Then, look to add vocabulary specific to your child.
Look at each activity or lesson that happens each day (you might not want to do this all at once - too daunting). What does the typical child say during these activities? What is the aac user saying and doing during these activities? Determine what might be needed to eliminate the difference between the two; different vocabulary, alternate teaching strategies, engineering the environment, changing the way questions are asked, etc. Remember that children learn best in their "zone of proximal development." Tasks that are always too easy may pose as many problems as tasks that are always too hard. Children may need to be required fewer repetitions to show mastery than their peers.
Follow the child's lead; paying careful attention to their communicative intent. Use expectant looks and least prompting necessary to generate a response. Time delay procedure use a specified time to wait before prompting. Mand-model teaching uses the cue "What do you want?" Provide structured or guided intervention within the classroom or other natural environment where the message is functional, using peers as models not only of the message, but of the social routines that go with messages. Maximize opportunities for incidental teaching by engineering the environment and changing adult behaviors; especially those that anticipate the child's wants and needs.
Many discrete trial formats can be modified and used within naturally occurring contexts. Discrete trial does not have to mean mass repeated trials. While some children initially learn well in structured, isolated contexts, generalization must be built in to the teaching system.
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