Monday, January 19, 2015

If You Give An AAC User A Large Vocabulary . . .

A few weeks ago, Maya accurately (and surprisingly) used the word "cubicle" during speech therapy. There was a character hiding in a poster, and the expectation was that she would say "behind the desk" . . . but instead she said (via Mini, her talker) "behind cubicle." It seemed too specific to be accidental (she has several thousand words in her device, and she picked cubicle) . . . but no one could remember even teaching her the word cubicle. Some probing the next day revealed that, oh yes, it was a deliberate selection (that story is here).

When a 6 year old who can't speak correctly uses the word cubicle, adults pay attention. When an AAC user uses sophisticated, appropriate vocabulary, it is a strong reminder that not being able to speak isn't indicative of decreased cognitive functioning. Sometimes, the best way that we can help the AAC users in our lives (whether they are your family members or children on your caseload) advocate for themselves is to make sure that they have a robust, colorful, extensive vocabulary. And there are at least three important reasons for this, as far as I can tell:

1. It's more motivating to use exciting words. Maya wasn't motivated to talk about which items were big and which were small when presented with a field of items . . . but she was interested in jumping in when we added giant, huge, enormous, tiny, and some others.

2.  A large vocabulary provides the user with a better likelihood of being able to say exactly what they want to say. A young AAC user could see a school bus drive by and think "That bus shines like the golden sun, roars like a lion, and speeds by like a racecar" . . . but without a large vocabulary, he may only be able to say "Bus yellow loud fast." (And honestly, I'm not sure I would even try to share my complicated thoughts if I could only produce "bus yellow loud fast.")

3. As mentioned above, communication partners are influenced by what they hear. If an AAC user is relegated to only using simple words, then their thoughts sound simple, no matter how amazing they might actually be. If teachers, therapists, and family are only hearing simple words, there is a subconscious lowering of the bar. A child who can say gigantic instead of big sounds like someone who needs more words, more opportunities, more conversation.

It's a cycle, right?

If an AAC user is given a lot of words, they can use a lot of words, which causes others to raise their expectations and presume competence . . . and then those communication partners will program more words.

The more I thought about this cycle, the more it felt exactly like one of those "If You Give A Mouse A Cookie" children's books . . . so I made an AAC themed book that follows that pattern. 

If you're interested in printing and sharing, it can be downloaded here.

(click to enlarge pictures)

For another great story about presuming competence and programming exciting words, check this out.

If you're interested in thesaurus style printable books to teach some interesting synonyms, this blogger has created some (one is free, the rest are for sale). If you have time to create some of your own, all you need is some time with and some clipart. (And if you do that, please email them to me! Not kidding.)

Wednesday, December 31, 2014

AAC Family Post: December!

Here are some photos from AAC families, near and far, in December---thanks to all of those who submitted pictures! The next AAC family post will be on the last day of January (2015!). Photos can be emailed to
5 year old Westin talking to Santa using Proloquo2Go!

From Lemmy's mom: "Lemmy (age 4) was talking to his Aunt Rita with the iPad using Speak for Yourself. He was talking about various toys and I (his mom) went and found them for him. He was really amused. I think he was enjoying me running around the house trying to find them."

Harry (3 years old) chatting while hanging up Christmas decorations in Australia!

 Harry uses the PODD pageset on the Compass app.

 Josh (6) at the park . . .

and feeding ducks!

 Isaac (5) uses TouchChat60 to talk to his mom. She said that winter break is a little too long for him!

 Wyatt greets Santa and wishes him a Merry Christmas! (You can read more about that meeting here.)

Cymbie heads out with her sister, Ainsley (3), and Speak for Yourself to see some friends on her 7th birthday!

 Mirabel, age 3 and lives in Ohio,  "helping" mom at work on a weekend with Speak for Yourself in her talker, a plate with donuts and Baby Signing Time on her DVD player. She is also signing eat in this picture!

Tom (using Speak for Yourself) joking around by spelling out the word "poo!" (Editor's note: Ha! Maya would totally do this.) 

E (3) and C (19 months) color together and use C's talker to discuss crayon colors. E already knows how to help C into babble and is gentle and playful about prompting use of C's talker. C is in her second week of using SFY!

"We have since added the keyguard to C's talker. She is sitting on Mommy's lap making jokes- calling Mommy the names of her therapists and giggling about the silliness!"

Joshua using his iPad mini with Speak for Yourself at the zoo!

From mom: "Carlos Andres, who uses a Tobii I12 with eye gaze. We've had a HUGe mount that is almost limiting, however, the table stand has finally arrived!! I kept the box in the picture! We are so thankful for "Tobii" he's become part of the family. ;)"

From mom: "Santa left a message for the kids on Felix's talker, obviously Speak For Yourself was pretty easy for him to learn. 'Thank you for the cookies, your (gingerbread) houses look great, love Santa.' "

Thursday, November 20, 2014

Communication Breakdowns & Repairs, with AAC

Although the phrases "communication breakdown" and "communication repair" may be new to you, the concept isn't. I guarantee you've experienced many of this situations, especially if you have children, or a spouse.

A communication breakdown happens when there's a disconnect between the sender of a message (the speaker) and its receiver (the listener).

Think about how often this happens in daily life--even for adults with normal hearing and typical speech skills (the ability to speak loudly, to clearly articulate sounds, etc). Maybe I take special notice of my own communication breakdowns because I hate repeating myself----but it happens pretty often. Now imagine how often it would happen if you couldn't speak clearly.

Listen to Maya speak in the video below. You may be able to guess what she's saying, but it's more likely that you won't. In the second loop of the video I provide context and captions---clues that serve to repair the breakdown, and everything becomes more clear.

 Maya's speaking life is more or less one big communication breakdown. I expect that this will shift, that as her articulation improves she will be more understood, but I also expect that the shift will happen slowly. Unfortunately, people are so eager to understand her speech, to validate and encouraging her speaking, that they often jump in, make assumptions, and kind of run her right over. She'll say "bug" and they'll reply "Bus? Yes, you rode a bus to school. Your bus is yellow, right? Do you like to ride the bus?" More unfortunately, when these breakdowns happen Maya tends to just stare blankly at her listener, or wanders away to something different. Rarely (very very rarely) does she take the initiative to stand her ground, to tell the listener they misunderstood, to try to get her point across. She doesn't try to repair the breakdown, she gives up.

This isn't unexpected, really. It's taken her a long time to speak at all, and if she tries and it doesn't work . . . well, then what? She's got a limited repertoire of speech sounds, and it's hard to think on your feet and come up with another way to more clearly express something that you couldn't say the first time. More than that, communication partners speak quickly, change topics quickly, and move on quickly. Life doesn't pause while you try to come up with another way to say "bug." She also has had a lifetime's worth of experience of not being able to keep up verbally. Frankly, I'm consistently impressed at her dogged pursuit of speech, and the amazing proliferation of speech and sound attempts that have occurred over the past 2 years. And, while sometimes she can use her talker to clarify what she's saying, sometimes the word (or sentence) she was saying just isn't there---or maybe she doesn't think to switch from speech to AAC.

And so, communication repair has become a huge target of ours. We are determined to empower her to become frustrated when people don't understand, to assert herself and say "No, that's wrong!", and then to draw on a variety of tools to help clarify and re-communicate her point.

Step One: Provide the Tools

I started by creating a page in Maya's talker (she uses the Speak for Yourself app) that can be easily used for communication repair. The ideas for the words and phrases on this page came from a variety of SLPs and AAC families, gathered primarily in a few FB groups. (A lot of these came from a great draft in the SFY user group.)

If you're an AAC person, there are two things to note. First, this page uses a fair number of phrases and sentences. In general, I like having one button per word, but I think that in times of communication breakdown an AAC user should be able to protest/redirect very quickly. Second, I have maximized the motor planning of a SFY user by stacking the buttons in the same location as things that they are related to on the primary page. For example, the phrase "slow down" is located in the same area (right column, fourth button down) as the word "down" on the primary page.

The information presented below, including the list of repair phrase and the color coding, can be downloaded and printed here.

Here is a master list of the phrases included on this page--since the buttons can only hold a certain number of characters, it's difficult to guess what they all mean. (The word in parentheses shows which location the word is under, when they are related.)

Top Row:
I don’t understand (I)
I understand.
okay (OKAY)
Ask me a yes or no question (ASK)
Put that word in my talker. (PUT)
I need help to find the word I want. (HELP)

Second Row:
You don’t understand (YOU)
Do you understand?
Are you listening to me? (ARE)
What do you mean? (WHAT)
I have no button for that. (NO)

Third Row:
Something from the past.
Something from today. (TIME)
Something in the future.
I have a question. (HAVE)
I give up. (UP)

Fourth Row:
That’s not what I said. (NOT)
the opposite of
Slow down. (DOWN)

Fifth Row:
It starts with
I will spell it
I will give you a clue (THINK)
This person is a clue
This place is a clue
You aren’t close
You’re getting closer
You’re very close
You got it!
Start over

Sixth Row:
It rhymes with
I changed my mind (KNOW)
I’m talking about (TALK)
That’s not right (RIGHT)
I’ll tell you how close you are.
Try to guess (TRY)
Can you say it again? (AGAIN)
Seventh Row:
It sounds like
This is frustrating (FEEL)
Listen to me! (HEAR)
I want to tell you something (TELL)
A question
An idea (SLEEP)
A place (THAT)
A thing (THIS)
A person (FRIEND)
An action (WALK)
A feeling
An event (WHICH)

Bottom Row:
It’s important
It’s not important
Never mind
I need a new word (NEED)
Wait! I have something to tell you. (STOP)
Be patient with me (BE)

The color coding is as follows: 
Orange= the most important buttons I want her to use (kind of assertive buttons)
Blue = questions
Bright yellow = strategies
Greyish purple = hints 
Peach= things that I wanted to look like a clump
White = everything else

Step Two: Teach the skill
This is clearly the more difficult step. How do we get her invested? We've learned that she is much more likely to use a new communication skill if she's had the opportunity to practice it . . . but it's difficult to practice repair. If you're the listener, it's hard to model how she should give clues (and sometimes it's hard to realize you've misunderstood in the first place). If you try to create fake misunderstanding scenarios, it's a gamble whether the AAC user will play along. And the idea has to be explained, too . . . "hey, if I don't understand you you should tell me to stop, ok?"

Enter one of our awesome speech therapists, who created a fantastic social story to introduce the idea of communication repair. The book starts by giving voice to the frustration of a communication breakdown, then moves on to lay out the two important parts of communication repair: stop the listener and let them know a breakdown has occurred, then try to use other tools to relay your point.

Here's what the book looks like:

Maya wanted to be dancing in this picture :)

The entire book can be downloaded here (as a PowerPoint file) and can be modified with your own photos or screenshots.

The book was introduced featuring one strategy from her communication repair page, "It starts with . . . ". This is a great technique for Maya, and one that she used spontaneously in the past, but she never had a button to basically say "now I'm going to tell you the first letter." New pages will be added to the book as different strategies are introduced and practiced during speech sessions. I'm going to send a copy into school and have shared it with our other therapists, so that they know what we are working on and can be mindful of potential communication breakdown and our repair strategies.

I hope that this page will help Maya become a more assertive communication partner. She has the right to be understood, and she has the right to say "Hey! You're not correct! Stop talking and listen to me!" Now it's our job to make sure that she has enough practice with it that it will jump to mind when a breakdown occurs, and that she feels like it's worth her time and effort to work through the repair process.

Friday, October 31, 2014

#AACfamily Friday: The end! (for now)

Thank you to the families who sent in pictures of their AAC users this week! (I didn't even manage to get a picture this week.) I have loved seeing, and sharing, photos of AAC users and their families/teachers/therapists. I am going to continue with the AAC Family posts throughout the year on the last Friday of each month---so feel free to email them my way ( at any time.

Without further ado . . .

 This is Charlie from Nottingham, UK, showing off his skills using his new Talker with the PODD app . . . 

even on horseback!

 This is Lily Grace, age 5, checking out the sea otters at the aquarium with her papa. Lily Grace uses a PODD book.

 This photo is a selfie of Alyssa Hillary (22), of Yes, That Too with laptop showing desktop and text to speech app. The speakers aren't really showing up (off to the side) but the set-up is a Windows 8 machine with eSpeak and Logitech speakers, for part-time AAC use by a graduate student and TA (that'd be Alyssa, taker of picture and person in the picture).

Joshua, 5 years old, using Speak for Yourself.

Hosea (4) using Speak for Yourself at a pumpkin patch in Florida.

Mirabel, age 3, getting a treat after her audiology appointment. Two modes of communication . . . saying "donut" on the talker followed by signing "please" . . .one very clear request! 
(Which was promptly rewarded!)

Lemmy in Virginia using SFY on his iPad! He's just starting out and still a bit excited (as you can see from that blurry hand haha). He's exploring babble with his mom.
Lemmy has CVI, so his buttons are rainbow colored with high contrast black and white icons.

Felix showing off his talker with its new red cover!

Less than a year ago, Harry (now 3) used a 20 location PODD book to announce his mom's pregnancy on Facebook . . . 

and now he's using the 60 location PODD pageset on an iPad (on the Compass app) to chat while his newborn sister sleeps! (Congratulations on becoming a big brother, Harry!)