Incorporating AAC to get the best from your learners
Individuals with Autism Spectrum Disorder (ASD) often struggle with communication. Just like ASD itself, communication skills fall on a spectrum, ranging from children who do not acquire speech and require alternative and augmentative communication (AAC) to those who speak well and may not appear to have a disorder at all.
For children who require AAC, tablets have become a huge asset. Prior to the advent of tablets, AAC devices were clunky, heavy, costly and often not very user-friendly. Now that tablets are accessible for many individuals who require them to communicate, parents and practitioners find themselves asking a whole new host of questions: Where do you begin? What is evidence-based practice when using a communication app? How do you help your learner acquire functional communication?
Where Do You Begin?
Many parents and teachers I work with are concerned about implementing AAC. They worry that it means they’re giving up on the child ever speaking or that it might discourage them from speaking. It’s very important to recognize that the main goal is for the child to be able to functionally communicate.
Often when I start working with a child who is not speaking, they have ways of communicating their wants and needs. They may pull a parent’s shirt, then guide them towards a cabinet and wait patiently while the parent guesses several items they might want. This is not functional and it’s definitely not efficient. Other times I walk in and the child communicates through tantrums.
Once the goal of communication is your focus, the next objective is to teach the child the benefits of communicating, so you should start with items and activities that are the most motivating for your individual learner. Perhaps your child loves bubbles, apples and the trampoline more than any other items available – the first language targets you will present would be these three things.
Many parents and practitioners begin with language targets that are beneficial in the environment, such as greetings. This does not lay the foundation for the child to be motivated to communicate more in the future, however. Starting with what the child is motivated with teaches them the utility of communicating. Once they have lots of practice with this, you can begin to introduce other targets.
Unfortunately, research into the use of communication apps is still relatively scant.1 Many of the evidence-based practices are modified from the large body of evidence from Picture Exchange Communication Systems (PECS) and devices that predate tablets, such as the Dynavox, Quality research into the use of tablets for AAC is beginning to be published, though.
Recently 15 studies in which a tablet or smartphone was used to teach communication skills to individuals with autism and other developmental disabilities were reviewed.2 The reviews found that tablet-based systems were not only effective in teaching communication skills to individuals with developmental disabilities, but that several individuals used them to communicate in novel contexts – an example being an app like SuperSpeak.
They also found that the use of tablets to teach communication skills was often preferred by individuals with developmental disabilities, as well as more efficient in teaching communication skills in fewer sessions. It is important to note the need for more research, however.
The findings stated that the teaching strategies varied from study to study. And another group of researchers found that there were individual differences in the rates of acquisition based on the display and design elements of the app on the tablet,3 suggesting that individual differences must be accounted for.
When implementing an AAC device for any learner, you must assess how they best learn. Have they learned other skills through modeling? Do they follow one-step directions well? Do they respond well to physical prompts? Answering these questions should inform your instructional strategy for teaching learners how to communicate.
Acquiring Functional Communication
In light of the dearth of research in this area, it may be a bit intimidating to implement AAC.
As mentioned, it’s best to start with what is most motivating for a learner. It bears repeating that the goal is to teach functional communication and to motivate the learner to communicate with greater frequency.
Finally, take data and let it guide the decisions you make in teaching functional communication skills. You should look at how many sessions or how many trials it takes before your learner is independently using a new word, as well as how the rate of acquisition changes over time. Hopefully, once your learner has figured how to request a few items using the device, acquisition time will decrease with new language targets.
In the end, the key is to tailor your instructional strategies to specific learners.
Sam Blanco is an applied behavior analyst at Superplus, a provider of augmented and alternative communication tools. The company’s app SuperSpeak uses gaming world strategies, clinical research and practical teaching to facilitate communication between children with special needs and their parents, caregivers and therapists. Sam loves incorporating games and technology into her practice and is dedicated to sharing resources with parents and educators. Follow her on on Twitter and read more about Superplus here.