Go with AAC: Everything Has A Name - Ep. 022
Tune in to hear our third and final podcast in our Ready, Set, Go! series on AAC. I’ve put together a basic communication checklist to help track the foundational skills early communicators need.
---- Links ----
Communication Basics Checklist is located in the Free Resource Library.
Episode 16: Choose Your Hard
Episode 20: Ready, Set, Go! With AAC
Episode 21: Get Set With AAC: Mythbusting
Susan Berkowitz Website
AAC Core Words on TPT
Reading With Core Words (stars at minute 2:24 in video)
Music: Simple Gifts performed by Ted Yoder, used with permission
Transcript
Dan: Welcome back to The Mindful SLP, the show that explores simple but powerful therapy techniques for optimal outcomes. I'm Dan, here with my co-host Denise Stratton, and today we are finishing our three part series on AAC. Denise, would you please briefly describe what we covered? The last two AAC episodes.
Denise: Sure, and I'm calling the whole series Ready, Set, Go with AAC because I have seen clients be successful with AAC use as they move through a skill set. So in the first podcast on AAC, that I'm calling the Ready podcast, we talked about helping clients understand how to choose and how to plan. And in the second Get Set podcast, we did some myth-busting around AAC.
Dan: Which brings us to today's topic, Go, because everything has a name. What do you mean by everything has a name?
Denise: Well, most of you listeners are probably familiar with the story about Helen Keller and the day she connected water running over her hand with the word water. And that was a new beginning for her. She called it the day I learned everything had a name, which I just love. Prior to that day, she was pretty good at imitating words that Anne Sullivan taught her, but Anne knew she really hadn't caught on to the idea of language and how individual words are used.
Well, after Helen learned water, she ran around the house, touching everything and asking for its name. She was unstoppable after that day in her thirst for language. So I think go is the appropriate word for the stage because I've seen clients reach that stage where they really, really get it.
Dan: I think that's probably the dream of every speech therapist to have a client that makes that leap.
Denise: And I don't have a story exactly like Helen, I mean, who does? Her story's amazing, but here's my story about a boy I'm going to call Brian. He had autism and he was nearly non-verbal when he started with me and he didn't have an AAC device. We were using Velcroed pictures for low tech AAC while I did lots of planning and choosing activities with him.
And I was educating his family about AAC and he had made good progress and he was putting three and four picture symbols together. That's a lot of pictures and the day I knew he was in the Go stage, it was when he lunged over my lap to grab a specific picture off of a clipboard because no other picture would do. He knew its name, he knew what it meant, and that's the picture he had to have. And it really impressed me because I had a lot of pictures out. He was so motivated. And that was a little like Anne Sullivan's day with Helen at the well, and let me tell you, he got his electronic AAC device soon after that, and was I ever glad.
Dan: That is such a gratifying story, I know from our year end book review podcast, number 16, just how much you admire Anne Sullivan and what a wonderful advance forward AAC devices have been for this world. Has AAC always been something you've enjoyed working with?
Denise: No way. If you would ask me a couple of years ago, if I would be doing a podcast on AAC in my wildest dreams, I would have said no way.
My success with AAC clients is really recent. And I even used to turn parents away from our private clinic who had a child with AAC because I didn't think I could serve them well.
Dan: What's changed?
Denise: What changed is I found a way to take clients from random button pushing picture symbol touching, to deliberate, independent, thoughtful word choices.
So I always think that if I'm having a particular problem, even after years of working in the field, well, maybe there's another SLP out there who's having that same particular problem. So if I find a way through it, I want to share it. And so even though a part of me says, this is kind of presumptuous, Denise, to do three podcasts on AAC, the other part of me says, well, if it helps someone it's worth it. Yeah. And also, I just know from experience, since I've had my private clinic, it's not uncommon to have families give up on AAC, like we talked about in the last two podcasts. I still have a lot to learn about AAC, but now I know I can make progress.
The day I described with Brian lunging over my lap to grab a picture, that's the kind of engagement and awareness of how to use picture symbols that I've been waiting my whole career to see.
Dan: So what do you want to share with us in this podcast?
Denise: There's three things I want to share. Lots of resources for families and SLPs, a checklist of sorts for clients who are beginning to use AAC, and my takeaway. But actually I said that in reverse order, because I want to start with my takeaway.
Dan: All right, well, let's do a countdown to launching with AAC. Here we go, number three.
Denise: It almost seems too simple, but better communicators make better AAC users. So don't lose sight of the basics of communication.
Dan: What are the basics?
Denise: Okay. This leads right into my checklist of nine things to remember. So therapist, consistent joint attention. You might have joint attention with something highly motivating, like bubbles, but you need joint attention and lots of different activities. If you don't have someone's attention, are they really learning?
Dan: What do you mean by joint attention? I mean, I'm, my joints are hurting today because it's raining outside.
Denise: Well, these therapists are familiar with it, but it's when you are both attending to the same thing, and your eyes meet their eyes and your eyes look at the object and you look back at the person. So it's looking back and forth at each other and whatever you're doing, that's joint attention.
Dan: So it's gotta be you and the client, not just the client. Okay. Good. Number two.
Denise: Teach them to choose. As we talked about in the Get Ready podcast, and I've got this great puzzle pointing activity that you can go to my simple tools video and watch, I'm going to show you one thing I do that teaches them to choose and point.
Dan: Number three.
Denise: After they can choose, teach them to plan. Now that's a little bit harder. It's basically multi-step choosing to meet a goal.
Dan: Give me an example of planning.
Denise: Well, one thing I love to do is a very simple tinker toy model. It's a fan and it's got very few pieces. But what I do with it is I take pictures with my iPad of just two pieces and then the next two pieces that I would anticipate them using.
And then I think there's two more and I just show them the pictures on the iPad and have them point to the piece they want. And if they point to the piece they already have, I may have already given them, then there's a, what you call cognitive dissonance or kind of like, I'm like, no, you already have that.
And they have to think, oh, And plan about what piece they really need. So I love doing things like that for planning.
Dan: Does that work well with Legos as well? Or is that too generic?
Denise: Um, Legos are a little bit harder there. The shapes are almost all exactly the same rectangles. You know, I really like it with the tinker toys.
Dan: Okay. Number four.
Denise: Turn-taking with eye contact. Now, you've got some joint attention going here too, but I really love to do some turn-taking with ABCs. And a lot of the kids I have who use AAC are on the spectrum and they love their ABCs, the kids on the spectrum. So there's a couple of things I do with the alphabet that they just really get into, very simple, and you wouldn't think it'd be so motivating, but it is. I have these chalkboards in my room that are child height. So we'll take some colored chalk and I'll write A, I'll hold the piece of chalk out to them. I'm standing right next to them, we're next to each other. I wait until they get eye contact with me.
I hand them the piece of chalk. They write B. I hold my hand out and I just wait until they hand it back to me. Sometimes I have to kind of move my body around so that, yes, you're still looking at me. We're still in this together. Maybe a gentle touch. I don't ever manhandle them, but, and I'll pat my hand, you know, and then they hand the chalk to me and I'll say thank you.
The point is we're making eye contact. Every single time we go back and forth and some kids are so motivated to get those ABCs written that they'll stay with you. So we're getting this joint activity, joint attention turn-taking going. And the other thing I do with ABCs is I have some ABC stencils and we'll just lay them out in a row order of the alphabet and I'll have a stack in front of me, of all of them. Um, I'll put down the A, no, I don't put it down. They have to hand it to me. I'll have to hand them the same thing with the chalk. So maybe I should make a simple video. This is kind of hard to explain, but we pass them back and forth. They have to hand me the letter and make eye contact. I have to hand them their letter and we lay it out in a row.
And what was so amazing. I had one kid I was doing this with, and we were in the middle of the alphabet, you know, like around J or something, and all of a sudden he just stopped and he looked at me. And he just stared at me for the longest time. And it wasn't to get the letter or to give me the letter. It was just to make contact with me, and when you see these kids do this, it's kind of like they're drinking you in. It's really amazing. They're all of a sudden understanding this whole eye contact body language thing. And they just, they just stare at you.
Dan: That's great. That's cool. All right. Number five, accomplishing something together.
Denise: So again, really great for kids on the spectrum.
They're so into their own worlds sometimes. They have a toy and they don't want to engage with you. They just want to go off in the corner with their toy. So I have some toys that snap together. I have some cows where there's a head and a tail and you have to snap them together. I have some Popsicle molds where the top of the Popsicle goes on it.
I take one part, they take the other part. We have to accomplish this together. I'm holding one part, they're holding, the other part, I move my part towards their part. We have to be watching each other and accomplish it together.
Dan: Number six.
Denise: Sometimes you don't need words. Silent eye contact communication is really powerful. It can be really sophisticated. You don't always need to be thinking about the device or the words, just like I said, really looking at each other, drinking each other in. Just remember that.
Dan: Number seven.
Denise: Keep your activity simple. You can always increase complexity. It always surprises me how much better I do when I keep things really, really simple.
Dan: Number eight, do lots of symbolic play.
Denise: So language is symbolic. Early childhood is all about developing symbolism. And so just remember with your clients, I've had this happen to me when we're really focused on getting them to learn how to use the AAC device that they need to be growing in all areas of language.
So they need to develop the symbolic language to symbolic play. That's really important. And again, start really, really simple. I have a food set, but am I going to bring out all my 20 different kinds of food and all my puppets and everything? No, no. Um, when I'm starting, maybe we'll just pretending to eat one play pretend food ourselves, or maybe we have one stuffed animal out, something like that. You start really simple.
Dan: Number nine, always look at the whole child.
Denise: Just like I talked about last week with Kelsey, is this AAC system the best one for them consider their vision, their motor, their cognitive, their sensory, just always be looking at the whole child.
Dan: I know, that's gotta be a bit of a reminder that you need to do because you get in the heat of therapy and sometimes your focus narrows.
Denise: Yeah. It's just natural because we have these goals. We've written things we need to meet. We just always have to remind yourself to step back and observe.
Dan: So this is a really long list of things to remember. So we're going to have this in a PDF for you, and we're going to add it to our toolbox. So you need to go to SLP proadvisor.com/free, right now to sign up for our free resource library. You'll find this and many other free resources that Denise has developed to help you in your therapy. It's always growing with new resources. So you'll want to check back often. That's SLP, proadvisor.com/free. And if this sounds like an advertisement, it may sound like an advertisement, but since it's free, why not? All it costs is your email address so that we can just keep you aware of what's going on. And when there's something new in the resource library.
Denise: So that's my checklist and all of the above can apply to any beginning language learners. And our AAC users are often beginning language learners, but here are some fantastic resources specific to AAC. And by the way, I'll link all of those in the show notes. Susan Berkowitz, who wrote the book, Make the Connection that we talked about last week, she has a PDF step-by-step guide to using aided language stimulation. So aided language stimulation is how to use the AAC device to communicate with the individual all the time in real life situations.
And I joined her resource library and got it for free, so I'll link to that too.
Dan: The show notes are always located at SLP proadvisor.com/blog/ 22. For this episode.
Denise: One of Susan's suggestions on that step-by-step guide to aided language stimulation I absolutely love. To make words easier to find with a paper system, you can use highlighters to just draw their attention to that target picture you're wanting them to find. Um, and with electronic devices, there's things like changing button colors or border colors. That is an idea I'd never thought of, and I thought that is so awesome. Also on Susan Berkowitz's teachers pay teachers store, I just download an AAC core word. It's Teach Me Six Core Words. So you got a beginning AAC user, she's got six core words though, she's got activities to do it. And what I absolutely love in that download. She talks about errorless learning.
Dan: Oh, that's one of your favorites. Tell us about errorless learning.
Denise: I love errorless learning. I use it in my Impossible R Made Possible course, but it's all about minimizing errors. Because whatever we do tends to get stuck in our brains. So lots of errors equals lots of times of that action being repeated, even though it's an error. So for AAC users, it's providing an immediate model of the target word, whatever you're doing, you model immediately with no time delay, and then you gradually increase the time delay and as the client becomes more capable, they don't need your immediate model, but if they make mistakes, you can immediately go back to decreasing your time delay. So you're just teaching them to learn, to choose the target pictures independently without those errors. Oh, and by the way, she's also got a data sheet that goes with that so you can track their progress with a time delay, errorless learning.
Dan: Okay. Getting back to Susan Berkowitz's core words. Tell me what are the core words where clients should start,
Denise: I love the whole idea of core words. So toddlers have twenty-five words about that make up 95% of what they say. Wow. So they're really functional. I mean, think about this. If you could only use 25 words, which words would you use?
Dan: Probably water, food, blankets, toys. I'm thinking like a little kid here. And of course my favorite ice cream cookie.
Denise: Guess what? That's really not the words that toddlers use.
Dan: Really? What do they use?
Denise: Cause you chose lots and lots of nouns. Yeah. More. Go. Me. You. Want. It. That.
Dan: Well, my toddlers are now 26 years old. So that's probably why.
Denise: So just think about what you can do with those kinds of words that I just demonstrated for you. I kind of set you up for that because that's what we tend to think, oh, let's give them all these nouns, but they're not as functional as these other kinds of words. So core words, some of them are a little bit more abstract to picture. Nouns are really easy to have a picture there, but they're super, super important. So with these core words, which is really important, it makes sense to teach those first because that's how normal toddlers develop and they need less words to get a lot done.
And there are tons and tons of resources out there, but I'm going to link one. I like Gail van Tottenhove. I hope I said that correctly, has a list. So I'm going to link that list of the core words she's got, like the first 10, and then the first 25, and the first 50. So I really like that. Also there's a website called Practical AAC and it has tons of information on blogs, but one blog I really like, it shows how to build a core vocabulary board that will last.
Imagine if someone only had six core words and like okay, I'm putting these all together right next to each other and they learn those six and you got to add more in, right. Are you going to rearrange your pictures to make room? Cause now you want...
Dan: That would be logical, but is that the right thing to do?
Denise: No, cause imagine if you had to rearrange your apps on your phone every time you added a new app.
Dan: Yeah. It would drive me crazy.
Denise: What you do is you have blank spaces where you know, where you anticipate words are going to go.
Dan: Oh, so when you're making that board, you space them out a little bit further.
Denise: And they're organized according to key. So there's a thing called the Fitzgerald key and it's got color coding for the types of words. Pronouns have one kind of color coding, verbs have another, and the nouns have another. Prepositions another, but they all stay in the same area. Everything of one color stays in the same area. So that's really, really cool. And that's why movable pictures aren't great. Even though in my story about Brian, we were using movable pictures because that was what I was able to do at that time. And what I knew that it's so much better to have a static pictures, a core word board where the pictures are in the same area.
Dan: I'm gonna go reorganize my iPhone now so that I can have space for future once I like that.
Denise: Okay. And last but not least. I love, love, love this idea. So I've always had this sort of conundrum in my mind that you need to model, model, model, lots of receptive vocabulary to these AAC users, but they have a limited number on their board because like maybe they can only handle having six.
So how are you going to model lots and lots of vocabulary for them to learn receptively when expressively they camp too many on their board? I know, I saw this YouTube video. I thought this is so wonderful. So, um, this therapist had her big core word board, maybe 25 words, maybe 30. I can't remember, but, and it was like this big poster board that she was holding up and she had a book, I think it was Go, Dog, Go. And she showed how you could read the book and she just read it while she used all these core words on her board. Here I am, you can't see me, I'm pointing, pretending that I have this board, but it's a great YouTube video and I'm going to link that and SLPs, so once you see that, you'll be like, oh, there we go. Light goes on and families too. You can totally do this. You can read books to the child using a board, just to show them, not the board that they're going to use. If they have, are still working on a limited number of words.
Dan: But you can have your board, which is going to eventually influence them to adopt those words into their board. I liked that.
Denise: Yeah. So it's the best idea. And I didn't even see it until last year. So now I want to conclude with a 'rest of the story' tale. In the first AAC podcast, I mentioned two mothers who had given up on AAC and they told me, I just know what they need. You remember? I was talking about that. Well, one of those clients was Kelsey, who we talked about in the Get Set podcast, and after looking at the whole child, we discovered she just needed a device where she could use her head rather than her hands. And after that, her mother was all in, her mother was like, whatever body part she can use, I don't care. We're doing this. Well, the other mother who told me, I just know what he needs, well, she actually called me later to see if I had room on my caseload, but I didn't. I had to put him on the waiting list. Well, I just found out that they continued to search for a speech therapist, they got a grant, they found a great place for speech therapy. And that makes me so happy for them, because I really think that it was some of my myth busting in that conversation with that mom that started her thinking about trying again.
So even if you aren't in a situation to work with AAC, you can always be an advocate for these children by sharing what you know, and busting a few of those myths.
Dan: That's great. What are some of the key things you want every SLP generalist to know about AAC?
Denise: The recipe isn't that hard after all. Although it may take a long time, depending on the client, build the basics of communication while you use aided language stimulation and errorless learning to teach core vocabulary. That's it, when you master the simple, the complex takes care of itself.
Thank you for listening to the mindful SLP. We hope you found some simple tools that will help optimal outcomes in your practice. This podcast is sponsored by SLP pro-advisor. Visit SLP proadvisor.com for more tools, including Impossible R Made Possible, my highly effective course for teaching those troublesome Rs. A link is in the show notes at SLP pro-advisor dot com slash blog slash 22.
And if you enjoyed this podcast, please give us a five-star rating and tell your fellow SLPs, and let us know what you think. Join the conversation at slpproadvisor.com.
