Once a team has determined the tasks/skills within communication that are needed to be changed to allow the student to become a more independent communicator, you need to determine what system to use. I have attended AAC trainings on many different systems and after every training, I leave thinking that if I am not using X system for every student, then I am doing things wrong and not supporting the student. NEWS FLASH- there is no one system that works for every child. If there was, we would be using it. Once I accepted that just like me, students have preferences and different learning/communication styles, it allowed me to look at the child first in picking a system, instead of picking a system and then trying to make it work for the child.
In my years working with students who use AAC, I have found that while there are no prerequisite skills for using AAC, there are some foundational language needs for different systems. That being said, you should ALWAYS try a system with a student. This could be low-tech paper options, a communication book, a dynamic display device, or a combination of all of these. I am going to say something that may be unpopular in the AAC community, but for a dynamic system to be the right fit, the person needs to have initiation of communication, persistence in communication, and the understanding that communication is between at least two people. If the person does not have these, then you can put the most expensive high-tech system in place and it will not be used. However, if you take the time to teach these communication foundations (with a system), then when you put a dynamic system in place you will see much better communication results.
These foundational communication needs may be seen in many different ways. When working with parents, teachers, or others involved in the evaluation ask these questions:
- How does the student let you know they want something?
- If the student does not get what they want what does that look like? Do they try to let you know again, try a different way, or just stop after one try?
- How does the student engage with others, what does this look like?
Answers to these questions will let you know if the student has these pillars of communication. Very often they do, they just may look non-traditional. It could be a child grabbing a person’s hand to take them to the refrigerator. Right there you have hit all three skills- initiation, persistence, and communication between two people. There are times however when a student does not have these skills or does not use them consistently. When that happens you do need to teach the skills because without them communication progress may not happen and all involved are likely to get frustrated. You don’t want just to assume that the individual will learn them on their own.
I have found that PECS (Picture Exchange Communication System by Pyramid Learning) is a great tool to teach or strengthen these communication foundations. PECS is specific in the way you teach each of these skills, it is not just about having pictures in a book and the student handing them to you. It is about strategies that teach initiation, persistence, and communication with another person. What I found is that once these foundations were well established, the student often needed to move to a dynamic communication system such as a speech-generating device. However, there are some students for which PECS is the best long-term communication system.
When I first learned about PODD (Pragmatic Organizational Dynamic Display by Gayle Porter) books, I felt I had found the missing link to AAC systems. For years I felt that there was a need for an in-between for students who had moved past the language capabilities of PECS and still needed the kinesthetic aspect of a book. Before I found the PODD books, I wondered if some students needed to be able to physically change the pages themselves instead of just selecting a button and having the page changed. The layout of PODD books with the pragmatic branch starters made my SLP heart so happy. There were so many language options and ways to expand language with the PODD. For students who see themselves as verbal communicators, and try to talk as their initial mode of communication, PODD is a good option. It allows the student to clarify by using the pictures and I have found that it can assist in clarity of speech when the student sees the picture that represents the word. PODD is also a system that I have seen work for students who are very visual and learn well from repetition.
Speech generating devices/ dynamic display systems seem to fall into two categories. While most systems are now using core-based vocabulary, there are specific differences between systems that have pre-stored messages and those that use motor planning/ icon word sequencing.
Systems that use pre-stored messages, have a stronger category base to them. Some examples are ProLoQuo2Go by AssistiveWare, TD Snap by Tobii/DynaVox, AAC Coughdrop, and TouchChat with WordPower by Saltillo. Some of these systems can have buttons with entire messages in them which can be great for curriculum-based activities and for students who are gestalt language processors. You have flexibility in setting up these systems with the vocabulary of your choice. These systems also can allow for the creation of sentences by putting words together and then selecting the message window. Over the past few years, these systems have been incorporating more motor planning and core words located in familiar locations on the screen.
Another type of dynamic display system is one that uses motor planning with icon/word sequencing. The most common of these systems are LAMP Words for Life and Unity both by Prentke Romich. The idea behind these systems is that like in speech, you need to learn patterns for words. That the word “orange” is the same word regardless if you are talking about a color or a fruit; it is the context that gives it meaning. The motor pattern to say the word “orange” is the same regardless of the context. These systems have a single word attached to each motor pattern. There is a strong focus on core words that can be used together regardless of the topic. Very little customizing is needed in these systems. At first, these systems can be very confusing for the adults in a child’s life, but if the adults take the time to learn the rationale behind the icons and learn the sequences, you see the lightbulb go off. Both LAMP and Unity have a built-in word finder that can be used to search for a word and learn the motor pattern for the word. Literacy is strongly supported with these systems because you put the words together to make a sentence and don’t have any pre-stored messages within one button.
Everyone needs a communication system regardless of which system is selected. By beginning an evaluation with the SETT, the team will be able to identify the tasks or skills to focus on with data collection and then identify what features are needed from a system to give that individual the tools they need to become an independent communicator. Through a trial with a device, or multiple devices, data will indicate which system best meets the needs of the person. For assistance with an AAC evaluation or training for your staff on doing an AAC evaluation, please feel free to reach out (pbuckingham.kansas@gmail.com), I would love to work with you.
Buckingham Educational Services & Training, LLC 