MODULE IV
FOR TEACHERS

Foundations of Augmentative and Alternative Communication (AAC)

Augmentative and Alternative Communication technique for Inclusion (AAC-Inclusion)

1. Monitoring Progress in AAC

Monitoring progress in augmentative and alternative communication (AAC) is a key element of the therapeutic process. It makes it possible to assess the effectiveness of the methods used, adjust therapeutic goals and make decisions about modifying the communication system. Regular progress analysis also helps determine whether the implemented solutions genuinely increase the user’s communicative independence and improve their quality of life.

1.1. Objectives of Progress Monitoring

The main purpose of monitoring is to determine whether the AAC user is developing their communication competences and whether the AAC system meets their current needs. Progress assessment makes it possible to:

·       track the development of communication skills,

·       identify the user’s strengths,

·       detect areas requiring additional support,

·       assess the effectiveness of therapeutic strategies,

·       plan the next stages of therapy,

·       document the outcomes of educational and therapeutic interventions.

Monitoring should be a continuous process carried out by all members of the team supporting the AAC user, including the family, teachers, therapists and other specialists.

Areas to Be Monitored

a) Frequency and Spontaneity of Communication

One of the basic indicators of progress is the number of communication attempts. Attention should be paid to:

·       the frequency of using the AAC system,

·       the number of initiated interactions,

·       spontaneous communication without prompting from the environment,

·       communication undertaken in response to questions or instructions,

·       the time needed to begin a message.

An increase in spontaneous initiations often indicates a growing understanding of the function of communication and greater confidence on the part of the user.

b) Communication Functions

Communication is not limited only to expressing requests. An effective AAC user should gradually develop a range of communication functions, such as:

·       requesting objects or actions,

·       refusing and expressing disagreement,

·       making choices,

·       commenting on events,

·       asking questions,

·       expressing emotions and opinions,

·       conducting social conversation,

·       providing information.

In practice, it is often observed that people beginning to use AAC first learn to request, while a more advanced goal is the development of social and conversational communication.

c) Vocabulary Development

An important indicator of progress is the expansion of the range of words and symbols used by the user. Monitoring includes:

·       the number of symbols used,

·       the diversity of vocabulary,

·       the frequency of using new words,

·       the ability to use vocabulary in different situations,

·       the use of core and topic-based vocabulary.

It is worth paying attention not only to the number of words, but also to their functionality and usefulness in everyday life.

d) Building Messages

As communication skills develop, the user should move from single symbols to more complex utterances. The following should be monitored:

·       message length,

·       the number of words in an utterance,

·       syntactic correctness,

·       combining symbols into sentences,

·       using different parts of speech,

·       the ability to talk about events.

For example, the user may progress from the message “drink” to a more developed message such as “I want to drink juice.”

e) Independence in Using AAC

Assessing independence makes it possible to determine the user’s level of autonomy during communication. The analysis includes:

·       the need for prompts,

·       the type of support required (verbal, gestural or physical),

·       the ability to find symbols,

·       independent navigation between pages of a device,

·       ensuring that the AAC system is accessible.

A decreasing level of support is one of the most important indicators of therapy effectiveness.

f) Effectiveness of Communication

It is crucial to assess whether the user’s messages are understandable and lead to achieving the intended goal. In this area, the following are monitored:

·       the percentage of messages correctly interpreted by communication partners,

·       the number of misunderstandings,

·       the effectiveness of meeting the user’s needs,

·       satisfaction with communication,

·       the ability to repair communication breakdowns.

g) Social Participation

Contemporary approaches to AAC emphasize the importance of participation in social life. Therefore, it is necessary to observe:

·       activity during educational activities,

·       participation in family conversations,

·       contact with peers,

·       participation in play,

·       engagement in social events,

·       building and maintaining relationships.

The ultimate goal of AAC is not merely the use of symbols, but increasing the person’s participation in social life and improving the quality of their functioning.

1.2. Methods of Monitoring Progress

a) Systematic Observation

The most commonly used method is observing the user during everyday activities. Observation should be carried out in different environments, such as home, school, kindergarten or the therapy room.

b) Observation Sheets

Observation sheets make it possible to record specific communication behaviours, for example:

·       the number of initiations,

·       the type of messages used,

·       the level of support,

·       the effectiveness of the message.

c) Communication Logs

Parents, teachers or therapists can keep notes about important achievements, difficulties and new skills that appear in everyday functioning.

d) Video Recordings

Recordings allow for a detailed analysis of communication behaviours and comparison of the user’s functioning across different periods of therapy.

e) Analysis of Data from AAC Devices

Modern communication devices often make it possible to collect data on:

·       the number of symbol activations,

·       the most frequently used vocabulary,

·       the length of messages,

·       the time spent using the device.

1.3. Documenting Progress

Documentation should include:

·       therapeutic goals,

·       support strategies used,

·       observation results,

·       a description of the skills achieved,

·       recommendations for further work.

A sample record may look as follows:

1.4. Difficulties in Monitoring

Certain challenges may arise during progress assessment:

·       differences in the user’s functioning depending on the situation,

·       the impact of fatigue, health or emotions,

·       the lack of uniform assessment criteria,

·       limited cooperation among team members,

·       focusing only on the technical aspects of AAC.

Therefore, monitoring should take into account both quantitative data (e.g. the number of messages) and qualitative data (e.g. communication effectiveness and social participation).

Summary

Monitoring progress in AAC is a process of systematically collecting and analysing information about the development of the user’s communication competences. It includes assessing communication frequency, communication functions, vocabulary development, independence, message effectiveness and the level of social participation. Regular evaluation makes it possible to adapt therapeutic goals to the user’s needs, increase the effectiveness of support and provide conditions that foster communication development and fuller participation in social life.

2. Cooperation Between Parents and Therapists in AAC

Cooperation between parents and therapists is one of the most important factors affecting the effectiveness of augmentative and alternative communication (AAC). Even the best selected communication system will not bring the expected results if the actions undertaken by specialists are not continued and supported in the home environment. Parents, in turn, need appropriate support, knowledge and guidance in order to effectively help their child develop communication competences. For this reason, AAC is based on partnership cooperation among all people involved in the user’s life.

2.1. The Importance of Cooperation Between Parents and Therapists

A child using AAC learns communication not only during therapy sessions, but above all in everyday life situations. Parents are the people who spend the most time with the child, observe their needs, interests and ways of expressing emotions. Therapists, on the other hand, have specialist knowledge of communication development, therapeutic methods and the selection of appropriate AAC tools.

Combining parents’ experience with specialists’ competences makes it possible to create a coherent support system that enables the child to develop communication skills in different environments and situations.

2.2. The Role of Parents in the AAC Process

Parents perform many important functions in the process of implementing and developing AAC. Their most important tasks include:

·       ensuring daily access to the AAC system,

·       encouraging the child to communicate,

·       creating natural opportunities to use AAC,

·       modelling the use of symbols and communication devices,

·       observing the child’s progress and difficulties,

·       providing information to the therapist,

·       emotionally supporting the child while learning new skills.

Parents are also the best source of information about the child’s preferences, interests, daily needs and the situations in which communication is particularly effective or encounters difficulties.

2.3. The Role of Therapists in the AAC Process

Therapists are responsible for professional planning and implementation of activities supporting communication development. Their tasks include:

·       assessing the child’s communication needs,

·       selecting an appropriate AAC system,

·       setting therapeutic goals,

·       conducting therapy,

·       training parents and other caregivers,

·       monitoring progress,

·       modifying therapeutic strategies according to the user’s needs.

An important task of the therapist is also to build parents’ sense of competence and support them in the everyday use of AAC.

2.4. Principles of Effective Cooperation

a) Partnership and Mutual Respect

The basis of effective cooperation is treating parents as equal partners in the therapeutic process. This means recognizing their knowledge of the child and taking their opinions into account when making decisions about therapy.

Parents and therapists should jointly set goals and agree on ways to achieve them. Such an approach increases the involvement of all parties and promotes better outcomes.

b) Regular Communication

Continuous exchange of information makes it possible to monitor the child’s progress and respond quickly to emerging difficulties. Communication may take place through:

·       conversations after sessions,

·       individual consultations,

·       contact notebooks,

·       electronic messages,

·       meetings of the therapeutic team.

Regular information sharing helps maintain consistency between actions carried out at home and during therapy.

c) Joint Goal Setting

Therapeutic goals should correspond to the real needs of the child and the family. Goals established jointly are usually more functional and easier to implement in everyday life.

For example, instead of the goal “uses 20 new symbols,” a more practical goal may be “independently orders a favourite drink during family outings.”

d) Consistency of Interventions

A child learns more effectively when similar communication strategies are used by both therapists and parents. This applies, among other things, to:

·       the way AAC is modelled,

·       the type of prompts used,

·       methods of reinforcing communication,

·       expectations toward the child.

Consistent actions help avoid confusion and accelerate the learning process.

e) Training and Support for Parents

Many parents beginning their AAC journey experience uncertainty and concerns related to using new communication tools. Therefore, educating the family is an important element of cooperation.

Training may include:

·       the basics of AAC,

·       using a communication device or communication boards,

·       language modelling strategies,

·       ways to encourage the child to communicate,

·       solving common communication problems.

The greater the parents’ competences, the higher the likelihood that AAC will be used effectively in everyday life.

2.5. Benefits of Cooperation

Effective cooperation between parents and therapists brings many benefits, such as:

·       faster development of the child’s communication competences,

·       more opportunities to communicate,

·       better adjustment of AAC to the user’s needs,

·       increased independence of the child,

·       greater family involvement in the therapeutic process,

·       improved quality of life for the child and their relatives.

Research indicates that children whose parents actively participate in the AAC implementation process more often use the communication system in everyday situations and achieve better results in communication development.

2.6. Barriers to Cooperation

Despite numerous benefits, cooperation may encounter various difficulties, including:

·       parents’ time constraints,

·       lack of knowledge about AAC,

·       differences in expectations regarding therapy,

·       insufficient communication between specialists and the family,

·       stress related to the child’s disability,

·       organizational and financial problems.

Recognizing these barriers and seeking solutions together increases the chances of successfully achieving therapeutic goals.

Summary

Cooperation between parents and therapists is the foundation of effective implementation of augmentative and alternative communication. It is based on partnership, mutual respect, regular exchange of information and joint goal setting. Parents provide knowledge about the child’s everyday functioning and create opportunities to practise communication skills in the natural environment, while therapists offer specialist knowledge and substantive support. Close cooperation makes it possible to create a coherent system of interventions that supports the development of communication, independence and the child’s active participation in social life.

3. Good Practices

Ewa Przebinda, Miroslaw Michalik and Ewa Grzelak distinguish a series of guidelines that help aided language stimulation bring results.

·       Do not quiz or test.

Aided language stimulation is based on processes similar to the acquisition of a native language by typically developing children, who hear speech in a natural context and in various situations. People with complex communication needs who are learning to use AAC should also be allowed this kind of immersion in the language of signs they are learning. Before we begin asking questions, offering choices and requiring answers, there must be a period of so-called modelling without demands, during which the communication partner speaks and uses signs in real situations but does not expect or require any reaction or response from the student. It is also important to ensure that the situations in which we model are engaging and attractive for the learner. Time spent on modelling without demands is not wasted; it should be seen as an investment in the further therapeutic process, in which trust, relationship and motivation to communicate are built.

·       Do not require imitation and repetition immediately.

In the literature on augmentative and alternative communication, aided language stimulation is also called AAC modelling or modelling that supports language development. It should be emphasized that this term does not mean teaching in which imitation is expected directly after a model has been demonstrated. The purpose of aided language stimulation is to teach spontaneous communication by presenting the meaning of signs and how to use them in a natural context, and by creating situations in which the student will be engaged in using this knowledge. This should not be confused with requiring the learner to imitate immediately after presentation. After a period of modelling without demands, spontaneous use of signs is observed in people with complex communication needs.

·       Take into account the student’s age, personality and interests.

There is no minimum or maximum age at which augmentative and alternative communication can be introduced. However, it is important to adapt the content to the person’s age and learning style. It is also necessary to ensure an appropriate level of interest, engagement and motivation. The communication partner is responsible for creating attractive situations for the learner and supporting the development of communicative intent. Instead of teaching vocabulary by showing pictures, for example “The boy EATS ICE CREAM,” it is better to use AAC signs while the student is actually eating ice cream.

·       Make sure the student has the opportunity to observe, but do not require looking.

Use aided language stimulation near the learner, but do not demand eye contact and do not use commands such as “look” or “look here.” Many people with complex communication needs use peripheral vision or are unable to process information from visual and auditory channels at the same time. Through many opportunities to observe the use of a sign in context, they can learn to take in information in the way that is optimal for them.

·       Emphasize key words according to the principle of gradual difficulty.

When addressing the student, focus on emphasizing key words in the sentence. This means that it is not necessary to perform or point to every sign in the sentence. The recommended strategy is to grade the level of difficulty, that is, to point to or perform one more sign in the utterance than the student can point to or perform independently. If the learner is not yet using signs, we represent only one concept in the sentence with a symbol; if they use one, we point to two symbols during modelling, and so on.

·       During aided language stimulation, speak in full sentences.

During modelling, full sentences should be spoken in order to provide a correct language model, while only individual signs in the student’s AAC system are performed or pointed to. Pointing to or performing a sign must occur simultaneously with saying it in the sentence, for example: “Now we are going to eat SOUP.” In the case of a high-tech device with speech synthesis, the word may be spoken in an uninflected form, but the communication partner should say it in the correct form, thereby supplementing and providing the correct language model, e.g. “Oh no, there is no SHOE” - we click the symbol labelled “shoe,” but say the correct form in the sentence.

·       Do not require grammatical correctness from the very beginning.

In the process of language acquisition in a typically developing child, the number of mastered words and communication functions increases first, followed by development in the length of utterances. Grammar and knowledge of its rules develop the latest. Based on this fact, it is recommended that aided language stimulation first emphasize growth in vocabulary and communication functions and the creation of increasingly longer utterances, and only later address grammatical aspects, for example through the strategy of expanding utterance length. In addition, a communication partner who always speaks grammatically correct sentences provides a correct auditory and language model. The learner may point to the symbols “car,” “go” and “shop,” and the communication partner responds: “Yes, you are right, we will GO BY CAR to the SHOP.”

·       Use the strategy of expanding utterance length.

This strategy consists in enriching the AAC user’s utterance by one element in relation to what the student has demonstrated. In this way we increase the student’s vocabulary, teach sentence building and broaden the range of communication functions. We repeat what the AAC user has communicated and add one element to the utterance, for example: student: “eat” - communication partner: “I WANT TO EAT”; student: “jump” - communication partner: “JUMP MORE.” In this way we show how to build sentences and combine symbols in new configurations, paving the way toward the main goal of AAC intervention - the emergence of spontaneous utterances that have never been directly taught before.

·       The three-to-one rule.

This rule aims to reduce the number of questions directed to the child and to support children’s speech development. Asking too many questions may lower motivation to communicate and turn dialogue into an interrogation. Before the communication partner asks any question, they should make sure that for every question there are three statements that do not require the student to answer, for example: “Oh, look, a CAR is DRIVING. Oh, and that CAR is so BIG.
I wonder WHERE it is GOING. And where do you GO BY CAR?”

·       The need for perseverance.

Learning a new communication system takes time, and some students will need more opportunities to learn signs and more examples of how they are used. It is necessary to be patient and not stop using aided language stimulation. The communication partner must also learn the communication tool and the location of symbols. If the learner is already using signs spontaneously, modelling should not be stopped; instead, their utterances should continue to be expanded with new functions and words.

·       Whenever possible, model in the individual communication tool.

Aided language stimulation should take place in the student’s individual communication tool, except in situations where access is impossible or difficult. A fixed and unchanged location of signs supports the process of learning the meaning of symbols. This phenomenon is known as motor memory and helps us in everyday situations by relieving our memory when, for example, entering PIN codes, typing on a keyboard or using a phone. Changing the location of a symbol in the communication tool slows down the process of creating utterances and burdens memory - the student not only has to focus on what they want to communicate, but also has to search for the correct symbol.

·       The more people use aided language stimulation, the faster the learning process progresses.

Ideally, every person in the student’s environment should engage in aided language stimulation, as this creates more opportunities to teach the child the meaning of symbols. All people - parents, siblings and therapists - involved in modelling are valuable. It is worth emphasizing that in real life it may not be possible to achieve full involvement of the environment, but this does not mean that AAC should not be introduced. In learning to communicate, the “all or nothing” principle does not apply. In practice, modelling often begins in one environment and the number of people who model gradually increases.

·       Aided stimulation throughout the day.

Learning to use AAC signs requires many exposures to modelling during the day. A minimum of 200 such situations per day is recommended.

- Aided language stimulation in naturally occurring situations

Daily routines can be used to teach the meaning of signs through aided language stimulation. Every day we perform a series of activities that happen naturally and do not need to be arranged. These include meals, going for a walk or to the shop, cooking or washing. For modelling, choose first the routines that are pleasant and neutral for the student.