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Appendix in 2023 SIG 12 Perspectives Article

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Appendix in 2023 SIG 12 Perspectives Article

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https://pubs.asha.org/doi/10.1044/2023_PERSP-22-00200

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Part-Time AAC Interview Questions (Garcia, 2017)

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Part-Time AAC Interview Questions (Garcia, 2017)

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https://drive.google.com/file/d/1EoJgthl7ieLFeaEfBex6Mn4Mf3qqFfJ4/view?usp=drive_link

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Questionnaire for Communication Partners and How to Teach Communication Repair.pdf

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Madel, R. & Bugaj, C (Hosts). (2021, Oct 21) Coaching Call with Anya Ashouri - Part 2: Focusing on AAC Strategies, Not Just Tools. [Audio podcast episode]. In Talking With Tech: Xceptional Podcast Network.

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This week, the TWT team interviews Anya Ashouri, an SLP and AT Specialist for a Non-Public School who had questions about identifying students in her school who are complex communicators but were not given AAC to communicate. Anya describes how she came to learn that her school needed more robust AT, the steps she took to train herself on AAC and AT, and asks Chris and Rachel for advice on getting admin and parent buy-in for robust AAC.

Before the interview, Chris and Rachel talk about a journal article from May 2020, called "The Effects of Telepractice to Support Family Members in Modeling a Speech-Generating Device in the Home". The article resonated with Chris and Rachel because they both had always felt that coaching family members through tele practice can lead to greater success than direct therapy alone.

Key ideas this week:

🔑 If we are building from the ground up, we should tell people what AAC is and why its important. It's easy to overwhelm people with jargoin if they are not familiar with AAC.

🔑 Many people thing about the SETT framework to select the AT tool, but that is only one part of it. As you are having this discussion, discuss what kind of outcome you want? What else needs to change in the environment? Do we need to change the tasks?

🔑 When you visit a classroom, be conscious of how you can help all the kids, not just one student. Helping teachers with ways they can promote language development for all students is a good way to build rapport and buy-in.

Links:

"The Effects of Telepractice to Support Family Members in Modeling a Speech-Generating Device in the Home". by Sarah Douglas, Elizabeth Biggs, Hedda Meadan, and Atikah Bagawan
https://pubs.asha.org/doi/10.1044/2021_AJSLP-20-00230

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Episode 196: Coaching Call with Anya Ashouri: Getting School Admin Buy-In for AAC - Talking With Tech

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This week, the TWT team interviews Anya Ashouri, an SLP and AT Specialist for a Non-Public School who had questions about identifying students in her school who are complex communicators but were not given AAC to communicate. Anya describes how she came to learn that her school needed more

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Madel, R.& Bugaj, C (Hosts). (2023, Jan 23) Chloe Rothschild: Teacher, Author, Advocate, and Part-Time AAC User In Talking With Tech: Xceptional Podcast Network.

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This week, Rachel interviews Chloe Rothschild, an autistic advocate, author, teacher, and speaker who uses AAC to communicate part-time. Chloe currently serves on the Board of Directors for The Arc, a disability advocacy group, as well as working with the Ohio Center for Autism and Low Incidence. Chloe joins the podcast to share her amazing insights into using different communication modalities depending upon the demands of the situation, as well as a discussion of using her Apple Watch for AAC, working with nonspeaking children in an autistic classroom, why she like to use symbols to communicate even though she is a fast typer, and more!

Key ideas this week:

🔑 There are many reasons why someone may not speak in some situations, such as their anxiety level or the demands of the situation. We should not assume that every person who uses verbal speech can use it all the time.

🔑 Chloe uses pre-programmed "quick fire" messages via Proloquo4Text on her Apple Watch to communicate in some situations, such as when she needs a break out in the community.

🔑 Chloe prefers to use her symbol-based AAC system, Proloquo2Go, instead of her text-based AAC system, Proloquo4Text. Chloe says she "thinks in pictures", so when she looks at her grid of symbols, she instantly knows what the symbols mean. When there are no symbols, she has to read every word every time, which her takes longer.

Links:

Chloe's website: chloerothschildasd.com
My Interception Workbook: A Guide for Teens, Adolescents, and Adults by Kelly Mahler, Chloe Rothschild, and Jarvis Alma.
Chloe is a Board Member of The Arc for People with Intellectual and Developmental Disabilities: thearc.org

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Episode 255: Chloe Rothschild: Teacher, Author, Advocate, and Part-Time AAC User - Talking With Tech

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This week, Rachel interviews Chloe Rothschild, an autistic advocate, author, teacher, and speaker who uses AAC to communicate part-time. Chloe currently serves on the Board of Directors for The Arc, a disability advocacy group, as well as working with the Ohio Center for Autism and Low Incidence. Ch

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Everyone Deserves AAC: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Communication

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Everyone Deserves AAC: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Communication

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Donaldson, A., endever*, c.., & McCoy, J. (2021). "'Everyone Deserves AAC: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Communication" Perspectives of the ASHA Special Interest Groups. Vol. 6. 315-326. https://doi.org/10.1044/2021_PERSP-20-00220

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 Perspectives of Part-Time Augmentative and Alternative Communication Use in Adults and Implications for Pediatric Service Delivery

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 Perspectives of Part-Time Augmentative and Alternative Communication Use in Adults and Implications for Pediatric Service Delivery

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Koerner, S., Glaser, S., & Kropkowski, K. (2023). Perspectives of Part-Time Augmentative and Alternative Communication Use in Adults and Implications for Pediatric Service Delivery. Perspectives of the ASHA Special Interest Groups. Vol. 8, 747-760. https://doi.org/10.1044/2023_PERSP-22-00200

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Augmentative and Alternative Communication for Speaking Autistic Adults: Overview and Recommendations. Autism in Adulthood 

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Augmentative and Alternative Communication for Speaking Autistic Adults: Overview and Recommendations. Autism in Adulthood 

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Zisk, A., Dalton, E., (2019)Augmentative and Alternative Communication for Speaking Autistic Adults:

Overview and Recommendations. Autism in Adulthood . 1 (2), 93-100. https://doi.org/10.1089/aut.2018.0007

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Lawrence, L. (2017). Tapping Into the ‘Augmentative’ of AAC. https://doi.org/10.1044/leader.MIW.22022017.38

Tapping Into the ‘Augmentative

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Zangari, C., & Weatherford, S. (2014, April 30). AACtual Therapy: On Motivation and AAC with Samantha Weatherford. PrAACtical AAC. https://praacticalaac.org/praactical/aactual-therapy-on-motivation-and-aac-with-samantha-weatherford/

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Motivating clients to use and learn more about their AAC systems can sometimes be a challenge, particularly if the learner has had decades of life experience before being introduced to AAC. In this post, we welcome SLP Samantha Weatherford, who works in the areas of early intervention and adult rehabilitation. She blogs at So To Speak regarding the educational, professional, and clinical processes of becoming an SLP. She resides in Delaware with her cat Simon, and took some time to share her thoughts about helping adult clients get motivated to use AAC.

Have you ever started the AAC training and trialing process with an adult client and realized, "This person is just not interested in being here or doing this?" Maybe it's just me, but I feel like this happens quite often. I would never rule-out the possibility for AAC eligibility as a result of an hour long evaluation, but many times I see that caregivers are very gung-ho to get an AAC system put in place, while the client isn't necessarily on board.

How then, do we get a client motivated? Can you? ( Spoiler alert : you can try!)

1. Reinforcers - We all know this. I ask the client and caregivers in the evaluation: What do you like to do? Who is important to you? What are a few of your favorite things? Then hopefully, if some of those things are tangible, we can use them to get the person motivated to use their communication aid. This tactic tends to work more for the developmental disability population in regard to requesting, but it can be helpful when an adult with an acquired disability wants to talk about what makes them who they are - and they haven't been able to in a long time!
Many clients are motivated by music - this switch access iHome by Enabling Devices is often very motivating and reinforcing.

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2. What is this person's best sensory input modality? - I'm currently working with several young adults with diagnoses of Deaf/Blindness as well as severe physical disabilities, which can prove to be a bit of a challenge. For one patient who is completely blind, we use tactile input to help him learn more about his choices and how to access them. For example, I've Velcro-ed a rough material onto the "stop" button, and a soft material onto the "more" button. I assist him, hand over hand, to initially find the buttons and access the message and immediately reinforce the message. Another patient just responds better to real pictures rather than line drawings - Why? I don't know! It is just what works and gets them motivated to do more! Explore with your patients, and figure out how you can get information in, so they can get information out!

3. Success! - If I went to the gym every day for a year and didn't feel satisfaction and success with my exercise I probably wouldn't go anymore. Because it is not motivating to fail. When your client does something well, make sure you let them know and encourage them to do it again. I'm working with a young woman right now who is trialing some eye gaze systems. It took us a long time to figure out that this is the best way for her to experience success with communication and until we figured it out she would shut down as soon as she came in the room. Don't make your therapy sessions painful by trying to force a communication aid that clearly does not interest the person and that they might not be experiencing success with!

4. Heart-to-Heart - This is not something I particularly enjoy doing. I recently saw a patient with a degenerative disorder whose speech is 98% unintelligible to a familiar listener with context. We tried every system I could think of but she just was not motivated to use it in a functional, every day sense. And finally I had to say, "I know you're trying really hard to make me and your caregivers happy, but YOU want to keep using your speech. I respect that and I understand it, but we've got to face the facts here and make a decision." Long run, she still wanted to use her speech but we had the tough love talk that we needed to have so she could understand where her caregivers were coming from. We can't keep up therapy forever without progress, even if it is great fun.

5. Anticipation - Often you may find that when an adult has a disability their caregivers do a lot for them. Which is fantastic and I love that so many of my clients have such great support systems. However, always anticipating what a person needs is like cutting off a person who stutters. It reduces the opportunity to communicate before the communicating gets to even occur. I see a lot of patients whose caregivers want a communication device but when we probe to see what this person would need to actually communicate...there is not a lot because everything is done for them. We may think of doing this with a child (i.e. putting something they need on a shelf and acting the fool when they point and vocalize to get it) but it is something to consider in the event that you observe a lot of anticipating and routine for an adult. I don't love this strategy because often caregivers know what a person needs via behavior ("When he rocks that way he's hungry") and I don't want to give the idea that we should not respond to known communicative attempts, so tread lightly here. Robin Parker wrote about more ways to create communication opportunities for adults which can be found HERE!

6. He's just not that into you - Sometimes we have to take a step back and say, "Is it me?" And sometimes...yes, it is you. You are not motivating or maybe even de-motivating (if that's a word) for the client. That is okay (I know it hurts...we SLPs are a sensitive bunch and we like to be good at everything.) See if your practice wouldn't mind you switching with a different clinician for a session or coach a motivating caregiver through your session. If you observe no difference in their response when you do this then maybe they just aren't internally motivated or they're feeling overwhelmed by something else. If there IS a difference in their response, then honor the client's preference just like you would for someone who can say, "Hey I don't like you, I want a different SLP!"

7. On that note - Consider your environment. You can easily shut down a whole session with just the way you look. I do not wear scrubs because half of my patients think they're coming to see the doctor and it stresses them out - why should I propagate the idea by dressing like a medical professional when I don't work in a hospital? Are any of the caregivers overwhelming for this person? I have seen many patients whose caregivers are awesome, but very excited and get a little carried away trying to encourage the patient to use a communication aid. Would this person mind stepping back, or even out for a minute just to see how the patient does without that prompting and cueing? Maybe just try changing rooms - go on a little field trip, or consider doing therapy in their natural environment if possible.

At the end of the day you cannot make anyone use an AAC system and we don't want to recommend something that is going to end up with dead batteries in a closet somewhere. If you have tried your hardest and put in your best effort and you don't feel that the client is motivated to use a communication aid then that too, is a recommendation. Typically in this situation I suggest a possible future re-evaluation in the event that the client's communication needs change. I also try at this point to put something no-tech in place for basic communication and health status (communication book, alphabet board, gesture dictionary, picture ring) because I do not like feeling like I'm leaving a family high-and-dry.

Hopefully though, using some of these strategies or one of your own, you get through and find a communication system that is the best fit for your client. Please share below if you have any tricks of the trade that keep your adult clients motivated and interested!

This post was written by Carole Zangari

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AACtual Therapy: On Motivation and AAC with Samantha Weatherford

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Motivating clients to use and learn more about their AAC systems can sometimes be a challenge, particularly if the learner has had decades of life experience before being introduced to AAC. In this...

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Zangari, C. and Garcia, A., (2017, September 17). How We Do It: Using AAC to Repair Communication Breakdowns. PrAACtical AAC. https://praacticalaac.org/praactical/how-we-do-it-using-aac-to-repair-communication-breakdowns/

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We've had many nice comments about the resources shared by AAC SLP Alicia Garcia, clinical lead of the AAC Clinic at One Kids Place, a children's treatment centre in northern Ontario. With over two decades of experience in pediatric rehabilitation practice in private and public settings, Alicia's ideas for how to support AAC learners and their families are tried and true. In today's post, Alicia shares thoughts and materials for situations in which the AAC is needed to repair communication breakdowns.

Children with unclear speech not only have different intelligibility levels but also different levels of awareness, focus, and interest on repairing their communication breakdowns. We use different approaches based on how they react and respond when they are not understood.

As a general guideline when a communication breakdown occurs, regardless of the child's profile, we first try determining the level of urgency or importance of the child's intended message. If it looks like the message is time-sensitive, we ask questions such as: "Do you need help?" "Do you want permission to do something?" "Do you need me to come with you?" "Can it wait?" If we perceive urgency, we focus on solving the child's problem, as opposed to addressing the breakdown.

When the child has no awareness that a breakdown has occurred, we try helping him/her notice that they were not understood in a gentle, subtle manner. It is important to focus on maintaining the child's interest in communicating. At this stage we, partners, take most responsibility to repair the breakdown by:

Looking for language and speech patterns: learning about the child's most common conversational topics, typical sound errors; conditions that may help improve intelligibility such as slower or louder speech

Proving feedback and asking for repetition e.g., I'm sorry, I didn't get that; Say that again?

Asking questions: try guessing what the child might be saying e.g., Did you say____?" Is it about _____?

Using familiar translators: If we know of a peer or family member in close proximity who understands the child, we acknowledge verbally the breakdown and involve the child in finding help e.g., I'm sorry, I don't quite understand what you're telling me; let's find Johnny

Some children may have the awareness that they are not understood but don't have enough focus or attention to use AAC to repair the breakdown. In these cases we try:

Introducing AAC by modeling during natural, incidental communication: when we hear a potential breakdown (i.e., we know what the child is communicating but other people may not), we model by pairing what the child is saying with a picture, a gesture or a sign

Prompting and expecting the use of AAC tools only during scripted, game-type activities (as opposed to natural face-to-face exchanges). For example, we practice using a device during barrier games where the partner and child take turns describing and guessing pictures or objects, or practice pointing to pictures during functional scripts such as pretending going shopping, ordering at restaurant, meeting new people, answering teachers' questions

Some children seem to have some level of awareness and good focus but no interest or desire to repair their communication breakdowns. We focus on encouraging engagement, in making sure the child understands that we are interested in what they have to say. We try finding out why the child has no interest in repairing breakdowns and try developing a consistent clarification process for partners to implement. We focus on promoting opportunities to have the child experience payoff of successful repairs.
Tips to Teach Children How to Use Augmentative Communication for Clarification Purposes
Children whose speech is not clear frequently have a difficult time learning to use pictures to clarify the messages they are trying to communicate. Just having a device or pictures available is not enough. They need training to learn to use these tools to make themselves understood. The following tips are recommended when introducing a clarification system (device, picture book etc):

Teach the child to respond to the question: What is it about? The child needs to understand that just repeating what he said does not help us understand him better. We start teaching the child to respond to this question by MODELING the phrase "talking about" many, many times during the day. For example, when the teacher talks about how cold it is today, the communication partner says: "Ms. Smith is talking about the weather" and then looks for the picture of weather on the device

Spend time with the child learning the location of the pictures on the AAC system. Both, communication partner and child need to be able to find pictures within categories in a relatively fast manner. You need to spend time with the child exploring where pictures are located. E.g., applesauce is in the FOOD and DRINKS button, swimming is in the ACTIVITIES button, mom is in the PEOPLE button. Partners should do the navigation out loud e.g., "I'm trying to find the word HOCKEY.... Let's see... is it here, under Activities?... No, it's not... Maybe it's here, under Sports... YES, I see it here"

Until she child learns to navigate the AAC system, partners should take ownership of repairing the communication breakdown. Partners should hold the AAC system in front of the child and point to pictures of categories while asking questions such as "Are you talking about... someone?(PEOPLE)... something you did? (ACTIVITIES) ... a place you are going (PLACES)? Partners should gradually fade the level of support until the child is comfortable finding pictures to repair communication breakdowns on his own

Communication partners need to be become more systematic and aware of their questions and requests for clarification. It is recommended to follow a pattern of steps. For example, asking the child to:

1. Slow down (encourage him to keep trying)

2. Say it in a different way (i.e., "tell me more")

3. Show with his hands or body (by acting it out or pointing at things in the environment) or Draw it

4. Use the device

Other valuable clarification resources are the iPad Calendar and Camera Roll:

CAMERA ROLL: encourage the child to take photos or objects and events representing activities he has participated in. Photos allow the child to initiate conversations - especially with less familiar partners. Have the child take photos from special places he goes (movie theatre, restaurants), people he encounters, activities and events he participates in. Encourage the child to take photos of books and characters he likes to talk about. This will be a way for the child to have contextual cues readily available. Add in photos from new units at school that the child has difficulty saying e.g., dinosaurs, volcanoes, insects. Model using the camera roll. You can add labels to pictures while keeping them in the camera roll using the app PhotoName.

CALENDAR: it keeps family and school partners informed about new or interesting topics that the child may want to talk about. It also lets the child comment on activities in which he participates in regularly. The app Photo 365 allow partners to enter photos on a blank calendar grid.

You can download Alicia's handout on this topic and a questionnaire for communication partners here.

This post was written by Carole Zangari

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How We Do It: Using AAC to Repair Communication Breakdowns

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We've had many nice comments about the resources shared by AAC SLP Alicia Garcia, clinical lead of the AAC Clinic at One Kids Place, a children's treatment centre in northern Ontario. With ov...

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Zangari, C. (2020, February 17). PrAACtical Research: Recasts in AAC Mediated Interaction. PrAACtical AAC. https://praacticalaac.org/praactical/praactical-research-recasts-in-aac-mediated-interaction/

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PrAACtical Research: Recasts in AAC Mediated Interaction

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Today, we welcome back guest author Dr. Kathy Howery for another wonderful discussion of an important AAC research article. Dr. Howery’s work in AT and special education spans three decades a…

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Communicate and Collaborate! Strategies for Facilitating AAC Use at Home and School.

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Communicate and Collaborate! Strategies for Facilitating AAC Use at Home and School.

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DeFelice, H., Scheer-Cohen, A. R., & Hughes, D. (2014). Communicate and Collaborate! Strategies for Facilitating AAC Use at Home and School. Perspectives on Augmentative and Alternative Communication. https://doi.org/10.1044/aac23.3.157

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Zangari, C. (2018, July 9). Insufficient Options: Messages to Consider Adding to the AAC Device. PrAACtical AAC. https://praacticalaac.org/praactical/insufficient-options-messages-to-consider-adding-to-the-aac-device/

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How would it feel to be really hungry but allergic to everything on the menu at the only place in town that is still serving food?

Can you imagine finding comfortable shoes that you were dying to buy to wear with your navy suit except that they only had fuschia and neon yellow in your size?

Have you ever been frustrated by filling out a form that gave only choices for racial groups that you don't identify with?

Let's face it: It's incredibly, maddeningly, and impossibly frustrating when our options are overly limited or the choices don't include things that we want or need. We feel trapped. It's frustrating, demeaning, and downright infuriating to be constrained in those ways.

And yet, most people who use AAC face that situation every day. Their language is limited by the options available to them in their SGDs, communication books, or AAC apps. Until they are literate, they are constrained by their communication tools.

One thing we can do to ease the frustration is to provide messages that express the problem.

"It's not here."

"Not one of these."

"Not on this board/book/screen."

"I have something to tell you but it's not in here."

"I don't have a way to tell you."

"I wish I could tell you what I'm thinking."

We can also add messages that move toward a solution.

"Give me more choices."

"Ask me Yes/No questions."

"I need that word/sentence/question."

"Add it to my book/board/device."

Once added, we can model the use of these messages in our interactions with the AAC learner, and, eventually, teach him/her to use them in repairing communication breakdowns.

Do you have other messages that can help AAC learners cope with the limited options in their communication books/boards/technology? We'd love to hear your ideas.

This post was written by Carole Zangari

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Insufficient Options: Messages to Consider Adding to the AAC Device

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How would it feel to be really hungry but allergic to everything on the menu at the only place in town that is still serving food? Can you imagine finding comfortable shoes that you were dying to b...

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George Jeffrey Children’s Centre. (2023). Clarification Strategies for Communication Partners of Individuals Using Augmentative & Alternative Communication (AAC). https://georgejeffrey.com/resources/augmentative-alternative-communication

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COVID-19 Resources

Read the latest information and resources on COVID-19 guidelines and recommendations for Clients and Caregivers.

While you wait program

Our "While You Wait" (WYW) Program is a central point of contact for families waiting for assessment services for their children after being referred to the Centre.

News from OAP

Please see link below about Ontario Autism Program (OAP) Caregiver-Mediated services.

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Augmentative & Alternative Communication - George Jeffrey Children's Centre

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Resources for Augmentative & Alternative Communication.

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https://leader.pubs.asha.org/do/10.1044/2023-0119-transvoices-autism-AAC-choice

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This week on TWT, Rachel interviews Alyssa Hillary Zisk! Alyssa is a graduate student in neuroscience who shares their experiences as an autistic adult who uses AAC part of the time to communicate.

Key ideas this episode:

🔑Some autistic adults experience intermittent or insufficient speech.

🔑Some of these adults use AAC part of the time.

🔑It is important to give AAC users the same chance to participate in discussions and to allow them to communicate in whatever modality they choose.

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Episode 78: Alyssa Hillary Zisk: Adults With Autism Who Use AAC Part-Time - Talking With Tech

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This week on TWT, Rachel interviews Alyssa Hillary Zisk! Alyssa is a graduate student in neuroscience who shares their experiences as an autistic adult who uses AAC part of the time to communicate. Key ideas this episode: 🔑Some autistic adults experience intermit

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Using the Communication Bill of Rights to help with Part-Time AAC Evaluation

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Using the Communication Bill of Rights to help with Part-Time AAC Evaluation

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https://jamboard.google.com/d/1P_eKZW_2TcV0Dnuqykt_1hPVivp18DxJHUhGUmBNtLU/edit?usp=sharing

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ATIA 2024 Poster: Part-time AAC Users Full Time Solutions

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ATIA 2024 Poster: Part-time AAC Users Full Time Solutions

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https://www.canva.com/design/DAF5UVQ44lc/sRcP8Oso_mIJJUrNy4hpRw/view?utm_content=DAF5UVQ44lc&utm_campaign=designshare&utm_medium=link&utm_source=editor

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ATIA Poster: Part-time AAC Users Full Time Solutions

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Check out this Poster (Landscape) designed by Cici Fritts.

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Promotion of Communication Access, Choice, and Agency for Autistic Students

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Promotion of Communication Access, Choice, and Agency for Autistic Students

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Donaldson, A., Corbin, A., Zisk, A, & Brandon, E. (2022). Promotion of Communication Access, Choice, and Agency for Autistic. Language, Speech, and Hearing Services in Schools.

https://doi.org/10.1044/2022_LSHSS-22-00031

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Cici Fritts, M.S., CCC-SLP

cici.fritts@leanderisd.org

Candace Hayden, M.A., CCC-SLP

candace.hayden@leanderisd.org

Assistive Technology Specialists in Leander ISD (outside of Austin, Texas)