Our monthly Noala club on Dec 13, 2022 focused on using AAC devices for individuals with complex communication needs, barriers to utilising these devices, and how individuals can use the devices in different contexts to allow for communication to generalise. We were warmly welcomed by speech and language professionals in the US and UK who actively use these devices with their ASD population. As always, we let the evidence guide us and our organic experiences with personal experiences. Reviewed by the three peer reviewed articles, let's highlight the key takeaways from this session.
In having a conversation based on the research article, we discussed common and not so common ways of using AAC. Included, VSD - a form of alternative communication that uses common scenes from a person’s life in order to connect to these scenes in a way that will foster communication. This is an implementation of AAC that the team hasn’t used and isn’t very well known in the community at large. But it's good for those in their younger years of developing core language. The team stated that typically they program their devices with core words that they implement collaboratively with the teachers, and strongly encourage parents to add to at home when new target words come up.
A critical discussion point that came up was training in the world of AAC. Some speech and language professionals are able to teach staff in more formalised sessions that are set aside for AAC training. The time constraints of being in schools, can lead to using break times to inform staff in 15 minute sessions per day. We all agreed that devices need to be troubleshooted often as is the case with any tech device, and we agreed that navigating this, needs to be a part of the training for both parents and teachers.
While we focused on children, we discussed the needs of adults who use the devices and how others need to be educated as this device may guide them from place to place i.e. home to grocery store to daily activities. Additionally literacy is an area that can be targeted, specifically teaching orthographic skills by letting the individual sound out words while typing.
Many of the noala club members discussed using the PECS app, since it's a quick way to add visuals that the child is interested in/is part of what they need to know at their specific stage of development. Based on this article, we also discussed the crucial role of parents and training them, so progress can be optimised. Some send Youtube videos to parents, as well as videos of how they use it in sessions, so that parents can feel comfortable using the device.
When touching upon parent’s fears of AAC destabilising communication by limiting their children’s use of words, a participant mentioned a research article that examined the communication of individuals using AAC devices. It revealed that 0% of children displayed a reduced ability to communicate verbally when using AAC devices; however their verbal output increased(Miller, Light and Schlosser 2006). Additionally, all of us agreed that AAC never stands alone and goes hand in hand with communication with words in both receptive and expressive language.
There was a discussion also about maximising communication when having a group of students with different levels of communication supporting each other. This can look like one student having a device and another having a communication book, older students without devices encouraging their peers to communicate by asking for what they need, and making children and adults feel comfortable by waiting and being silent as they type out what they want to express.
We discussed parents needing to know how to use the device, but also recognising how overwhelming it can be. We touched upon research in the article that focused on interviews with parents and their level of satisfaction with speech therapists using AAC devices with their children. Some parents were not confident in speech therapists finding the correct device or knowing how to use the device properly since it wasn’t in their domain. Some parents mentioned the importance of having someone with an AAC background to complete the assessment and be the point person during intervention when the device is being used.
Our discussion revealed differences across the US and in the UK. While in both countries the waiting lists are long and at times it is difficult to receive a speech and language evaluation for a device, the speech and language therapist is responsible for the AAC device from beginning to end; assessment through intervention. They are very attentive to providing parent instruction and they encourage the student to take it home daily. In schools in the US, some educators leave the devices at the school, which diminishes the power and purpose of the AAC device. Additionally the Assistive Technology team performs the assessment in NYC to determine the type of device warranted, while the occupational therapist often helps troubleshoot the device and make recommendations for goals. In other states in the US, the responsibility lies solely on the SLP.
Our discussion of AAC devices showed us that there is a lot more work to be done, in terms of having universal training in schools, and having a system in place for parents to receive the information required to use and troubleshoot the AAC device. Additionally, we know that the future of AAC devices will be able to capitalise on technology in ways that will allow those with complex communication needs gain more power in their voice. Ultimately, when designing the AAC device, it is important to not let the technology distract us all from the main priority: the interests and motivating tools that will help the individual communicate.
Noala club is a free monthly online session during with our speech and language community gathers to discuss a specific topic between practitioners, evidence based. This session counts as a CPD activity. If you would like to join our next session sign up at the link below.