Introduction to Augmentative & Alternative Communication: Aided Symbol Systems

1. Introduction to Augmentative & Alternative Communication: Aided Symbol Systems Priscilla Kershaw

2. CommunicationWhat if you can’t communicate? • Individuals with significant communication difficulties cannot convey their needs and wants, cannot tell stories, or relate events, emotions, etc. • Relationship-building is affected • Independence is affected • Learning is affected • Depression, frustration, isolation is seen. • People who are unable to communicate have a high risk for abuse & neglect – the silent victim is the perfect victim

3. “One of the greatest challenges faced by people with severe communication impairment is trying to convince other people we are not merely breathing blobs of flesh, but truly human beings who are capable of creative thought.” (Michal Williams, 2000) ”

4. Augmentative and Alternative Communication • AAC plays an important role in facilitating communication in people with little or no functional speech. AAC is the use of less frequently used means or modes of communication (for a temporary or a permanent period) to compensate for the lack of verbal expression to facilitate the participation of people with significant communication difficulties in society.

5. Unpacking the definition • “Less frequently used means and modes of communication” • Communication is more than words! • However, spoken/written words carry most of the meaning • People who cannot speak and/or write adequately, need to rely on other modes (ways) that are not so frequently used.

6. Why is AAC so important? • Communication is a basic human attribute • We are wired to ‘connect’ • THAT a person communicates is more important than HOW he communicates • AAC can reduce frustration and isolation • AAC can facilitate speech and language development • AAC can facilitate entrance into literacy • AAC facilitates interactions and greater independence • AAC provides access to different communication contexts and partners

7. Who can benefit from AAC? Persons with significant communication difficulties “little or no functional speech” (LNFS) < 30 words

8. Who can benefit from AAC? • In a South African study, Bornman & Alant (1997) reported that 35% of children in schools for children with intellectual impairment spoke less than 15 words… • Much higher than comparable international figures.

9. Basic AAC principles • “Wait & See”replaced by “Try & See”. • Will AAC inhibit speech development or speech recovery? • ALL people can and do communicate • Speech is the most effective communication tool humans have • If a person CAN learn to speak, they WILL!! • But, while they cannot use speech effectively, we need to give them other tools that will enable them to participate

10. Basic AAC principles • Multimodal system • Variety of communication functions (e.g. for greeting, protesting, requesting help, requesting “more”, indicating “finished” • Partners need to model use of AAC • Always facilitate independence and social inclusion.

11. What AAC systems are available? AAC Systems Unaided Aided

12. Aided AAC systems • Anything we use for communication apart from our own body • In AAC, we use aided symbols such as written words or pictures that represent a meaning/message. These symbols are permanent. We display / store the symbols, and have a way of choosing the symbols

13. Aided AAC systems Level of representationReal objectsColour photographsBlack and White photographsColoured picturesLine drawings

14. Aided AAC systems Objects Why use objects? • Easy to understand, as the thing the individual needs/ wants looks exactly like the real thing • Can manipulate, touch, use it • Good for beginning communicators • Helps children with visual problems

15. Aided AAC systems Objects Different types • Real objects (e.g. comb) • Miniatures (e.g. Barbie utensils) • Textured symbols (e.g. piece of leather for horse riding). Includes raised symbols • Tangibles (e.g. shoelace for shoe)

16. Aided AAC systems How to use objects First understanding, then expressing! Use to scaffold understanding • e.g. collecting objects around a theme, letting learners touch, feel, use. • Schedules: To help learners predict what comes next • Shoeboxes, plastic bags, schedule boards

17. Aided AAC systems How to use objects • Use for making choices • Choice board, for beginning communicators • E.g. during snack time • Partial objects can be used in remnant books

18. BUT Objects are big and bulky Limited options on display at a time Limited portability Safety and durability? You cannot say much using only objects! Mostly nouns, maybe some activities Aided AAC systems

19. Aided AAC systems Photographs & pictures Why use photographs & pictures? • Quite easy to understand by user and partners • Can represent objects, verbs, people, places • More portable than objects • Reproducible • Can be individualised • Two types of photographs: Commercial: product labels, adverts, magazine pictures Own: more personalized, digital photos

20. Aided AAC systems How to use photographs and pictures First understanding, then expressing! • Use for understanding: Around a teaching theme, e.g. cut out food pictures from a magazine • Use for making choices, e.g. snack time, tuck shop

21. Aided AAC systems How to use photographs and pictures • Schedule for the day’s activities • To represent the children – for turn-taking • In communication books • E.g. taking pictures of an activity done in school – write a story about the children

22. Aided AAC systems Graphic symbols: Line drawings One drawing represents one word/concept Hand drawn Preferably use a black cokie pen • Commercially available, • e.g. PCS, Bliss • Variety available • Created by individuals or companies • for different purposes and populations • Most come in hard copy or • electronic dictionaries

23. Aided AAC systems Picture Communication Symbols (PCS) What is PCS? • Clear line drawings, using bold strokes • More than 3000 words in 3 dictionaries

24. Aided AAC systems Graphic symbols: PCS • Mostly pictographic • Some ideographic e.g. ↑ • Divided into 6 groups: social, people, verbs, descriptive, nouns, miscellaneous • Not all concepts are picture producers • Lots of training materials, games, symbol displays • Purchased on CD - Boardmaker ? ?

25. Aided AAC systems Graphic symbols: PCS With whom can it be used? • Variety of disabilities, e.g. apraxia, autism, intellectual disabilities, CP, post-operative conditions • Children or adults

26. Aided AAC systems Graphic symbols: PCS Implementation possibilities First understanding, then expressing! • Storybooks • Schedules • Communication books, wallets • Communication bracelets, necklaces • Communication boards • Talking mats • Picture Exchange Communication System (PECS) Workshop: Using communication boards

27. Advantages Looks easy to learn: Many pictures can be easily recognised Appropriate for all ages Standardized size for placement on communication devices Training materials available Easy to reproduce (print or photocopy) Disadvantages Problem with abstract concepts Symbols are not always culturally appropriate There are no rules for making new symbols Some aspects of language (e.g. plurals, past tense) are not depicted Aided AAC systems Graphic symbols: PCS

28. Aided AAC systems Making a board with graphic symbols • Choose vocabulary: Not only nouns!! • Organise your vocabulary: • Fitzgerald key (or modified Fitzgerald key): By word type (parts of speech) to encourage sentence formation • Categories (e.g. people, places, body parts, feelings… • Frequency of use, e.g. most frequently used ones at easiest point of access • Alphabetical • Colour code your vocabulary (e.g Goossens, 1993)

29. Aided AAC systems Making a board with graphic symbols • Social words • Pronouns (you, I, she…) • Verbs (action words) • Describing words • Prepositions • Nouns (people, places, things)

30. Example of a board

31. Aided AAC systems Traditional orthography (TO) • The most powerful aided symbol system • 26 elements (and a bit more, such as punctuation and spaces) combine to express any message • Mirrors spoken language perfectly • Displays: Alphabet board (QWERTY or ABC arrangement), E-Tran, auditory scanning board • Disadvantage: Need literacy skills, takes long (one concept such as ‘restaurant’ needs the user to make 10 selections Workshop: Using an alphabet board

32. Considerations when selecting & using symbols The symbols to be used should be: • clear – adapt for visual impairment • matched to the child’s/ adult’s perceptual level • portable • acceptable ( for user & communicator partners ) • easy to learn ( must have an immediate effect ) • effectiveness ( should serve a purpose for the individual & not replace current modes ) • flexible • easy to reproduce e.g. drawing, photocopies etc. • understandable/ intelligible • Made accessible to all significant others!!!!

33. Considerations when selecting & using symbols • If AAC is used to help a child develop language skills, we need to ask: • How linguistic (i.e. like language) is this symbol system? For example: • Does it allow for expression of many concepts? • Does it allow the child to use grammar rules (e.g. plural ‘s’, past tense etc.) • Does it allow for the combining of elements to get new meaning? • Systems that are more difficult to learn (such as Bliss) are often more like language.

34. Software programs Boardmaker Picture This Writing with Symbols Organization Websites www.caac.up.ac.za/ www.interface-sa.org.za www.isaac-online.org Commercial websites and companies www.ablenet.com www.sensorysoftware.com www.mayer-johnson.com www.enablingdevices.com www.tashinc.com Inclusive solutions: Phone: 011 678 5685 www.inclusivesolutions.co.za Resources

35. Bornman, J., & Alant, E. (1996). Nonspeaking children in schools for children with severe mental disabilities in the greater Pretoria area: implications for speech-language therapists.South African Journal of Communication Disorders, 43: 53-61. Crossley, R. & McDonald, A. (1984). Annie’s coming out. New York: Viking Penguin. Goossens, C., Crain, & Crain, S. (1986). Augmentative Communication intervention resource. Wauconda, I.L.: Don Johnson Inc. Lloyd, L. L., Fuller, D. R., & Arvidson, H. H. (Eds.) (1997). Augmentative and Alternative Communication: A handbook of principles and practices. Baltimore: Paul H. Brookes. Von Tetzchner, S., & Grove, N. (2003). The development of alternative language forms. In S. von Tetzchner & N. Grove (Eds.), Augmentative and alternative communication: Developmental issues, pp. 1-27. London: Whurr. Bibliography