Finding the Words May - June 2008

Finding the Words…with augmented communication!

Part 1

The mother of a three-year-old on the spectrum called me not long ago. "Max doesn't talk," she began, "and I don't think he ever will. So, what would you recommend instead? PECS?" Most of us in the autism community know something about the Picture Exchange Communication System (PECS), and often find it useful in jump-starting reciprocal communication in our youngsters. But I realized this mom was considering using PECS to do more than 'augment' Max's oral communication, or provide a temporarily 'alternative'. She thought she had to make an either/or choice about Max's communicative future. Would it be oral language or visual symbols?

How many other parents hold this perception, I wondered? At that moment I knew that the time had come to address AAC in this column, and look more deeply at where Augmentative and Alternative Communication fits for our kids: at age 3, and as they grow up. AAC has certainly come of age in the autism community, and it's time we do too, about AAC. So, with this hope, our new series begins, this time exploring the natural dimensions of augmented communication.

At its simplest level, augmented communication means that while you are encouraging your child's oral language development, you are also including some 'augmentative' input to him (pictures, perhaps) and output from him (pictures, perhaps). On the 'inputting side,' it is to a young child's advantage to 'augment' your oral language to him with sign language, or with materials such as drawings, photographs, and other visual supports. If a picture is worth a thousand words, we shouldn't underestimate their value to our visual kids! On the 'outputting' side, it may also be to a child's advantage to provide him the opportunity to 'augment' his own oral language as well (pointing to pictures, for example).

'Augmenting' oral language is something parents and teachers do naturally, and we can readily think of at least a dozen modalities we use all the time in our daily communiqués with children: body language, facial expression, picture books, concrete choices, notes on the fridge. Sometimes we're talking at the same time and these modalities 'augment' our speech. Other times, we are silent, and they are 'alternatives' to speech. AAC, thought of in this way, begins to have a ring of real naturalness to it!

AAC sometimes seems synonymous with 'high tech' equipment in our modern world; a little historical context puts this in perspective. In the mid-60's, before the term AAC was coined, the concept of total communication was first embraced by teachers of the hearing impaired as a departure from the notion that deaf children should be taught with either oral language or sign language. It implied that children could be taught with both modalities simultaneously, and this would enhance learning. In the next decades, total communication was broadened to include others who might benefit from sign language and other forms of communication augmentation. At a time when only 'low tech' options existed, total communication meant supporting a child's receptive and expressive language through multiple modalities including speech, gesture, body proximity, eye gaze, sign language, pictures, spelling with alphabet boards, drawing, writing, and typing.

Today, total communication concepts are embraced within the field of augmented communication, which supports the availability of all communicative modalities to enhance language comprehension and expression. A child might use one or more of them in one exchange, and something completely different the next. Because contexts, supports, and social dynamics are constantly changing, any of us might nod during one conversational turn, shrug the next, and wax eloquent the next. It all depends… And as Thomas' story in our last column illustrated, wordless communication is often the most effective!

One of the tenants of augmented communication is to avoid taking away communication that an individual already has in one modality, in an attempt to teach another modality. This tenant certainly doesn't preclude developmentally-appropriate communication skills gradually replacing immature skills. As our kids learn and progress, we will always be supporting their emerging skills. But what this AAC tenant means is that at any particular moment, it is ok for your child to use a picture card when he asks for juice, use a word approximation the next time, and lead you to the refrigerator the next. ASD kids seem to come into each moment with a different set of supports and challenges from the last. So, we have to be open to whatever mode of communication our kids have available…now! To stay with the juice example, we would be wise to keep in mind that a child is most likely to come out with a new word when he is motivated, but not in dire need of it. When he is really hungry, and needs the word "juice" the most, he is likely to scream or cry or fall asleep, but not retrieve, or 'find' the word. As we continue with Thomas' story in the next columns, you will see how, over the years, he has self-selected his own modalities for the varying conditions of his life!

Let's pause here for a little background information, and a few definitions. If you have been reading this column regularly, you know that our kids' communication takes place in several contexts at the same time. You may want to review some of our earlier topics: how language develops for our kids, how language retrieval compares with language development, how dyspraxic speech on the spectrum can be supported, how intentionality can be recognized in our kids' communication, and how you can help make your child's communicative attempts successful.

We have many communication goals for our kids. We want them to communicate effectively with others. We want them to comprehend and use language. And we want to give them the opportunity to become effective speakers. But communication does not equal language, and language does not equal speech. Each is a process of its own. Most communication doesn't even involve language; it's more about the nonverbals, and the vocal tone. And language doesn't have to involve speech. As long as it's about words, it's language, whether it's written, typed, or finger spelled. Even though words are combinations of arbitrary phonetic symbols that can be spoken with sound, they can be just as successfully written as sequences of corresponding letters.

How does all this matter in augmented communication? Well, sometimes we care, and other times we don't care, if our augmentation is language or not. When children are young, we routinely augment language comprehension with non-language elements, like real objects and pictures. But even the picture that's worth a thousand words is not a 'word' because it does not contain phonetic structure. In its purely illustrative state, it can't promote phonetic understanding. The same limitation is true of most signs. They may mimic the item they represent, be conceptually symbolic, or sometimes include a critical sound in the word. But, finger-spelling aside, signs are generally not phonetic language.

Eventually we need to bridge back to words if we are to promote language development. Pictures and signs worked as a conceptual bridge in the first place, but as children grow, we need to add written words and phonetic structure to our augmentative signs and symbols, by turning our visuals back into the words they illustrate and represent.

But that's a story for next time… Until then, you have lots of food for thought, and a few 'words' to live by. One of them is 'augment', itself, which means 'to make greater'. As you realize the 'augmentations' you naturally use with your child already, please know you are making your impact greater in the process, and helping your child's development to be 'greater' as well!

Call quote: We have to be open to whatever mode of communication our kids have available…now!