Finding
the Words Nov - Dec 2008
Finding
the Words…with augmented communication!
Part 4
Hello
again, dear reader. I've thought about you many times this fall, and hoped that
you and your child have had some fun, and some success, with the augmentative
communication you have used together! I hope you've identified ways your child
lets you know what he loves: earmarked the page of a favorite book that marks
nighttime, or recorded a smile that means 'I love you' in your child's book of
communication!
When I
left you last time, you had written several chapters about your child, starting
with his favorite things in Chapter 1. In Chapter 2 you noted how your child
indicates his desires, and you learned that these actions are his 'modalities'
of communication!
You
were beginning the third chapter of your child's book when we left off. We had
just described some of the important modalities used by one little boy: eye
gaze, facial expression, body orientation, manual manipulation, and vocalizing.
With these five modalities, our young Russel could communicate that he loved
automatic doors, and tight-fitting lids, that he could put together the
alphabet, that he intensely disliked any letters being missing…and much more.
Russel was on his way to using spelling, writing and typing as speech
augmentations, and his language flourished once he could assemble letter
combinations that created words!
Please
pause for a moment and think of one of your own child's loves… How did you
learn he loved it? How does your child show you? You are in the middle of an
AAC assessment right now…and I want to help you keep it going!
So
let's consider another child, and another set of modalities. As a toddler, Lee
always carried around a book or a favorite picture. He was especially
interested in colors, and toted around newspaper ads if the color scheme was
right. Carrying pictures from place to place, Lee would hand us one he
especially liked. Developing a picture communication system for Lee seemed
natural as the next step in augmenting his communication.
Lee
was dyspraxic, so 'motor planning' speech he'd never said before only happened
when Lee was well supported (See When Speech Gets Stuck, Autism Asperger's
Digest, Sept-Oct, and Nov-Dec, 2004). Of course, we supported Lee physically
and emotionally, but pictures were Lee's best support for talking! When he was
comfortably engaged with pictures, Lee could access messages that were
difficult-to-impossible otherwise.
Lee
could also use a whole hand point, which along with some nice manual gestures,
gave us a good indication of what was on his mind. His strong eye contact was
his fail-safe, as he could hold a gaze until his intentions were understood and
acknowledged! Over time, the use of pictures developed the most, and Lee learned
to use pictures to trigger more precise communiqués. They remained his best
modality for some time, while his reading developed, and his speech access
continued to become easier.
We
want to return to your child's Chapter 3, but first, we have one more
illustrative story. Diego is a boy with
severe vocal dyspraxia, and highly restricted voice access. He likes to sign a
little, and has been taught a few signs that he uses periodically as part of
his smorgasbord of communicative options. Diego also enjoys his voice-output
device, where activities he likes are represented with line drawings. Diego
also loves to reference other media, and will play movie clips he's found on
the Internet to communicate his social interests and messages. Lately, Diego
has also begun to draw, and this has become the flexible modality he prefers.
Starting with the line drawings on his voice-output device, Diego began
modifying them to better match his intentions. His favorite symbol, 'tickle',
now communicates what he prefers: '3, 2, 1 tickle'! Diego knows that more
proprioception, more fun, and more alerting lead to easier speech access!
Diego's AAC thus serves as 'alternative communication' when he can't access
speech, and 'augmentative communication' (and a speech trigger) at others!
Now
let's look at our list of modalities:
• eye gaze, facial expression, eye
contact
• body orientation, manual manipulation,
picture referencing
• pointing, manual gesture, signing,
drawing
• spelling, writing, typing
• vocalizing (including crying,
laughing, using intonation)
• referencing with other media
Yes,
dear reader, you now have the tools to look at each of your child's
communicative attempts and communicative successes, and figure out the
'modality' of each! Your Chapter 3 can really take off, and you can note which
modalities your child prefers, which he is best at, and which are used in a
variety of situations. Please take some time now to jot down some thoughts, and
then we will move on to Chapter 4.
Done?
OK. Now let's consider Chapter 4 – Modalities my child might develop. In this
chapter, you will select one or more of your child's modalities to further
develop. Please know that Chapter 4 is an exploration, not a decision. You might
consult your SLP, OT, or family friend to help you think it through. You are
never locked into an idea if it doesn't work well. Remember to look back at
your Chapter 3 often, and think about modalities your child is already using
successfully! This will help you restart when you need to!
Here
are some possible scenarios:
• You can try pictures if your child
relates well to them. You might take photographs of some of your child's
favorite things, and see if he can use them to make simple selections. One
caveat is to use these photographs in a true 'augmentative' fashion, however.
If favorite movies are routinely stored in a closet, for example, photographs
of them might be taped on the closet door, for use in making a selection. Try
not to 'require' your child to select a picture of something that is within his
easy reach or eye gaze. We don't have to use picture choices; rather, we can!
Let the modality work for you and your child, not the other way around!
• You might try manual gestures, and
talk to your OT about ways to increase reaching towards things, and pointing to
things that are within easy reach. Sign language requires some dedicated
attention to the use of the hands, and it will be helpful to you to have the
partnership of your OT and SLP, should you decide to try this option,
• You might also try spelling with
letters, if your child seems to have an early interest in how things are
spelled. The advantage of the written word is that it represents speech, and is
an automatic bridge to the spoken word…but that is a story for next time. …
Suffice
it to say that you have many options. Please remember that AAC is about
communication, so it works only when it is the best way for communication to
occur. If your child has already said it, or gotten it, for example, then it is
communicatively pointless to select the option from an array of pictures!
Please remain open to possibilities, and flexible enough to recognize
communication whenever and however it happens. …
All the
best to you this fall, and we will look forward to continuing our series with
concluding remarks next time!
Marge
Blanc, M.A., CCC-SLP founded the Communication Development Center, in Madison,
Wisconsin 10 years ago. Specializing in physically supported speech and
language services for children with ASD diagnoses, the Center has successfully
helped scores of children move through the stages of language acquisition. Read
more about their work at www.communicationdevelopmentcenter.com or email Marge
at lyonblanc@aol.com.
.