Finding the Words Jan – Feb 2009

Finding the Words…with augmented communication!

Part 5

Welcome to our final column on augmented communication! As we conclude this series, let's first review some of the guiding principles we've established along the way:

* AAC is a natural phenomenon, and one we adults employ every day. It enhances children's understanding of the world, and helps the world understand our children's thoughts and developing speech. Picture books, letters on the fridge…we use them all naturally - and so do children.

* AAC isn't just high-tech computers and voice output devices. It's also the words a child points to in a book; it's 'joint referencing' to the video case on the shelf a child 'points' to with his eyes; it's the selection of breakfast cereal a child makes by grabbing it; it's also the pouty look that comes when a toy is missing from the array presented to a child.

* AAC adapts to change: change in the circumstances and change in our children. If it's right for your child, it enhances communication at the moment - and bridges to speech and language development in the future. If adults don't get 'stuck' in one particular method or modality, we can make sure AAC remains all it can be as our children grow and mature.

In Parts 3 and 4 of this series, you were asked to think about your child's interests and learning style, and to write a book about your child to help in decision-making about AAC. Please review the exercises in these earlier columns, and, if you are new to this column, complete the exercises outlined there before continuing on. As you worked the exercises, you: identified what your child communicates spontaneously, and how he accomplishes this; identified your child's natural communication modalities; and selected certain modalities to develop as augmentations to your child's developing speech. Hopefully, during the last two months, you have tried out your child's personalized AAC, and now you are ready to evaluate your efforts.

In this final episode of our story, we want to help you think more about AAC as a bridge to your child's future communication. The more you are able to look ahead to where your child is going, the more you will be able to think of your child 'on the road to the future'. As you do this, you will select AAC that fits both the current situation - and helps point the way to the future. In this column, you will learn how to write the next chapter of your child's communication story: Chapter 5 – Planning for my child's future…AAC and beyond!

The first step is to write the Introduction to the chapter, by reframing your child's communication at the end of Chapter 4. Here are some helpful questions:

* Does your child continue to enjoy vocalizing? If you can say 'yes', please reframe your answer to, "Yes, my child is learning to talk" or simply, "Yes, my child is a speaker." Please remember - speech is a motor skill, and your child will continue to develop it for years to come. He has his entire childhood to do it! If your child isn't vocalizing as much, however, it might be that the physical supports for speech need to be increased.

* Does your child spontaneously use the AAC you helped him learn? If you can say 'yes', you might reframe your answer to, "Yes, my child's AAC is working." If he isn't using the modality you chose, it is time to look at introducing another to see if it is a better fit.

If you answered 'yes' to both questions, and your child is both a speaker and an AAC user, you are ready to expand both modalities…and ready for the next part of Chapter 5: Expansion. Here are some questions to get you going in the right direction:

* Is your child talking more often, knowing his speech will be supported and honored? If not, he might be concentrating on using AAC, with limited energy to support speech. You might need to build in some 'talking time' so your child knows how much you value his speech, and how you will continue to physically support and acknowledge it.

* Is your child using more than one AAC option to communicate flexibly and independently? If not, your child might need another option or two to use in different situations, making sure that at least one of them matches his cognitive maturity. Picture options may be adequate for limited choice-making, but once a child has the understanding to be a reader, written words can be introduced as one AAC option.

If you answered 'yes' to both questions, your child has a taste of both worlds: the viability of his developing speech, and the communicative usefulness of AAC. Your child can communicate some things with speech and some with AAC, and you are ready to begin bridging to his long-term future. AAC does not preclude speech development, but it takes focused effort to keep both moving forward simultaneously. Here are some questions for the third part of Chapter 5: Planning:

* Have you consulted an experienced Speech-Language Pathologist (SLP) who can assess your child's speech development over time, and help you set up your child's environment to support the stages of speech development? (See the article, "When Speech Gets Stuck" on our website.)

* Have you consulted an experienced SLP who can assess your child's language development over time? (See "Finding the Words: To Tell the Whole Story")

AAC does not preclude language development any more than it precludes speech development, but language must be addressed directly when a child is young. English is a phonetic language, not a pictorial or iconic one, so when a child is ready, he needs developmentally-appropriate exposure to the spoken and printed word. An experienced SLP can help you know how much time and effort to devote to speech versus language versus communication, and where AAC fits in. With a profile of your child's development, you will know better how to use your limited time and resources, and those of your child.

The fourth part of this chapter, Retrospective and Prospective, will not be written for some time yet. The question is a broad one, and demands re-thinking again and again:

* Is your child's communicative repertoire keeping pace with his social and intellectual interests, and his physical development? You might need to make sure he is developing a full repertoire of speech, written language, quick pictorial choices, as well as gesture. Remember to consult with your SLP (and OT) for re-evals along the way.

As your child matures, the mixture of communication/language/speech/AAC will change. You will be wise to anticipate this, and remember what the children in this series have taught us. Thinking back to the lessons of Russel, Lee, Diego, and Thomas, we will close this series with a 'retrospective' about Thomas. As you might recall, Thomas experienced precious moments of fluent speech access, separated by agonizingly-long periods of quiet. While his most memorable quotes have been highlighted in his own 'book of communication', his more common communiqués came in the words of his favorite video rewinds. Still other moments of communication were punctuated by gales of laughter and jokes repeated on his voice output device. Mundane requests on this device sufficed for mundane situations, but, being a 'real boy,' as Thomas pointed out, meant having access to all these modalities at all times. For Thomas, 'AAC and Beyond!' is a journey into the future, and it will be an exciting journey for your child too. We wish you all the best!