AUGMENTATIVE COMMUNICATIONS

Imagine Giving a Voice to Someone with Autism Who Can Not Speak

Table of Contents:

A typicallydeveloping child uses many single words before putting words together. You can use Brown's stages of language development as a guide.

Giving a Voice to Someone with Autism Who Can Not Speak

individuals diagnosed with autism are unable to verbally express feelings, thoughts and needs.  Their struggle to communicate even the most basic needs through gestures, facial expressions and body language can be frustrating and frightening to these individuals and their families.  The inability to communicate effectively often presents a barrier to learning and literacy and creates significant obstacles to social and emotional development and independence. Augmentative and Alternative Communication (AAC), also frequently called Speech Generating Devices (SGDs) or Voice Output Communication Aids (VOCAs), are devises that can provide a bridge from a life where thoughts, feelings and needs are held in silence, to a life where interaction, expression and learning are possible.

“Augmentative communication devices and strategies help us understand that many people with autism have a broad range of feelings, interests, opinions and keen intellectual capacities,’’ says Karen Kaye-Beall, director of the Augmentative Communication Showroom and Demonstration Center in Silver Spring, Md., where people with autism and their families can try out a wide variety of speech generating devices. “At their deepest core, people with autism are loving people who want to have close relationships with others. They just find it extremely difficult and confusing to express the thoughts and feelings that are locked up inside. Thus, developing and maintaining friendships is very challenging and people with autism can often feel lonely and isolated as a result of their disabilities. People often misunderstand this and believe that individuals with autism want to be alone. In many instances, that is simply not true.”

 

Why does Augmentative and Alternative Communiation (ACC) work so well for people with autism?

In a leading book on AAC by Joanne Cafiero, PhD, Meaningful Exchanges for People with Autism, www.woodbinehouse.com, Dr. Cafiero talks about all the ways AAC fits people with autism well (page 26)

  • Most people with autism are visual learner - AAC uses visual cues
  • Many people with autism are interested in inanimate objects - AAC tools and devices are inanimate
  • Many people with autism have difficulty with complex cues - Level of complexity can be controlled so AAC grows with the child
  • Many people with autism have difficulty with change - AAC is static and predictable
  • Most people with autism have difficulty with the complexities of social interaction - AAC provides a buffer and bridge between communication partners
  • Some people with autism have difficulty with motor planning - AAC is motorically easier than speech
  • Many people with autism experience anxiety - AAC interventions don’t apply pressure or stress (when introduced properly)
  • Many people with autism present behavioral challenges - AAC provides an instant means to communicate, preempting difficult behaviors
  • Many people with autism have difficulty with memory - AAC provides means for language comprehension that relies on recognition rather than memory.

On page 33, Dr. Cafiero lists the benefits of AAC for individuals with autism:

 

  • May stimulate brain development
  • Supports functional spontaneous communication
  • Facilitates access to social information
  • Facilitates inclusion at home, school, and community
  • Facilitates greater independence in the home, school, and community
  • Facilitates access to literacy experiences
  • Preempts the need to develop aberrant communicative behaviors (reduces meltdowns)
  • Provides voice and ears to people with autism, including psychological benefits of better understanding others and being understood
  • Facilitates an improved sense of self concept due to greater independence and fewer outbursts

Is an augmentative communication device only appropriate for people who are non-verbal?

Speech Generating Devices (SGDs) are programmed to provide a functional and effective vocabulary for any individual with communication problems, regardless of age or diagnosis.  There are no cognitive, behavioral, or language prerequisites required for most augmentative communication interventions. Nearly anyone can benefit from augmentative communication tools and strategies. 

SGDs are intended to enhance existing functional communication by:

1) Clarifying vocalizations, gestures, body language, etc.

2) Expanding the language of limited speakers by increasing their vocabulary to include verbs, descriptors, exclamatory comments, etc.

3) Replacing speech for people who are nonverbal;

4) Providing the structures and tools to develop language.

How do augmentative communication devices work?

With SGDs, a communicator just touches a labeled icon (which may be a Picture Communication Symbol or some similar graphics) on the display screen of the device, and the device will say out loud, the word, phrase, or sentence that the individual intends to express.  You can set the “synthesized” (computer generated) voice to sound like a boy or girl, or a man or woman’s voice.  You can also record your own voice or someone else’s voice and this is referred to as a “digitized” voice recording.  Communicators need to begin to communicate words and phrases that are most motivating and reinforcing to begin with, and gradually adding in more and more vocabulary.  Labeled icons (or buttons or cells) can be customized to each individual’s unique choices so that an SGD can be personalized and more closely express each individual’s wants and needs.  For example, if a person touches the buttons for “I am hungry”, the page may automatically change to display a full array of food and drink choices and condiments, as well as a wide variety of restaurant choices in the community.  By offering an array of choices, the communicator is not taken to Taco Bell, when he or she really wanted to eat at McDonald’s.  The communicator can choose mustard, rather than ketchup on their burger.  Little choices like these matter.

 

What are the ranges of topics an AAC user can communicate about using an augmentative communication device?

 

With consistent practice and depending on the capability and sophistication of the SGD, a communicator can potentially express nearly anything they will need or want to express. 

The basis of all communication is some type of language framework that must provide a vocabulary and that is appropriate for the communicator’s age and the multiple settings in which the person needs to communicate, such as at home, school, job sites, visits with friends and relatives and more.

As adults, we normally have a speaking vocabulary of between 10,000 and 30,000 words, but a “core” of just 100 words accounts for approximately 50 percent of words spoken.  Examples of such words include: I, to, you, the, that, have, a, it, my, and, of, will, in, is, me, on, do, was, etc.

Most of the more sophisticated, or high-tech Speech Generating Devices (SGDs) come already preprogrammed with 4000+ words and/or icons.  While there are variations between SGD vendors and devices to be sure, most provide preset vocabulary choices or pages to expand vocabulary that express:  Feelings/emotions; personal identifying information such as name, address and phone; names of family members, friends and other important people; actions of all sorts; possessions and toys for play; leisure activity choices including sports and music and more; places we visit in the community and geography; clothing choices; body parts and medical pages; calendars, clocks, holidays and special occasions; daytime, evening and weekend routines; arts and craft supplies, colors and shapes; commonly used social phrases such as hello, good bye, my name is, how much does this cost? etc;  There are also many “word group” pages that provide extensive vocabulary for specific classes, such as: Animals, dinosaurs, vehicles, furniture, appliances, utensils, hygiene, jobs and occupations, tools, money and more.  You can even tell jokes and riddles using an AAC device.

The ultimate goal of AAC is spontaneous, novel communications; the ability to access individual words, expressions and commonly used phrases; and to allow any individual at nearly any age, with any disability to say anything, talk about any subject, at any time.

 

where can I learn about the many different types of AAC Devices?

There are many hundreds of AAC devices that fall into four main categories: no tech, low tech, mid tech (low and mid techs often are referred to as Voice Output Communication Aids or VOCAs and high tech, often referred to as Dynamic Display Devices. No, low and mid tech devices are relatively inexpensive.  High tech devices can be very expensive. There are differing opinions and definitions as to what constitutes a low tech, mid tech or high tech communication system.

  • No tech: any communication system that does not require a power source
  • Low tech systems: Any communication system that requires a source of power and is very easy to program.
  • Mid tech systems: Any communication system that requires a power source and requires some level of training to adequately program and maintain the device.
  • High tech systems: Any communication system that requires a power source and extensive training to competently program and maintain the device. Typically these are higher priced with a few exceptions.
  • Text to Speech: Also (for the most part) belongs in the high tech category.  These key boards are used as AAC (speech generating devices) for those with good typing skills.   low cost alternative is the Fusion that costs under $450.00 www.keyboardinstructor.com

Most high-tech devices have touch screen keyboards that allow a communicator to spell out  words, and most have “word prediction” features, which means that after a communicator types in two or three letters of a word, several word choices pop up to choose from, and then all the person has to do is choose the word they meant to type and it provides a  typing short cut, and the entire word appears in the sentence.  Some devices even have word prediction memory and it remembers the words you type in most frequently, and provides those words amongst the first choices offered.

Elizabeth S. Rush, MA, CCC-SLP, CPM and Mary Joan McClure MS, CCC-SLP came up with what we feel is the quickest way to learn about nearly every device out on the market, without having to rummage through countless catalogs.  Go to www.aactechconnect.com and learn about their 14 day free trail on Device Assistant: providing information on close to 100 AAC devices currently on the market from major manufacturers. Information is provided in cooperation with all of the manufacturers.  A feature match tool providing side by side comparisons on almost 100+ AAC devices currently on the market from major manufactures.  Get up to 40 different specifications for each device.

 

Also see their Lite Tech Low Cost AAC Chart

There is information about 100 non-voice products and 250 voice  products on 67 downloadable pages.  Updated quarterly.  For a small cost, you will be able to download it for 30 days.  Includes:

  • non-voice communication tools
  • variety ofdigitized devices categorized by numbers of message keys
  • photos of each product
  • manufacturer/distributor information
  • features listed for each item
  • lists of client characteristics (i.e. individuals who might benefit from the item)

 

For those who love to rummage through catalogs to pick and choose, go to

http://www.aactechconnect.com/aacinfo.cfm for links to the major manufacturers of AAC devices. For those that want to see a chart that compares features of the major AAC devices, read this article and see the chart that follows the article:

Georgia Project for Assistive Technology – At Devices for Augmentative Communication for Students with Significant Cognitive Disabilities

If my child learns to use an Speech Generating Device (SGD), will they become overly dependant on the device to communicate and will they stop using the words and functional spontaneous communication they already have?

AAC is never used to replace existing functional language, but rather, to enhance it.  The SGDs and their programs are intended to increase, maintain, or improve a person’s ability to communicate by augmenting the skills he or she already possesses and providing alternative means when that degree of support is needed.  In a leading book on AAC by Joanne Cafiero, PhD, Meaningful Exchanges for People with Autism, www.woodbinehouse.com, Dr. Cafiero reviews various studies and concludes the following:  There is no research-based evidence demonstrating that AAC interferes with the development of speech.  Research indicates that AAC actually facilitates speech by increasing communication skills and interactions and provides verbal models for speech. Since SGDs usually have visual symbols and/or icons paired with voice output, this combination has been proved successful with people with autism to increase communication.  Case study research, although limited, shows that the more visual and verbal input received by a person with ASAD, the more expressive language he or she will generate.

Research and clinical practice has shown that AAC systems do not interfere with speech development. In fact, many children demonstrate an increase in language, speech and communication skills once an AAC system is introduced. Burkhart, L. (1993). Total Augmentative Communication in the Early Childhood Classroom. Eldersburg, MD:

Linda J. Burkhart. For ordering information contact: Linda J. Burkhart. In particular, see page 37: Augmentative Communication Techniques Can Reduce Pressure for Speech Production.  Proposed reasons for this include: 

  • Reduced pressure on speech production as the sole means of communication
  • Continued development of language skills
  • Continued development of conversational skills
  • Children will use the easiest method possible as their preferred means of communication. It is much easier for a child to use speech and/or vocalizations if possible to communicate than to formulate a message using an augmentative communication system

 

How much do these SGDs cost and will my private insurance cover the costs?

As mentioned before, the Device Assistant is available on www.aactechconnect.com and provider not only descriptive features of each device, but includes current prices of each device.  On average, for out of pocket costs for AAC, low tech devices go up to around $250 or less. 

The new hand held, powerful Proloque2Go http://www.proloquo2go.com can be loaded on an iPod or iPhone.  It costs just under $500 including the lowest level iPod, and the iMainGo 2 (handheld Speaker Case for iPod and iPhone which alone is approximately $40 on Amazon.com).

High tech devices can begin around  $2000 (RJ Cooper) but average between $7000-$8000 for PRC’s Vantage Lite or a Dynavox.  Most SGDs are covered or partially covered by one or more funding sources.  Leading SGD vendors provide funding specialists on their staff to help guide you through the various private insurance plan options and they also assist you through state-by-state Medicaid requirements for purchasing AAC. In Maryland, there is also a low interest loan program available for AAC through the MDAT Guaranteed Loan Program at 1-800-TECHTAP.  The Foundation for Autism Support and Training maintains an up-to-date price list for AAC devices and SGDs. Although FAST does not sell devices, we will refer you to vendors and coops who do sell these devices.

For additional information on insurance funding issues for AAC devices, go to the National Assistive Technology Technical Assistance Partnership (NATTAP) at http://resnaprojects.org/nattap/goals/other/funding/AACdevices.html

 

Where can I go to learn about and actually try out a variety of ACC devices?

The Foundation for Autism Support and Training (FAST) 301-260-2777 opened the first of its kind, AAC Showroom and Demonstration Center in Silver Spring, Maryland.  At no charge and by appointment, any person with autism in Maryland, or any family member of a person with autism may set up an appointment and come into FAST’s showroom and try out, learn about and play with a full range of the leading Speech Generating Devices in a relaxed setting.  Trained staff will be available to demonstrate devices, answer questions, and provide you with AAC reading materials to take home with you.

In Baltimore, there is another AAC showroom called the Maryland Technology Assistance Program. It is also free of charge and by appointment. Call Peggy Murphy at 1-800-832-4827.

Are there helpful websites about AAC strategies and topics?

There are many websites on AAC.  Here are just a few of our favorites:

YAACK

University of Buffalo, Assistive Technology Online Training Project (ATTO)

Georgia Department of Education

Quality Indicators for Assistive Technology Services

National Center to Improve Practice in Special Education Through Technology, Media and Materials(has videos of children using AAC)

American Speech-Language-Hearing Association

Speechville Express

 

Where can I receive advice, consultation and an AAC assessment on which particular SGD will best serve my child’s needs and where can I be trained on how to use a device?

AAC Assessment Model:  Most AAC professionals use the SETT Framework by Jo Zabala.  To learn about the processes involved in AAC assessment, go to:

The SETT Framework: An Assessment Process

In Maryland, most county school systems have departments of special education, and those departments have Assistive Technology (AT) Divisions.  Call your school system’s AT Division to set up an AAC consultation.  In Montgomery County, Maryland, call the Interdisciplinary Augmentative Communication and Technology Team (InterACT) at

(301) 657-4929. 

Private Services are also available through Kennedy Krieger Institute at 443-923-9200. 

The Foundation for Autism Support and Training (FAST) provides training for direct care technicians, special educators, parents, and SLPs on how to use SGDs.  FAST also maintains an up-to-date listing of AAC specialists in Maryland.  Call us at 301-260-2777.

For those enrolled in Maryland’s Autism Waiver, call the Speech, Communication and Reading Center (SCRC) at 301-260-2777 to find out about their comprehensive Augmentative Communication Program.  For Autism Waiver Coordinators who want to arrange an on-site AAC demonstration of leading equipment at your offices, call SCRC’s office number above.

Are there Speech and Language Pathologist jobs in Maryland where training is provided on AAC? 

FAST has competitive, part-time contracting positions for afternoons, evening or weekends. Training is provided.  Call FAST’s Augmentative Communication Showroom and Demonstration Center at 301-260-2777.

A typically developing child uses many single words before putting words together. You can use Brown's stages of language development as a guide.

 

http://speech-language-therapy.com/BrownsStages.htm

http://www.asu.edu/clas/shs/ingramd/shs465/stages.pdf

http://www.education.com/reference/article/acquisition-sentence-forms/

http://www.education.com/reference/article/acquisition-sentence-forms/

 

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