Workshop in Benalla, Victoria

1. Creating Opportunities for AAC
Use: All Day, Every Day

2. Charlene Cullen
Inclusive Technology Consultant
Speech Pathologist

3. Tell me about...
• What you have communicated so far today
• How you communicated
• Why did you communicate?

4. Communication helps us to
• Chat
• Get what we need and want
• Enhance our lives
• We can.. greet, comment, make requests,
protest/reject, give opinions, answer questions and
more!

5. AAC
• People with complex communication needs use
augmentative or alternative communication
(AAC) strategies

6. What is AAC?

7. Augmentative and Alternative
Communication (AAC)
• Augmentative Communication uses other forms
of communication (e.g. pictures, gestures,
signing) with speech
• Alternative Communication uses other forms of
communication instead of speech

9. What AAC strategies have you used?

10. Unaided and Aided AAC
• Unaided AAC: All techniques that do not require
any physical aids
• Aided AAC: Techniques where some type of
physical object or device is used. Aided AAC is
often divided into high technology or low/light
technology systems.
(Speech Pathology Australia AAC Position Paper 2004)

11. Unaided AAC

12. Aided AAC
• Messages (words, phrases, sentences) are
symbolically represented as photographs, line
drawings, tangible objects or letters/words.

13. Low/Light Tech AAC

14. High Tech AAC
• Custom Speech Generating
Devices
• Mainstream Technology
• iPod touch/iPad
• Android Phones/Tablets
• Laptops

15. AAC Myths and Legends
• Will stop someone from developing speech
• Low tech before High tech
• Has a little speech so doesn’t need AAC
• Too cognitively impaired
• Will fix all communication difficulties
• No need, as person can express basic needs

16. AAC Myths and Legends - Resources
• DynaVox Implementation Toolkit
http://www.dynavoxtech.com/implementation-toolkit/l
• Romski, M.A. & Sevcik, R.A. (2005).
Augmentative communication and early
intervention: Myths and realities. Infants &
Young Children, 18:3, 174-185.
• YAACK http://aac.unl.edu/yaack/

17. AAC Myths and Legends - Resources

18. So how do we introduce AAC?

19. Good practice approaches
• Aided Language Displays (ALDs)
• Engineering the Environment
• PODD
• Core Vocabulary
• CHAT Now

20. Aided Language Displays

21. Aided Language Displays
• Use a teaching method called Aided Language
Stimulation
• Requires modelling language using aided
symbols
• Individuals learn to communicate in the way they
experience the system of communication being
used

22. Let’s have a look

23. Aided Language Displays
• No one would dispute the fact that it would be
very difficult to become a fluent speaker of
French, if your instructor seldom used French in
your presence.
• Likewise, it is difficult for a nonspeaker to
become a proficient AAC user if other people
never model interactive use of their system
during all aspects of the day.

24. Aided Language Displays
• Prospective users must be provided with
frequent examples of interactive, generative use
to acquire any semblance of proficiency.

25. Have a go!

26. Aided Language Displays
• Aided Language Displays are NOT choice
making boards.
• Choice making boards supplement ALDs.
• E.g. during lunch time there is a choice board for
foods followed by lunch conversation board

27. Lunchtime ALD

28. Aided Language Displays
• If an individual is to gain proficiency in using
their aided AAC systems, others must begin to
use the AAC system to communicate with them.

29. Creating ALDs

30. Choosing activities for ALDs
• What happens across
the day?
• How frequently does it
occur?
• What activities are
motivating?

31. Aided Language Displays
• If you cannot use a communication system or
display throughout an interaction then how can
you provide modelling?
• If you cannot use it, is it designed well?

32. Choosing messages for ALDs
• Should enable you to keep a running
commentary of an activity.
• Should always be messages that the user could
“say”.
• 16 - 36 messages per activity
• Write them down and rank them

33. Food preparation – word based
1. Let me 13. Careful 25. Burn
2. More 14. Finished 26. Hurry
3. Get 15. Turn on 27. Set the timer
4. Open 16. Turn off 28. Cold
5. Put in 17. Hot 29. Cook
6. Stir 18. Look 30. Cut
7. No, don’t 19. Smell 31. Where
8. Yuck 20. Pour 32. What?
9. Uh oh 21. Make 33. When?
10. Taste 22. Spill 34. Please
11. Take out 23. Bowl 35. Spread
12. Good 24. Spoon 36. Close

34. Food preparation – Phrase/Sentence based
1. Let me 13. It’s hot 25. It’s done
2. Put it in 14. This is fun 26. Turn it off
3. Open it 15. Tastes yummy 27. Wanna save it for later
4. Turn it on 16. Not done yet 28. It’s your turn
5. Need some more 17. I know how 29. Help me please
6. No, don’t! 18. Take it out 30. Smells good
7. It’s yuckie 19. That’s too much 31. My mum makes this
8. Uh ohhh 20. I think it’s burning 32. It’s all gone
9. Be careful! 21. That’s my favourite 33. What a mess!
10. You forgot! 22. It’s not your turn 34. It’s cold
11. Is it done yet? 23. Can I take some home 35. Close it
12. That’s enough 24. Don’t forget 36. Gotta clean up

35. Words or phrases on ALDs?
• Cognitive level of the user
• Language goals
• Selection technique
• Time dependent nature of the activity

36. Have a go!
• Choose a motivating high
frequency activity
• Fold paper to 4 x 3 grid
• Design an ALD
• Remember to include
vocabulary such as names,
actions, positions, requests,
commands....

37. Software for making ALDs
• Online:
• http://connectability.ca/visuals-engine/
• http://mrsriley.com/home
• Boardmaker Software Family
• Matrix Maker

38. www.boardmakershare.com

39. Selection Technique
• Finger point, Fist point, Eye point, Head pointer,
Scanning
• Must not be too physically taxing
• Can work on a new technique in other activities
while an easy technique is used for
communication

40. ALD format
• 9 cell, 12 cell, 16 cell, 32 cell, 36 cell etc
• Matrix or horse shoe

41. Meaningful learning
• Often we teach in stimulus response activities
eg. Find the shoes, find pants
• Need to teach in contexts that allow the adult to
see symbols being used
• repeatedly
• interactively
• and generatively during meaningful activity

42. Meaningful learning
• By modelling how to use a display to initiate and
maintain communication, you show the adult
how to initiate and maintain – not just respond!

43. Meaningful Learning
• May help to “script” activities
• Needs to occur at least 80% of the time
• Slow and a few concepts to begin with, gradually
increasing in speed and complexity.

44. Engineering the Environment
• Storage
• Must be stored in close proximity to where they are
needed
• Must be stored in a way that helps with quick access
and set-up
• E.g. on back of bookshelf, on walls, cupboard doors,
on tables, inside the recipe folder, on kitchen pin up
board

45. Engineering the Environment

46. Engineering the Environment

47. Pragmatics
• Pragmatics – social use of language
• Using language for different purposes, such as
greeting, informing, demanding, promising,
requesting
• Changing language according to the needs of
the listener
• Following conversational rules
www.asha.org

48. Pragmatics
• Need to ensure AAC users have access to and
know how to use a range of pragmatic skills
• Dewart and Summers “Pragmatics Profile”
(1998)
• http://wwwedit.wmin.ac.uk/psychology/pp/

49. PODD
• PODDs have been developed over the past 15
years by Gayle Porter, a speech pathologist with
the Cerebral Palsy Education Centre (CPEC) in
Victoria. Each PODD format has been shaped
by the experiences of both children with
Complex Communication Needs (CCN), and
their communication partners.

50. PODD
• PODD is a way of organising
whole word and symbol
vocabulary in a
communication book or
speech generating device to
provide
immersion and modelling for
learning.

51. PODD
• The aim of a PODD is to provide vocabulary:
• for continuous communication all the time
• for a range of messages
• across a range of topics
• in multiple environments.

52. PODD
• PODDs can have different formats, depending
on the individual physical, sensory and
communication needs of the person who will use
it.

53. Let’s have a look....

54. Core Vocabulary
• Using common English words on an AAC
display to enable a user to construct their own
sentences.
• Approach used in lots of high tech systems but
not used as much in low tech due to difficulty of
arranging vocabulary for access.

55. Core Vocabulary
• FRINGE VOCAB • CORE VOCAB
• Low frequency words • High frequency words
• Only useful in one or • Can be combined to
two situations get your message
• Often related to a across in lots of
specific topic different situations

56. Core Vocabulary

57. Core Vocabulary
•WordPower 24 in TouchChat, AAC App

58. Core Vocab to supplement ALDS
• From the Disability Services Commission WA
http://www.boardmakershare.com/Activity/969086/Core-Vocabulary-Display

59. Speak for Yourself
• Uses core vocabulary
• 13,000 words and only up to 2 key
presses
• Gives user enough language so that
language development isn’t held
back
• Allows enough language for good
modelling throughout the day

60. CHAT-Now
• General interactive multi-level

61. Technology

62. High Tech and Light Tech
• Both are just tools
• Both need good vocabulary design and good
modelling to ensure success
• High Tech can be less forgiving but can offer
more access options
• Some students more motivated by high tech and
some don’t like it!!
• Most people need both – for different situations

63. Speech Generating Devices
• DYNAMIC DISPLAY • STATIC DISPLAY

64. Static Display
• May be more durable
• Generally cheaper
• Often run off AA or AAA batteries
• Overlay based - require Boardmaker or other
tool
• Need to work out system for storing and
changing overlays
• Need to ensure vocabulary is updated
• Harder to maintain in many ways

65. Dynamic Display
• May be more durable
• Usually rechargeable
• Tools for generating pages in device – and
sometimes in free software too
• Can change vocabulary on the spot
• Can change pages and levels easily
• Generally offer a wider range of access options

66. Access Options
• For a user who need alternative access, SGDs
can offer:
• Large range of access options
• Flexibility
• Complete control over device and other software

67. Mobile devices

68. What’s a good app?
Many AAC apps don’t reflect good practice
• 20% AAC apps are category based apps
• Some don’t include speech
• Some app manuals advise use of the app a
couple times per week until competence
improves

69. Apps for AAC
http://www.spectronicsinoz.com/article/iphoneipad-apps

70. Apps for AAC
• Tap Speak Sequence
• Tap Speak Choice
• Scene & Heard
• Touch Chat HD
• Verbally
• Predictable
• RIDBC Auslan Tutor

71. Access
Blue2 Bluetooth Switch Switchbox Switch4Apps
By Ablenet by Therapy Box by Pretorian

72. Access

73. Accessories

74. Let’s have a look

75. Have a look!
Think about:
• Vocabulary
• Ease of programming?
• Access options
• Portability and size
• Try programming a message
• Who might benefit from using it?
• What situations could you use it for?

76. InterAACtion Manual and CD
• resource is for people who live
or work with adults who have
communication impairment
• Ideas for age-appropriate
communication ideas
• Templates and steps to develop
your own communication aids

77. Communication about the individual
• About Me Books/Communication Passports
• Personal Communication Dictionary

78. About Me Books
• Also known as Communication Passports
• For support people
• Gives information about how the person likes to
be supported during daily routines
• Useful for exchanging information about an AAC
User between others
• Often not a tool used by the AAC user directly

84. Communication Passports
• Template available from CALL Centre Scotland
• www.communicationpassports.org.uk
• iPhone App coming soon
• Also from SCOPE UK at
http://www.scope.org.uk/help-and-information/publica

85. Apps to create Passports
• Pictello, Creative Book Builder,
Click n’ Talk, Story Patch
• Encourage AAC User to participate
in creating the book
• Model using it multiple times
• Keep low tech back ups too!

86. Personal Communication Dictionary
• A Personal communication dictionary records
and suggests meanings for the unique gestures,
body language, facial expressions, and
vocalisations of people who appear not to have
any formal method of communication

87. Personal Communication Dictionary

88. Additional AAC options
• Community Request
Cards
• Chat Book/ Personal
Storytelling
• Small Talk
• Social Scripts

89. Community Request Cards
• to request a service or object
• only need to have a “passing”
behaviour
• Use large print for easy reading
for communication partner and
symbol for person who uses
AAC
• Must be self explanatory
• Specific to person and situation

91. Community Request Card apps
• Most of them can be used this way if they are
editable
• TapSpeak Button, TapSpeak Sequence and
Scene & Heard etc

92. Social Communication
• Social communication is a BIG part of our
day.
• We use different forms of social
communication – small talk, storytelling,
greetings, wrap ups and farewells.

93. Social Communication
• Social communication is more than 50% of our
daily conversation.
• Light (1998) found that reasons for
communication between adults were (in ranked
order)
• Social closeness
• Social etiquette
• Information transfer
• Wants and Needs

94. Small Talk

95. Small Talk
• A type of conversational
exchange used for
initiating and maintaining
conversational interaction.
• Some conversation never
progresses beyond small
talk e.g. at a cocktail party.

96. Small Talk
• Small talk is used as a transition between the
greeting and information sharing stage, especially
when people don’t know each other well or don’t
possess a lot of shared information.
• Small talk is often the first step towards social
closeness.
• There are even websites to teach you how to small
talk

97. AAC Users and Small Talk
• Many AAC users use little or no small talk
• This can be because
• They don’t have access to small talk in their communication system
• They don’t see the need for it
• They think it is a waste of time.
• Light and Binger (1998) found that AAC users were
seen as more intelligent, valued and competent
communication partners if they used small talk.

98. Generic Small Talk
Generic Specific
• people can use with a variety Small Talk Small Talk
of different conversational How is your How is your
partners because it doesn’t family? wife?
refer to specific shared What’s What are
information. happening? you doing?
• Particularly effective for many Don’t you Nice
AAC users as it has many look nice! haircut.
She’s She’s a
different uses. great. great
teacher.

99. Generic Small Talk
• researchers looked at the frequency and types of
generic small talk used by speakers of various ages
without disabilities.
• 3 – 5 year olds - 48% of all utterances at both home and pre-
school/school were generic small talk
• 20 – 30 year olds - 39% of all utterances were generic small talk
• 65 – 74 year olds – 31% of all utterances were generic small talk
• 75 – 85 year olds – 26% of all utterances were generic small talk

100. Generic Small Talk
• Most of the age groups used continuers as the
most common form of small talk eg. Really? Yeah?
Great! Cool!
• Some words were specific to certain age groups
e.g. “bummer” used only by the 25 – 35 year olds
• Differences also based on friendship groups,
geographical location, interests and life
experiences.

101. Small Talk and Mealtimes
• Balandin and Iacono (2000) tried to script the
content-specific vocabulary needed for
mealtimes for an adult in the workplace
• In this situation, the only predictable thing was
small talk (and often sports after the weekend!)

102. Adult Generic Small Talk
Try it out…

103. Adult Generic Small Talk

104. George’s Small Talk

105. George’s Small Talk
• Young man with athetoid cerebral palsy
• Attends a day centre for adults
• Uses a device but only uses the spelling page
• Controls communication device with a head
switch

106. George’s Small Talk
• Over 20 other people with disabilities and 6 staff
attended George’s centre, most of whom talked
• George rarely used his device during the day
• Staff requested a review of his device because
he didn’t “ever” use it

107. George’s Small Talk
• A speech pathology student observed him in two sessions.
He “used” his device constantly but only spoke with it twice
• She observed that by the time he had formulated a
message the conversation had moved on and he erased
and moved onto a new message
• A two pronged approach was used
• A conversational topic was established before each group e.g. “What
are your favourite films?” and then George could compose
messages in advance
• A small talk page was programmed and George practiced using this
in one-to-one and then small group conversation

108. George’s Small Talk
• At the end of 8 weeks the same speech pathology
student observed George in the same two sessions
• George used his device 46 times - 5 of these were
topic setters, 41 were small talk continuers
• Several other people in the centre commented
spontaneously that “George was much cleverer
than they thought” or that “They enjoyed talking to
George much more”

109. Fat Cat Snappy Chat
• One of a series of apps
• Addresses areas of weakness in
AAC systems or that AAC users
don’t use
• Small Talk in Snappy Chat
• Communication Breakdown in
Chat Repair
• Useful in combination with other
systems not stand alone

111. Sequenced Social Scripts

112. Sequenced Social Scripts
• Sequenced social scripts can really help a user
to
• Get a 'feel' for the anatomy of a conversation
• Develop turntaking skills
• Learn to interact with a variety of partners
• Enjoy successful interactions

113. What are Social Scripts?
• support individuals in learning to claim, start,
and maintain turns in a conversation
• Also called Participation Scripts
• Much of the information in this section is taken
from “Can We Chat? Co-Planned Sequenced
Social Scripts: A Make It / Take It Book of Ideas
and Adaptations” by Caroline Musselwhite and
Linda Burkhart

114. What are Social Scripts?
• Social Scripts are interactions such as joke-
telling, sharing life stories and general
conversations
• They help persons using AAC move beyond
wants and needs to using 'real' communication
for conversational purposes
• Often give developing communicators a sense
of the power of communication

115. Anatomy of a social script
• Attention getters
• Starters
• Maintainers, holders and interjections
• Turn transfers
• Closings

116. Attention Getters
• These are the phrases that start an interaction
and make sure that someone is ready to listen
• Creative attention getters can motivate a listener
to be interested in hearing more
• They can also change perceptions of others
about the person who is using the script, by
conveying, humor, age appropriateness, and
initiative
• AND they can be very motivating to use!

117. Hey, you guys
Waz up
Dude
Yo
Helloo
Come here
Let’s talk

118. Starters
• Once attention is gained, starters set the stage
for what the person will be talking about
• Setting the context further prepares the listener
and allows the person to take charge of the
conversation
• Like attention getters, creative starters pique the
interest of the listener and often get a natural
response that encourages the person to go on
and tell the story, complete the joke, etc.

119. Guess what I did?
I have a secret!
Wait till you hear what I heard!
You won’t believe this
Did you see the game?
I’ve got something to show you
Wanna hear a joke?

120. Maintainers, Holders and Interjections
• Phrases such as "Shall I give you a hint?", "You
know what happened next", "You will never
believe what she said after that“ etc.
• Allow the person to add interest to the basic
story line while maintaining control of the
conversation
• They also prompt the listener to make
comments and naturally encourage the person
to tell the rest of the story

121. It was so funny
Guess what happened next?
Wanna hint?
I hate that!
Can you guess?
I’ll give you a clue
It was so embarrassing
And then it got even worse

122. Turn Transfers
• After the person has communicated his story, or
sometimes in the middle of a longer story, turn
transfers invite the listener to comment or give
their opinion
• They give the person the power of turning the
conversation over to a partner, without ending
the conversation

123. What do you think?
Isn’t it amazing?
Can you believe it?
You won’t tell anyone will you?
How about you?
Is that amazing or what?
What did you see?

124. Closings
• Closings allow the person to take the initiative of
ending the conversation
• It helps the listener and also avoids that
awkward feeling of “well is that all?”
• Again the person’s personality and humor
comes through in the choice of closings used
• Often several closings in sequence are
appropriate, because people typically take
several turns when finishing a conversion

125. Nice chatting with you
Enough about that
What have you been up to?
Catch you later
Can you find someone else for me to tell
about this?
Hasta la vista baby

127. TapSpeak Sequence
• Opportunity for quick errorless communication
• Jokes
• News
• Cheering at sports events
• Gossip
• Messages
• Interviews etc.

128. Have a go!
• In pairs pick a topic e.g. Joke, prank, gossip,
message
• Generate a sequenced social script
• Find another pair and try your script out

129. Personal Storytelling
• As we get older the percentage of small talk
decreases and the percentage of storytelling
increases
• Older adults, in particular, use stories to entertain,
teach and establish social closeness with their
peers

130. AAC and Storytelling
• Storytelling with AAC systems has become
practical and possible with improved technology
• However, we must be careful that the stories are
ones which the person would choose to tell
• Storytelling is very personal and must be
individualized

131. Alexicom Elements Story Maker
• We build social closeness
through storytelling
• We use stories to identify
people we might want to be
friends with
• This app allows storytelling on
the fly – easy to add pages as
you go between

132. Michael’s Storytelling
• Michael is a young teenage boy
• Lives with his Mum, Dad and
brother in Perth
• He has intellectual disability
• He uses gestures, words, sounds,
facial expression and a Maestro
for communication

133. The Royal Show

134. The Royal Show
• 1 We went to the Royal Show
• 2 I like to go up the Ferris Wheel
• 3 I petted the baby animals
• 5 The Katich family came with us too
• 6 Daddy & I went on the bumper cars
• 7 We watched some people chop wood
• 8 Mummy bought us some fairy floss
• 9 Fireworks
• 10 Money
• 11 We had to buy some tickets
• 12 We had something to eat

135. Sarah’s Storytelling

136. Sarah’s Storytelling
• In her forties she was in a motor vehicle accident and is now
a quadriplegic
• She has a good understanding of spoken English but very
limited expressive communication, including very little facial
expression
• She has control of a single switch with her left thumb, but
tends to fatigue quickly, although her stamina is increasing
• She has a multi-level communication book which she
accesses with eye pointing

137. Sarah’s Storytelling
• She has a range of in-house care staff who tend
to stay around for between 5 months and 3
years
• Many of these staff assume she doesn’t
understand what is said to her because she
doesn’t give body language feedback

138. Sarah’s Chat Book
Inside this book are some of my photos.
The writing tells you about them. The
questions are things I am interested in
about you. Please read out the writing and
the questions and we can find out about
each other together - but be warned - it
might take more than one visit!
Sarah

139. This is the first decent photo of me - sitting at the piano
when I was 11 like a good girl! You won’t see that often.
•Did you learn an instrument? If so, what was it?

140. •Me and my cat in 1955. I’m the one on the right.
•Did you have a pet as a child. If so, what was it?
•What was its name?

141. •The wedding day - myself and Pete.

142. •Peter loved sailing. This was a fantastic day. It would have
been sometime in 1984.
•Have you ever been sailing? Do you like it?

143. •On the 12th of July 1985, Pete and I were hit by a car as
we were walking to a restaurant for dinner
•My life completely changed after that. Pete died as a
result of the accident and I am now severely physically
disabled
•Pete and I had over six wonderful years together. I still
miss him very much as you can imagine
•Luckily, I have many great friends and they, and my own
determination, have helped me to keep going

144. Sarah’s Chat Book
• Sarah’s chat book has completely changed the way
staff see her
• Each new staff member sits down and goes
through the book with her over a few different
sessions
• They realise how interested Sarah is in them and
they gossip with her more and it gives them topics
to talk about that they think will interest her

145. Other Resources
• Practical AAC
http://sites.google.com/site/praacticalaac/
• AAC Rerc
http://aac-rerc.psu.edu/
• Delicious
http://www.delicious.com/chacullen/AAC
• Twitter
#aacapps #augcomm #TweetAAC #assitivetech #SLPeeps
• Facebook
Augmentative Communication Resources and Help
Assistive Technology
• http://www.scopevic.org.au/index.php/site/resources/communicationaids

146. W ant to learn m ore?

147. Spectronics Free Emailed Update Service!
www.spectronicsinoz.com

148. Spectronics Online Training Services!
www.spectronicsinoz.com/onlinetraining