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- We are very, very lucky to have our presenter, Marie Sterling, with us today.

And Marie is joining us from snowy St. John's, Newfoundland.

So Marie's been working as a speech language pathologist in Newfoundland for 29 years now.

And the first eight years of her career she spent working in the healthcare field, primarily with preschoolers, and then for the last 21 years, she's been working in the education system with students from kindergarten through grade 12, and her primary focus has been on students in grades K to six.

Marie's worked with students with a variety of communication disorders, and has a particular interest and much experience working with students who have a diagnosis of autism spectrum disorder, and in the area of augmentative and alternative communication, which she's going to chat with us about today and share the benefit of her expertise and her experience as well.

- Okay, perfect.

So again, this session is on augmentative and alternative communication.

We'll go to the next slide, just carry on.

Few disclosures, I am not affiliated with any company that supports augmentative and alternative communication, and I don't receive any compensation for any of the materials or the resources that I mention.

And I just wanna make that clear because I do mention a number of resources.

So, in brief, in this session, we're gonna define augmentative communication, we're gonna review different types.

We're gonna look at how typically developing children learn language, and then how children using augmentative communication learn language, we'll consider our end goal for our AAC users, review some evidence-based strategies in terms of vocabulary selection, and then discuss some of the prerequisites for AACs, okay.

Quick introduction to me, as Shelley mentioned, I have been a speech language pathologist for the last 29 years, working primarily with children.

I did, at one point in my career, deal a bit with adults, but it was very marginal.

Really as my role as an SLP in the school system, I'm really a jack of all trades master of none.

So while autism has always been a keen area of interest for me, the augmentative communication piece of it is actually a more recent interest, particularly because with our case loads, it's really been the last 10 years that there's been an significant increase, I guess, in terms of the number of nonverbal and minimally verbal children.

So that area got me interested, or that got me interested.

And then about three years ago, I had a particular case where a student had typical language development and then because of his syndrome, he had lost his language.

And that got me looking into more of the research in terms of how to better try to implement augmentative communication.

And what I discovered is what we had been doing, and what I had been taught 30 years ago, was not the current view and the current thinking in implementation with augmentative communication.

So it kind of got me on a new path, and I started saying to those around me, "We're not doing this right."

So it kind of became my job this year to try and help others figure out how to improve our efficacy using evidence-based practice.

So I'm not an expert, but I will share things that I have found over time.

So one of the things that I've learned is you really don't need to reinvent the wheel when it comes to looking at implementing augmentative communication.

I have learned that there's lots of information out there and I've also learned that due to the volume of information, it can very easily become overwhelming, and there's been several times when I look at things and I go, "(screams) This is way too much!" and then I manage to streamline it or find something that kind of puts it into perspective for me.

So, biggest thing, I think, biggest takeaway from that is don't panic, okay?

So what is AC, let's start there.

I apologize for this slide.

Again, I've been housebound for a week, we're still in a state of emergency in St John's, so not using my own computer, so things have shifted on us.

AAC stands for Augmentative and Alternative Communication.

So augmentative just means in addition to, so for people that have some degree of speech, but for one reason or another, may need to augment their message, that they can produce verbally with some other form.

And then alternative means, instead of speech, so for those people that can't use speech, it gives them a different way to communicate.

So just have a brief video here on augmentative communication.

(soft music) - [Narrator] Augmentative and Alternative Communication, also known as AAC, is a way for an individual to communicate when they do not have the physical ability to use verbal speech or writing.

AAC systems are designed to help people express their thoughts needs, wants and ideas.

AAC can range from a simple set of pictures symbols on a communication board, up to a computer system that is programmed to speak with words or messages.

AAC might be a temporary system that is used while child's speech and language are developing, or might be the individual's primary means of communication for a lifetime.

AAC is used by those with a wide range of speech and language impairments.

Common causes for severe speech disability include congenital conditions, such as cerebral palsy and autism.

Also, many people acquire conditions that result in the loss of speech.

Some common examples include amyotrophic lateral sclerosis, or Lou Gehrig's disease, head injuries, and Parkinson's disease.

AAC can help people who are not able to talk at all.

It can also be a helpful strategy if a child is talking but is difficult to understand.

The use of AAC strategies can help children improve their ability to interact with others and to communicate better at home, at school, and in the community.

Using AAC can also help decrease inappropriate behaviors, such as crying, or tantrums, that are often due to the child's difficulty with communication.

There are a wide variety of ways that people access AAC.

Access is the way an individual makes selections on a communication board or speech-generating device.

Some of the access methods used for AAC include direct selection by pointing or reaching, scanning, using a switch connected to a device, head pointing and eye control.

Selecting the best way to communicate can be a complex process.

It's important to get an evaluation by a group of professionals who are qualified to evaluate the necessary skills to use an AAC system successfully.

An evaluation should involve a team of professionals working together in addition to the AAC user, and his or her family and caregivers.

This team often includes a speech language pathologist, a physician, an occupational therapist, or a physical therapist.

(soft music) - Yeah, so, when we look at AAC, we've got three different types, we have no tech, which is the type that doesn't require any extra equipment, and most of us use no-tech AAC in our daily interactions.

So it includes things like your gestures, your pointing, facial expression.

Sign language is also considered to be no-tech because you don't need anything in addition to your own body parts to facilitate it.

Next, we have low tech.

These ones basically, when you look at the difference between low tech and high tech, low tech, we often say, they don't require a battery.

So it would be things like communication boards with pictures on them, or words on them, writing, an alphabet board, a book with pictures in it that you use for communication, any of those would be considered low tech or light tech AAC.

And then we look at high tech.

So those are systems that use technology.

So things like a communication app on an iPad, or an eye gaze system, or a speech-generating device, would all be considered high tech AAC, okay?

In terms of the low tech options, we have core words and books.

There's lots of low-cost or free core boards online, Project Core, phenomenal website, I'd recommend everybody, I've included that in link at the end of the presentation, but I would encourage anybody who doesn't know anything about the Project Core website, to have a look, they've got modules that have teaching modules, 12 teaching modules, for implementation of core word systems with children, so it's a great, great system.

Proloquo2Go also has boards that you can print off.

The Pragmatic Organization Dynamic Display is a book of pictures that you use for communication and navigate through for communication, which is based on core vocabularies well.

Look at the next slide, sorry, Shelley has control of the slides.

These are just some pictures of some examples of some low tech systems, and the PODD book that I mentioned is on the bottom left.

This one is actually from the Proloquo2go homepage, and it's a what they call Big Core.

So it's a poster of the system, the board that you can use, so that you've got it for modeling for more than one student at a time.

Okay, next.

Then we also have high tech options.

So that would include things like iPad apps, and this is not an exhaustive list by any point, but some of the iPad apps that you can use for communication are Proloquo2go, Snap+Core First, TouchChat, WordPower, LAMP, Speak For Yourself, and then you can have dedicated communication devices as well.

Tobii Dynavox sells a number of those, including the eye system, the eye gaze systems, and there are other companies, it's just just examples, and these are some examples.

So the top left corner is Proloquo2go, on the right-hand side top is Snap+Core First, the bottom one is actually Sounding Board, which is a free app that enables you to make choice boards and the bottom right-hand one I think is GoTalk.

Okay, next slide.

So when we look at it, who is a candidate for using AAC?

Really anybody that can't get their needs met with spoken language alone, so they would benefit from AAC.

Now, there's a whole process to go through in terms of doing an assessment and looking at whether or not a person is a good candidate, but really anybody is not able to communicate effectively by speech alone, or they don't have speech to communicate, would be a good candidate.

And that includes students with Autism, who sometimes, they may be verbal, but there might be times that verbal is not the best option for them.

If it's a situation where they're under stress or anxiety, then that may cause them to not be as effective using their verbal speech, and an AAC system may be effective for them at that point in time as well.

Okay, and again, there are some conditions that we know are more susceptible to having difficulty with verbal speech.

So developmental disabilities would include autism, or Down syndrome, or cerebral palsy, doesn't mean that every individual with those disorders will have no verbal speech, but those conditions tend to have more likelihood that they will need an augmentative system.

There's acquired disorders, brain injury, progressive disorders, so ALS, Parkinson's, those types, or dementia, or aphasia.

So when we look at the communication, what exactly is communication?

Go, it's a process passing information from one person to another.

So basically, it's telling them something that they didn't know already.

Consider communication, it's a human right, everybody has the right to communication, they have the right to be able to communicate their thoughts and their needs.

I'm not gonna read, a lot of my slides are kinda wordy just 'cause I wanted to get the information out there, so I may not read all the information on the slides, but it's there for you to look at afterwards.

So when we consider communication, we need to look at how do we teach children to communicate?

So first of all, look at how do we teach typically developing children to communicate using language?

Basically, language is an interaction between the student, or the child, and the people in their communication, in their communication, sorry, the people in their environment that they communicate with, and the things that they're doing in their environment.

So from the moment that a baby is born, we start talking to them.

So they're hearing those spoken words from the time they're born until they start to speak themselves.

And typically with babies, it's 12 to 18 months before we hear their first word.

We don't teach language by teaching definitions, (clears throat) excuse me, it's not the way to develop language, go to the next slide, instead, we model things about what's going on around us.

So rather than giving them the definition for a dog, we would say look at the dog, he feels soft, he's such a nice dog, let's pet the dog, the dog is barking, the dog is loud, and in that way, they develop the construct of the word dog.

Infants typically don't understand us, initially when we're speaking, but they're engaged.

They're watching us, they're engaged, they're watching the body language, and they're picking up on other aspects of communication.

We just have a brief video here.

I'm sure most people have probably seen this video, it's one of my favorites.

- Okay, they need to work on that, right?

- Yes.

- Yes, okay.

- Oh, okay.

- Did you understand it, though?

- No.

- No, okay, all right.

(baby gibbering) - Huh?

(baby gibbering) - Nah, not this one, this is the grand finale of this.

- Okay.

(gibbers) - Yeah, that's the last one.

(baby gibbers) That's what I was wondering, I don't know what they're gonna do next season 'cause they did some stuff this time.

(baby gibbers) Exactly what I was thinking.

(baby gibbers) Oh, yeah, yeah, yeah.

(baby gibbers) Right, don't bring that in, you know what I'm saying, don't do the same stuff, you know what I'm saying, yeah, I was thinking that, yeah.

(baby gibbers) Yeah, like go somewhere else with that, but don't bring it here, you know what I'm saying?

Yeah.

(baby gibbers excitedly) That's what I'm saying, (mutters) was like, "Aargh, aargh, aargh," you know what I'm saying?

And I was like, "What in the world?" But don't do it here," you know what I'm saying, yeah.

- Yeah, yeah.

- Yeah, yeah.

(baby gibbers) Really?

I thought the same thing.

(both laughing) We think a lot alike, huh?

(baby gibbers) (laughs) Oh, that's crazy!

(baby gibbers) Right.

- So when we look at our students who are using AAC, and we consider how would they learn language, they learn it the same way that any child learns language, they need to be immersed in it.

The only difference is that what they're learning, instead of spoken language, is they're learning a symbol system.

So again, the average 18-month-old, has been exposed to about 4,380 hours of oral language for a rate of about eight hours a day from birth.

If you consider a child who's using augmentative communication, and if they only get speech therapy twice a week, for 20 to 30 minutes, it's gonna take them 84 years to get that same amount of language exposure to the language that they can speak.

So again, if they only see the symbols modeled twice a week for 20 to 30 minutes, it's gonna take them 84 years to have the same amount of exposure to their language, the AAC language, as an 18-month-old has had to spoken language.

So what that means then is we need to up the ante.

Why do we expect them to spontaneously begin using their augmentative systems the first day they receive it?

And I know that we've talked about this in presentations that I've done to our employees through the Newfoundland Labrador English School District, we've discussed how in the past, as speech language pathologists even, we would do assessments with the student and look at whether or not they're eligible for receiving an augmentative system, and we'd get the system and then we'd pass it on to the teachers thinking, "Here you go, now you've got it," you can figure it out and work with it," and we figure it'll be easy for the students," but not recognizing that it's exactly like teaching them another language.

So just in that same way as if we would teach them Spanish, or French, or Italian, they need to be immersed in AAC.

And again, this just reiterates that point, having a communication device doesn't make you an effective communicator, any more than having a piano makes you a musician.

And I relate this story all the time, I've had a piano in my living room for 20 years, I inherited it from my mother-in-law 20 years ago, still don't know how to play it.

So just because it's there doesn't mean that it's gonna make me a musician, just as a student having an AAC system is not gonna make them an effective communicator without education, and modeling, and training in that system.

So again, they need a period of learning and they need other people to model the language for them.

And it can be done by parents, peers are a great model, the research out there on the efficacy of using peers as models for language with the AAC systems had really positive results, and siblings, professionals, anybody at all, but it needs to be modeled on a regular basis.

So again, to teach AAC, you need to speak AAC.

So how do we do that?

The first thing is we need to learn the communication system that the student is using.

So if you have a student that's using Proloquo2go, you need to learn that system, if you have a student who's using PODD book, you need to learn that system, if they're using an eye gaze system with either Communicator 5, or Snap+Core First, you need to become familiar with the software so that you can model the language effectively.

And again, when we look at it, it's a little bit intimidating to think, "Okay, now I've got to learn the new language," and in addition to learning the new language, "I have to teach somebody else the new language."

But the reality is, if you look at it as what you've done with your typically developing children who have speech, and their speech is developing, it's the same constructs.

The only difference is that instead of speaking, you're modeling using the picture system.

And these ideas came from the AAC Toolkit by Shannon Werbeckes, which is available on Teachers Pay Teachers, but she has very nicely put together a package that is very concise and succinct and very step-by-step in terms of how to effectively implement AAC systems.

So again, in typical language development, we would model language to a baby for a year before we expect them to say their first words, when we're doing a AAC intervention and modeling on an AAC system, then that's exactly what we should expect as well.

It's gonna be a long time before we get words back, but that doesn't mean we stop modeling.

Typical children are gonna use single words before they use sentences.

The same expectation is there for our students using AAC, you learn one word first and learn to use that, and then two words, and then three-word combinations, and it grows like that.

Babies and children hear their language spoken around them most of the day, and that's one of the ways that they learn language.

So for our AAC users, we need to ensure that we're consistently modeling language using their AAC system throughout the day.

And finally, when we look at typical language development, babies will often go through a series, or periods of time, where they babble, or they play with sounds, and they play with the language, and it's done in a fun environment, there's no pressure to communicate, they're responded to even when the vocalizations aren't full words, and we saw that from the video we just watched, the father was responding to the child, the baby didn't have any coherent speech, for the most part, there were no words that we could pick out, but they were having a conversation.

In the same way, we need to do that for our AAC users, we need to let them play with their systems.

So sometimes they may be pushing buttons randomly, and you might think that they're not getting anything from it, but we would look upon that as babbling for those students.

And again, there should be no pressure to communicate, it's not testing, it's not a performance, they, when they're ready, and they've had enough models, they will start to use the system.

What they say has to be responded to and even if it doesn't make sense, we attribute meaning to what they're saying, to help them recognize the power of communication.

So again, AAC is like teaching somebody another language, it's like learning a second language.

So it takes two to three years for somebody to become proficient in basic social communication when they're learning a second language, and it takes five to seven years to become proficient with academic language.

The bigger thing here is that that is for typically developing children and adults, I mean, typically developing individuals, to learn a second language.

The students that we have that are using AAC often come with other challenges in addition to being non-verbal, so they may have cognitive challenges, they may have physical challenges, they may have processing challenges so that it takes them longer to process information and to get information out.

So in their cases, when we're looking at augmented communication learning as being a second language, it might take them even longer than the research shows for a typical second language learning.

So what that means is, even if it seems like progress is stalled, don't stop, keep communicating, keep modeling.

It's not a subject, it's communication, it's not a school subject, it's not something that we just do for half an hour a day, five days a week, it needs to be something that we're doing all the time in the natural environment, in our natural interactions with the student.

So what's our goal for our AAC learners, then?

We want them to be able to do exactly what their speaking peers can do.

So, be able to say whatever they wanna say to whomever they wanna say, and whenever and wherever they want to say it.

So they need to be able to generate their own thoughts and put those into communication with the individuals that they're interacting with.

So again, that means that we need to consider when we're developing a communication system, there are a bunch of factors that we need to keep in mind.

One of the things that we need to keep in mind is we need a system that can enable them to use a variety of communicative functions.

So, for example, they need to be able to express their wants and needs, they need to be able to request, to gain people's attention, to reject.

They also need to be able to give and get information, so they have to be able to question, to comment, to describe things, to plan events.

And they need social interaction, so things like their social etiquette, their social routines, they need to be able to tease, they need to be able to joke.

In addition to that, they also need to be able to combine words so that they can express their thoughts, and their feelings, and their opinions.

So the system we choose is gonna impact that, and it also needs to be a system that can enable them to learn literacy.

So, again, we provide the building blocks of language and communication by providing a system that has vocabulary that includes words with variety of grammatical categories, and also has access to the alphabet.

So when we look at that, how do we decide what vocabulary to start with?

And for years, we would, I mean, as I said, I've been in this field for a long time, so 30 years ago, most of what we did for students who we used AAC with, was we'd have activity boards for specific activities, we would have vocabulary that was very heavily laden with nouns, so we'd have pictures of objects there or we'd have picture drawings, line drawings of objects, but words that were concrete words that we could use.

We're gonna have a look at the research and see where things are now.

So when we do look at the research, we see that for about 50 words, 40, or 50%, of what we say is accounted for by about 50 words, 60% of what we say, about 100 words account for that.

When we consider our overall conversation, 80% of what we say in conversation is made up of about a range of 200 to 400 words.

So for example, in a conversation, everything that we say is only coming from a bank of 200 or 400 words, well, 80% of it is coming from a bank of 200 to 400 words, out of 250,000 in the English language.

So it's a relatively small number of words, 400 words out of 250,000, that make up the majority of what we saying in typical conversation.

And those words come from a variety of groups, we have pronouns, we have prepositions, we have verbs, adverbs, adjectives, demonstratives, and a few nouns.

High-frequency words, they're very versatile, they can easily be combined for meaningful phrases and sentences, and we'll have a look at some of that.

One of the other nice things about the core words is that they're consistent across populations.

So whether you're five years old, or you're a neurosurgeon, you still use that same bank of 400 words for 80% of what you say.

They're consistent across environments, whether you're at home, in a restaurant, at the mall, at work, you still use those 400 words to form 80% of your conversation.

They're consistent across topics, so whether you're talking about how your day was in school, or you're gossiping about something you saw after school, or you're talking about your work day, you still use those 400 words for 80% of your conversation.

And they're consistent across activity, so whether you're talking on the phone, you're eating, you're shopping, you're playing a game with somebody, again, 80% of what you say, comes from that bank of 400 words.

So that same 400 words make up 80% of the words that we use in conversation.

So again, we call those words core because they form the basis, so those 400 words form the basis of most of what we say, and the meaning changes based on the context, or on the environment, and I'll show you with some examples.

So, for example, if you consider the meaning of the sentence, "I want to go," that's four core words.

So you can see, we put them together, they go together nicely.

In the context of a board game, "I want to go," could mean you want a turn, in the context of a conversation regarding the grocery store, those same four words would mean, "Maybe I wanna go to the grocery store with you," if mom's getting ready to go to the supermarket, you might be telling her that you wanna go with her.

In the case of a non-preferred activity, if you say, "I want to go," it might mean, "I wanna go somewhere else, and not do this activity."

So you wanna avoid the work that you're doing because it's not something that's preferred.

So again, the same four words have three different meanings depending on the context.

So in addition to our core words, we have what we call fringe words.

So that's the other 20% of the words, which, in terms of number, there's a lot more of them, but they only make up about 20% of what we say.

It's comprised mainly of nouns, they're low frequency words, so, again, unlike the core words, which are high frequency and occur frequently in conversation, the fringe words are very context-specific and specific to the activities.

The fringe vocabulary, so again, they may be used in a specific environment or in a specific activity, but really not anywhere else.

So, if we look at this activity, if you try to create a meaningful sentence using only nouns, so using only fringe words, it's not possible to do, you can't make a sentence.

We have the words, bed, glasses, light, remote control, scissors, sofa, tap, tissue, there's not really any way to combine them that make coherent sentences.

You could say, "Tissue bed," and people may interpret that there's a tissue on the bed, maybe there's a tissue in the bed, maybe you need a tissue and you're going to bed, it's not really clear what the message is.

- [Shelley] Marie, I see that you have an activity built in next that you want folks to do.

I noticed there were a couple of questions.

Would this be a good time to address a couple of those questions?

- Yeah.

- [Shelley] Okay, I'm just gonna stop sharing.

- Yep, that would be great.

- So folks can see you.

- [Shelley] So one of the questions is, "What if you don't have experience in the software "that your student might be using," how would you handle that? - You need to become familiar with it.

I think we're all in the same boat.

I mean, one of the biggest, I think, the biggest factors that causes implementation not to be effective, is that we aren't modeling the system.

And as a speech language pathologist, I can honestly say that for years, as I said, I would do the trials to get devices for our students, teachers would be interested in getting the devices, and I would get the device, and I would pass it over to the teacher and it would be, "Here you go, good luck, see you later," and I check on them every now and again, but I really wasn't familiar with the systems either.

But the reality is, we need to look at teaching these systems as teaching a second language.

So if you were an early French immersion teacher, you wouldn't dream of going into the classroom without knowing how to speak French, it's the same thing for these students.

So we have to take their devices, and we have to learn the software so that we can effectively model for them.

(coughs) Excuse me.

- [Shelley] Thank you.

The next question is one that I certainly appreciate, the idea that it takes a very long time for a student to begin to use their system expressively can make folks a little nervous.

So this participant is wondering, "How long should we wait before we consider "that we might not have selected "the appropriate system for the students?"

- I think one of the ways, I mean, certainly none of these decisions should be made in isolation.

So you have a team of people that you work with, whether it's other instructional resource teachers, a speech language pathologist, whoever you can grab in on your team to help problem-solve is certainly one suggestion that I would make.

But the reality is that even if it is the right system, in order to determine if it's the right system, you do some assessment ahead of time to try and predict what might work for your student, but the other piece of it is that you have to ensure that the people that are implementing the system have been educated on how the system works, they've been educated on in terms of strategies to use that will be the most effective for modeling the language, you need to look at how often the system is being modeled for them.

So again, for these students, they may need to see a model of a particular word 100 times.

If they're only getting it modeled 20 minutes a day during the school day, then the likelihood that they're gonna use that word is diminished.

So you really need to look at, are you modeling effectively, they need 200 opportunities today to communicate, so you've gotta set up your routine within the school system so that they're getting the opportunities for communication.

And that's not setting up separate activities, it's within the course of their natural day, but also ensuring that they've got opportunities to use their system.

It's a tough call, it's a judgment call, but what I've been telling people in the professional learning sessions that we've been doing here, this school year, is that unless you're really sure that you are modeling as much as you can and as often as you can, and doing it at least 200 times a day, then maybe that might be where the issue is.

So you really need to take data and you need to consult with your team members to determine whether or not the system is effective for them.

- [Shelley] Great, thank you for that.

And one more question, "If a child with autism knows his system of AAC really well, "and can rhyme everything off, it's used in the classroom, "but they still have limited verbal skills, "how do you draw more language from that student?"

- I think the biggest thing here is to, if they're using the AAC to communicate effectively, then that should be it.

Part of the problem is there's a myth that verbal is the best way, and even if they're effectively using AAC, and they've got some verbal, then you want the verbal to develop, and how do you get that to happen?

The reality is the verbal will come if the verbal is gonna come in those situations.

For students with autism, there's so many other factors for them, there's sensory issues, there's processing issues, there's anxiety, there's so many things that can impact their communication, that if you have a student that's effectively using an augmentative communication system, then I would go with that.

There's not a lot of research out there.

It's interesting on the AssistiveWare website, they talk about part-time AAC users.

And so those users are your children with autism, or adults with autism, who, at sometimes, even though they're verbal, at times augmentative communication works better for them.

And there's no research to back it up, but they have had discussions with individuals with autism, and one of the things that they find is that sometimes, or they've been told, is that sometimes for the individual with autism, they call them mind words and mouth words to distinguish between their thoughts and their verbal output, and they said what their mind words say often don't come out as their mouth words.

So using an augmentative system enables them to be more effective in their communication.

Hope that answered the question.

- [Shelley] Thank you.

And there been a couple of more while you're answering that, so if you don't mind, I'll throw those at you.

Might be a little tricky because it's quite specific, but do you have any thoughts about possible AAC systems for a student who's nonverbal but is now also losing their eyesight?

- There's certainly a lot of options out there.

On the Core website, the Project Core website, they work with students who have visual impairments.

Again, in that case, I would certainly recommend calling in your visual itinerant that works with the student, but there are ways around it.

So even if you don't have a system that they can access independently, you may be able to do partner-assisted access, so that, again, there are a variety of ways to access.

And partner-assisted would be the partner provides them the words to let them choose, it's a whole process to learn how to do, but there are certainly options out there for students who are visually impaired, as well.

- [Shelley] Great, thank you, and we'll take one more for now.

It sounds like your recommendation is that students should be using their AAC systems across environments.

However, many of our students, we know, are using systems at school but maybe not at home.

What are your thoughts around that, or suggestions?

- Yeah, ideally, you want the system everywhere, I mean, again, it's their voice.

And as I always say here, and I know it may sound controversial, but sometimes we have difficulty with access, even more within the school, to their system, so it gets used in the classroom, but it doesn't get taken anywhere else in the school.

And I always liken it to, if you do not have that child's augmentative system with them at all times, then it's like putting a piece of duct tape over their mouth when they leave the room.

So it needs to be used at home as well.

We have the same issue here.

This year has been a year that we're really putting a push for trying to improve the efficacy of what we're doing in the school system for our children who are non-verbal, and minimally verbal.

We haven't tackled the homeschool piece yet.

Parents are very important piece of the puzzle, but again, there's only so much you can tackle at one time, but I would highly recommend, if it's possible, that the system travels between home and school, and the parents are educated on the system as well and on ways to implement the system effectively.

- [Shelley] Thank you very much.

I will attempt to take you back to your PowerPoint slides.

- Thanks.

- All right, here you go.

- So, in terms of this activity, I'll just get people to to jot down quickly, some sentences or some messages that you can come up with using those six words.

So these are six core words.

So again, we looked at the activity ahead of that where we had nouns, and you really couldn't ask a lot of questions or generate a lot of sentences when you were provided with six or eight nouns.

When you're provided with the core words, you've got a lot more options.

So I'll just go through some examples that I've come up with.

Each of those words, in and of themselves, are standalone words that would convey a message, so no on its own, you, you might mean, "You go," "you do it," I could be them requesting a turn, could be them asserting their independence, "I," meaning, "I wanna do it myself," want for requesting, go might mean, again, taking a turn at a game, it might be leaving the room, more is requesting recurrence of something, or more of something in terms of quantity.

You can combine the words as well.

So it really leaves you with a wealth of options in terms of messages that you can convey.

With regards to another example, a phone conversation between friends, so in this example, the first person says, "What would you like to do?"

Second one responds, "I don't know."

And the first one replies, "Why don't you come over here "and we can watch a movie?"

In that example, there's 23 words in total, 22 of those words are core words and only one word, movie, is a noun, so it's a fringe word.

With that, we have 95% of our words, our core words, in that conversation.

And then we have the words do, not, and you, used several times during the interaction.

There's no repetition of the fringe word, movie was only used once.

The core words can be used repeatedly in a variety of conversations for a variety of meanings, and the fringe word movie really is only useful in that context, talking about going to a movie or watching a movie.

So it's just a nice example of how versatile the core words are.

So when we consider all that then, we really need a system that's comprised of core words.

How do we select the AAC system for our students?

One of the things that we need to bear in mind is that even emerging communicators should have access to both types of vocabulary.

They need core vocabulary, and they need some fringe words in their vocabulary as well.

So ideally, we're gonna provide them with a system that consists of four words.

We want personal core words there.

And again, those could be considered fringe words, but I like to call them personal core words, because they're ones that are specific to that student, so people that they're familiar with, mom, dad, siblings, peers, close friends, places that are important to them, things that are important to them, those are important words to have on their system as well.

And then you need school core words, so letters and numbers.

So again, we're gonna work on literacy and numeracy with our students, literacy especially.

And then we have some fringe words, the nouns.

And again, I would highly recommend, in terms of the fringe words, having more common nouns versus more specific nouns, so things like room, chair, table, versus, I don't know, vestibule, or something that's much more specific, and can't be used in as many contexts.

And then you might want some common phrases or greetings as well, so that they've got the social vocabulary so they can interact with their peers.

Don't underestimate the amount of vocabulary.

A lot of times people will say, "Well, we'll start with one or two pictures "and then we'll increase it as time goes," and as we know that he understands" or he/she understands those pictures.

"The reality is that, especially if it's a high tech system, so one with the screen, as you adjust the size of the vocabulary, the pictures move around on the screen, because again, if it's a system like an app on an iPad, it's gonna take up the full screen.

So if you've got a grid that's three by five, and then you increase it to a grid that's seven by 11, then pictures are gonna move around.

Part of learning the vocabulary is the motor memory.

And it would be like you sitting down to type at a keyboard, and every time you sit down, somebody has moved the keys around.

You'd be able to do it, but it would be very frustrating, and you'd be slowed down a lot by having to try and find those keys again.

So you wanna start off with a robust vocabulary, as robust as you can.

And there's a lot of systems out there that will enable you to have a variety of vocabulary, but they have options where you can kind of blank out some of the vocabulary and then gradually add it back so that they stay in the same, the words stay in the same place, and the vocabulary doesn't move around.

- [Man] "The Language Stealers".

- What's wrong Z?

- Nothing's changed, still no AAC.

- No reading.

- No writing.

- No talking.

- Not for these kids.

- Blah blah blah, blah blah blah.

- Only teacher talking here.

- Only labels on things here.

- Only topic words here.

Hiya, Michael.

- Gladiator, oven, glove, microwave.

- Huh?

- These words are useless.

- What can we do?

- I don't know.

I've tried everything I know.

Core words.

- [Automated Voice] No.

- AAC role model.

- [Automated Voice] No.

- Communication Matters DVD.

- [Automated Voice] No.

- How to find words on MyTalker.

- [Automated Voice] No.

- Literacy.

- No, no core words for you, No role models, no communication DVD, we will not learn to use your talker with you and we don't teach literacy to over 16's.

(jingling music) - [Man] You must overcome the language stealers.

- [Woman] Take the nouns down and put up core words.

- [Woman] Learn to match speech sounds to print.

- [Man] Teach all of your friends.

- [Woman] Don't anybody asleep in their wheelchairs.

- Language is.

- Asking, doing.

- Directing, directing.

- Arguing, telling.

- Comment, choosing, not just naming things.

(scissors clanking) (vacuum machine whirring) - [All] Now we're talking.

- [Man] We can say anything we want with the core words and word parts.

- [Automated Voice] Teach us the codes to match speech sounds to print.

- [Automated Voice] Teach us to decode, segment, blend.

- [All] Don't be a language stealer.

- [Automated Voice] Put it in, get it out.

Turn it down, up, on, off.

- [Man] They come here, they make good things.

- [All] We want to read, we want to write, we want to speak, we have the right.

We want to read, we want to write, we want to speak, we have the right, we want to read.

- So again with that video, I really like that one 'cause it highlights how important having a system that consists of core words is.

So not that the fringe words aren't important, but it's highly important that the core words are there.

So that brings us to we've discussed how do we choose vocabulary, what kind of a system do we need in terms of the vocabulary for the system, how the children learn an augmentative system?

So then we look at how do we know when somebody is ready for an augmentative system?

Like this handy dandy flowchart, so is the person capable of learning AAC?

Are they breathing?

Yes, then they're a candidate for AAC?

No, not likely.

So the reality is that there are no prerequisites for AAC.

We have to presume competence, we have to presume that if we choose the correct system for the student, and again, there are a bunch of materials out there that can help you in terms of assessing what system might be best for the student that you work with.

So if we've chosen a system that fits them, and if we've educated the people that are working with them on how to effectively implement that system, and the system is being implemented consistently, then they should be able to learn it.

They will learn it to some degree, but again, they need instruction regardless of their diagnosis is.

So if they have the tools and the instruction, they should learn.

Again, so presuming competence is based on the principles that A, everybody has something to say, sorry, have one and one there, and two, everybody can learn.

So when we presume competence, we understand that there are opportunities need to be made for these students to learn, and we need to provide instruction for them to learn.

So, to allow them to reveal and realize their potential, we need to give them the words, so the core word systems, we need to enable them to communicate for all reasons, so not just for requesting.

Requesting is often one that's targeted initially because there's quick payback for the students, and they quickly realize the power of communication by making a request and getting the object that they requested.

But a lot of times we get stuck at requesting with students, and that's the only function that we target, or that we work on with them, and then they also need access to the alphabet.

Again, they may never become fluent readers, but with access to the alphabet, it enables them to generate spontaneous words.

So they may not be able to spell words correctly, but they might be able to give you word approximations, or they might be able to give you beginning sounds so that they can generate the words that they want, if that word doesn't have to be available on their system.

And again, just further to that point, sorry, further to that point, an analogy that I like, which I came across in some of the things when I was doing the research for this talk, was talking about skiing.

So if you are given skis that fit and you're given instruction on skiing, then that enables you to become the best skier that you can be.

Does it mean you're gonna become an Olympic athlete, not if you don't have the ability to become an Olympic athlete, but it does give you the ability, with the right equipment, and the right instruction, and the right opportunity, to become the best that you can become when it comes to skiing.

It's the same thing for our students with augmentative communication, if we give them the right system, and the opportunities to communicate, and help them learn, so give them the instruction to learn to use their system and learn to communicate most effectively, then they will become the best communicator that they have the potential to become.

So, what I'm gonna share with you in this last part is just some resources that I found, and some websites that are great in terms of information, again, it can easily become overly whelming, so (chuckles) I would advise you to look at things and if you become overwhelmed, step back, but do go back to it because it is worth going back to, but one of the resources that I found recently is an implementation tool kit that was put together by a speech language pathologist, Shannon Werbeckes, and she has a website, I guess, or blog, speechingmusings.com.

Her toolkit is available through Teachers Pay Teachers and I put the link there in these slides.

And in that, it includes an AAC training guide, it's about 110 pages long, but very user friendly and very, very common terms, not jargon-y at all.

There's another piece in there that has the training guide, but it has sheets in it they that you can edit, so make them applicable to your situation, there are some examples of some core vocabulary boards there, and then there's actually a PowerPoint included, that you can use with staff for training purposes.

And then there are also some good websites out there.

Again, this is not an exhaustive list, this is just some of the websites that I've come across and I've found helpful in the research and the work that I've been doing.

So PrAACtical AAC is one they have a wealth of information on there.

There are PowerPoints available to use, there are videos available that give you information, there's information for assessment, for implementation, all kinds of information.

Project Core is another one.

The Project Core website, actually Project Core is designed for teachers to help them with the implementation of augmentative communication systems.

So while the people that work on this project, or have been involved with this project, acknowledge that ideally, you would want a speech language pathologist involved, they also recognize that that's not possible in every situation for a variety of reasons, or certainly consistent contact with the speech language pathologist may not be available.

So, they have devised this with a grant, they have developed this website, which has 12 teaching modules, each module is set up so that you can either do it as self study, or you can be the coach and you can present it to a group of people, and they also have all kinds of support, they've got a core word boards that they've developed, which are 36 words on a page, and they've got a variety of forms of that.

So they've got it done so that is just a basic board, they've got it done so that the pictures are more for children that have visual impairment, like cortical visual impairment, they've got it with a dark background and brighter colors on front.

And anyway, I'd recommend go have a look at that website, it's certainly a wealth of information and very user friendly.

AssistiveWare is the company that makes Proloquo2go.

They also have some really good information on their website.

Even if your student is not using the Proloquo2go app, a lot of the information on the website is relevant in terms of just basic AAC implementation, so doesn't have to be specifically for students that are using Proloquo2go or the app for the PODD book.

And then Tobii Dynavox, Tobii Dynavox is the system that I'm familiar with, for eye gaze, I'm not sure what else is out there.

And again, I am not an expert in this area, I'm just sharing the information that I found, but one of the nice things with the Tobii system is that for their eye gaze system, they've got a website that guides you through setting up the eye gaze system, and then implementing it, and strategies for how you would get screen engagement, or responding, and that sort of thing, and it brings you through each step and provides practice activities and instructional videos for working with your students.

And then they've also got pathways for Core First, which is available either as an app or online, the online version, I think is a little bit more user friendly, but the Snap+Core First software can be used on the Tobii systems, but it can also be downloaded and used on an iPad.

So it's not only for eye gaze, it can be used with the eye gaze system, but then also with other systems that you access using your hands or if you did partner-assisted intervention, but it guides you through using that app.

And then finally, there are also a number of Facebook groups, and again, not an exhaustive list, and what I found with the Facebook groups, these are ones that I'm a member of, and it's great because a question will come up and then the comments are typically responded to, and a lot of times, on most of these Facebook groups, they're responded to by researchers in the field who've done a lot of work in that area and then they will guide you towards evidence-based practice regarding the questions that you pose, so, certainly a great resource to have.

All right, that's it from me.

Thank you all so much for helping improve the communication of your students.

I guess we're ready for questions now, if anybody has any questions.

- [Shelley] We do have some more questions for you.

I'm just gonna pick up where we left off.

How do you address core vocabulary with students using PECS?

- PECS as a different system.

So PECS will enable you to request.

They will say that PECS enables you to comment as well.

It is very limiting in terms of the number of functions that you can use, what I would recommend is, and again, you have to discuss this with your team, but I would expose the students to a core word system as well, I guess with the goal being to transition them from using PECS to a core word system, a core-word-based system.

So while you're doing that transition, you need to ensure that both systems are available because you don't want to frustrate the student.

The point is to communicate and to have effective communication, and if you have a student who has been using PECS effectively, you don't wanna just take that away from them and try and implement a new system, but you can do both together.

And I think that what you will find is that over time, if the core word system is being implemented effectively by being modeled regularly, then you will see the student transition over to that on their own.

- [Shelley] Okay, and how do we address a situation where we want to help team members understand that using visual boards is not the same as PECS?

- Hmm, I guess it really comes with education, educating them about, like similar to what we're doing with this webinar, educating them about why core language is a better system to use than the PECS system, so in terms of looking at the functions of communication with the ultimate goal, making them an autonomous communicator, so that they can generate any message that they want, to convey their thoughts, or their feelings, or their attitudes, or that kind of thing, their interaction.

So it really comes with educating the personnel that are working with that student to help them see that while the PECS may be effective for them right now, it's very limiting and it doesn't enable their language to grow.

If you have a system that's core-word-based, it allows them to grow their language and their language is generative, so they can generate the messages on their own.

- [Shelley] Great, thank you.

When you're referring to the core words, is there a particular source that you would recommend that provides a list of those core words?

- There are a variety of lists.

I guess the thing to do is, I don't have any specific one that I use.

We in our board tend to have a lot of the Proloquo2go apps, so we've used that one primarily.

And with the Proloquo2go app, there is a core word board that you can download, which is a picture of the home screen of the seven by 11 grid, but there's a wealth of things out there.

Project Core has their core word board, and the one that they developed is 36 words based on the DLM and its first tier words, so it's words that you would use in the education system.

So Project Core is a good place to start if you haven't done anything at all with core words, because it guides you through, as well, with the modules that they have, the training modules that they have.

- [Shelley] Great, thank you for that.

There's a question about selective mutism.

So can or should AAC be used with children who are selectively mute?

- Again, not my area, I apologize ahead of time, but selective mutism, there is an anxiety component with that.

So it's not just because they're not able to speak but the anxiety component is there.

I would certainly give it a try.

I mean, the reality is anything that can help with the communication for the students.

And again, if you look at some of the information that they have on the AssistiveWare website, with regards to the part-time AAC users, so your students with autism who are using AAC some of the time because speech is not always the best mode for them in certain situations.

So I would liken it to that, that it certainly wouldn't hurt to try, but I don't know anything in terms of research that would back that up, sorry.

- [Shelley] No, thank you for answering that piece of it.

There are a number of questions about PECS, "When transitioning from PECS to a core word system, "would you transition all of the fringe words "that are already being used in PECS "over to the core word system or how would you handle that?"

- I would, because depending on the number, but I would, because you don't want them to lose the ability to talk about what they've already learned to communicate about.

And again, I don't know research on that specifically, that's just speaking from experience with students that I've worked with, we've tried to keep those words available while modeling with the core system as well, again, because the goal is not to frustrate.

Even though a core word system is better in terms of being able to develop their language skills and their communication skills, the intent is never to frustrate the student, or the individual, so that they had an effective means to communicate with PECS and then if you take that away, that's gonna lead to frustration.

So you wanna keep it as frustration-free as you can.

- Right, and I think that's a great parting words, or parting lesson.

I just wanna take a minute, and if there are additional questions, by all means, I'll stick around on the webinar platform for a little while to gather those questions, and Marie has graciously agreed to answer additional questions via email and she provided you with her email address on the last slide.

I will send out the presentation slides along with the survey for your feedback at the end of the webinar, so if you'd like to have a copy of Marie's slides, she's graciously offered to allow us to share those.

You will be receiving a followup webinar survey just at the end of this afternoon as well with those slides, and with a survey where you can provide us with some feedback around additional information, or additional topics that you'd like to see addressed in our webinars.

Marie has very kindly agreed to offer a Part Two, followup to today's webinar, so on April 1st, you can mark it on your calendar if you're interested.

Part Two will be "How Do We Teach AAC?" so taking the next step.

So thank you so much, Marie, for offering to do that for us as well, and thank you for sharing all of this information with us today.

As I was listening, I was thinking there were so many kind of aha moments that I was wishing I had this information, and I won't say how many years ago, when I started doing some of this work, but I think it also speaks to the value of the communication between teachers and speech language pathologists, and both groups of professionals having the opportunity to share the best of what they know, and to share one another's expertise and training, and the value of bringing the new research and the new practice, and so on, along together as we move along collaboratively for the benefit of the students we're supporting together.

So thank you so much for sharing that with us today.

We're definitely looking forward to Part Two in April.

And I will follow up with folks in a little bit with the survey and with the presentation slides.

So thank you very much, everyone.

Have a great afternoon.

- Thank you.

- All right, take care.

- Take care.