Finding the Words July - August 2008

Finding the Words…with augmented communication!

Part 2

Hello, dear readers, and welcome to our second column on 'finding the words' with AAC (Augmentative and Alternative Communication). If you have not read Part 1 of this series, I would strongly suggest you do so, as Part 2 will then make much more sense!

In Part 1, we looked at the theory of AAC, from a practical and a historical perspective, and saw that 'augmenting' our speech input to our kids (with books, songs, our facial expression, etc.) just makes good sense, and is something we do naturally. We also saw that recognizing how our kids 'augment' their speech output is natural, too. We watch our kids' eyes to discover what interests them; we watch their smiles and their jumps of glee; we offer them objects to see which one they reach for at a particular moment; and we listen carefully to their voices, to hear sound patterns that indicate their feelings. Because 'augmented communication' is what we do anyway, it is familiar, taken in this context. And because it is so important, it's potential is something we want to further explore.

But, unfortunately, all we often hear about AAC are the 'brand names'. "Are you doing PECS?" "Do you have Board-Maker?" "Jack just got a Dynavox." So, our first task in Part 2 of this series is to demystify some of the aura that surrounds AAC systems and devices, and remind ourselves that while each comes with a set of goals and training instructions, none come with a translation manual for your child. You are the only one who can write that book, because you and your child are the only ones who really know your child's story. All communication, including your child's, emanates from personal intentions: the loves, desires, dislikes, and fears you watch for in your child's eyes, his reach, his tantrums. So, when you pick up a new AAC training manual, read it with your child in mind, and then put it in your book case…on the shelf just below the one that holds the story of your child. It never belongs on a higher shelf, and our teenaged teacher, Thomas, is here again to remind us why.

Featured in our last two columns, Thomas is now 15 years old, and he has lived through several instruction manuals. All that time, Thomas has mainly aspired to be a 'real boy'. Dealing with dyspraxia, a significant auditory challenge, and a language delay, Thomas would want us to know that being limited to one system or protocol, be it low tech or high tech, can be demeaning and unsupportive. It is hardly what real boys with real communicative intentions want and need. So he rebelled against the drill-style picture choices, instead reaching into the bag of un-drilled pictures, to find the one he wanted! "It never worked," recalls his mother. Instead, Thomas opted out, and waited until people really 'listened' to him, and understood that his 'totality' of communication was much more!

Thomas' family long advocated for a voice output device that Thomas could program himself and use to help refine his speech. "He always talked," adds his mother. "But he needed to hear the words before he could say them." Thomas now has such a device, and, this time, he 'owns' it, and only uses it with a select few, who won't take it away and reprogram it with things he doesn't want.

In the meantime, Thomas has invented his own set of AAC 'outputs', laughter being one of his favorites. He is the 'poster teen' for total communication, too, as he moves rapidly from one modality to another…just like most of us do in our daily communiqués. To Thomas' way of thinking, being a real boy means communicating all kinds of things that other real boys do, in all sorts of ways. Being serious one moment, playful the next – letting his own real personality shine through his ‘words’. Being 'cheeky' like his tank engine moniker suggests, Thomas will joke around using his Dynavox MT4, saying, "Let's go to Woodman's" about forty times, laughing all the while at the power of the voice output! To Thomas, total communication means getting his mother to drive the car, and pointing at each intersection until the car arrives at Wal-Mart. It means wanting the battery for his device to hold a charge so he can order at Burger King whenever he wants, and have a friend record a joke on it. It means making judicious eye contact with a true friend who gets the deeper meaning of particular communiqués. And, perhaps most importantly, it means using his voice whenever and however it is available, perhaps asking over and over, with a smile on his face, "Have bubbles?", until everyone scrounges the toy room so he will stop! That’s Thomas!

Of course, we parents and professionals don’t want our children limited to 'one size fits all' programs, and yet we often overlook other modes of expression that allow our children to demonstrate who they really are. We need to remember that one of the important tenants of augmented communication is to not take away communication that an individual has in one modality, in an attempt to teach another.

In his early years, Thomas rebelled against training protocols that limited his communication. Thomas "did the mechanical part" of various programs, his mother recalls, and would just "fill in the blank" whenever he was supposed to make a choice. He started not caring, and just "tuned out". Picture choices were somebody else's agenda, and they never became his own. Thomas wanted to talk…period! He honored the human voice so much that when he'd hear a girl he knew, much more vocally-challenged than himself, make an undifferentiated sound, he would go over to her and switch the screen on her AAC display. He could 'hear' the communicative intent, and responded! Thomas has always known the value of total communication, and has acknowledged it in others!

And, that's the way it is with total communication. Access to speech may come in fits and starts, but when that channel is open, AAC isn’t needed. A minute or an hour later, AAC may be essential. Thomas has taught us this: if a child says it, that's good enough; if a child uses AAC, that's good enough, too. If a child 'owns' his own voice and his own AAC, he is free to combine them, or let one trigger the other. And that is what we want: for AAC to be part of the communicative voice a child has…part of his total communication package!

This is also how Thomas has been teaching himself to speak better, by the way, and is also the way we can help our kids bridge from picture forms of AAC back to language. One can facilitate the other, if we provide the language bridge. Thomas did exactly that with his 15-Talker, a small AAC device he used before getting his MT4. Thomas would record music and his own voice, play it back, and practice. Thomas loved to rehearse songs this way, thus addressing auditory processing, expressive language, and his phonetic speech production, all at the same time.

Now that Thomas has recently added high-tech AAC to his repertoire, he and his SLP, Megan, are committed to keeping this device his own. Thomas' school-based SLP is committed to that too, so Thomas now has a fighting chance to show himself to be the real boy he knows he is!

Until next time then, dear reader, please remember that Thomas' story is important not because he's 'typical'; it's because he's unique. And so is your child! So, please revisit that book on your shelf at home that describes your child, especially your child's communicative intentions. Mark your place in that book well, and remember to refer to it before you pick up any of the plethora of 'how to' manuals out there. Your child's own story will always be your best guide. Remember that Thomas, the 'cheeky' real teenager, has told you so!