General tips on teaching

Adults often assume that communication is instinctive—presenting a child with AAC means he or she will simply pick it up and use it. However, everyone has had to learn how to communicate, taking years to accomplish this during infancy and early childhood. Children learn communication through imitation and the positive reinforcement of the results of their communicative attempts. They go through a series of stages, starting during early infancy with unintentional, reflexive behaviors, and move on to conventional, symbolic communication, typically speech. (See Normal speech and language development.)

Unfortunately, children with severe disabilities have physical, cognitive, sensory and/or other types of impairments that prevent them from being able to initiate or respond to communicative acts in a conventional or expected form. They may not be able to master the normal stages of communication development even in a delayed manner. Furthermore, their initial months or years may be complicated by medical emergencies and lengthy hospital stays during which they have little opportunity for communication or control of their environment. As a consequence, the child being given AAC for the first time often must not only learn how to operate the new system, but also acquire some of the basic concepts of communication. He or she must accomplish these skills with no natural models to imitate, and with teachers and partners who may be having to learn the system themselves for the first time (Light, 1988; Montgomery, 1986; Warrick, 1988).

Needless to say, teaching a child how to communicate with AAC is very challenging. There is no single method that will work with all children. Determining exactly what to teach and how to teach it must be highly individualized not only to meet the needs of the child, but to fit into the beliefs and lifestyle of the family as well as teachers, therapists and other persons who are involved. Therefore, while the following information is based on current best practices, not all of it may be appropriate for every child.

This section refers more often to teaching communication as opposed to teaching AAC. The reason for this is that the focus of an intervention should not be merely to teach a child how to operate or use an AAC device or system. The purpose of a communication program is to enrich a child’s quality of life, and its aim should be to teach a child communication and communication-related skills that will best enhance that child’s participation in the activities and events of his or her day. (See When does a child need AAC?) With a few exceptions, the following instructional techniques can be used with any type of communication or pre-communication skill, including speech. They also help to keep adults focused on the goal of developing communication, and not simply teaching the child specific AAC functions.

The following are general tips on teaching AAC to a child. As stated previously, they are not always right for all children all the time. How a child learns best is a highly individual matter.

• Ideally, both family members and teachers work together in teaching the child. This allows the child to learn in more environments and in a wide variety of activities. In addition, greater consistency can be maintained (Calculator, 1997). Using the same program at home and in therapy or at school is ideal, as long as it is appropropriate to the different settings, and not forced upon either party. When everyone who is involved in teaching the child feels confident and inspired, there is a greater probability of success. Without this, attempts to work with the child will be lackluster at best, and nonexistent at worst.

  In particular, whatever the family is counted upon to do must fit into their lifestyle and routines, and not be burdensome. To ensure that this occurs, everyone involved, and the family in particular, must have fundamentally agreed with both the choice of AAC and its accompanying teaching program.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

  The persons who will be carrying out the teaching plan should be involved in the decision-making process, and no plan formalized until a consensus has been reached (Angelo, Jones, & Koskoska, 1995; Hetzroni & Harris, 1996; Reichle, 1997). (See Forging an effective AAC team.)

• A related concept is the use of siblings and peers in interacting/teaching the child. Often it works to have them also use the same system while communicating with the child. For example, they can use sign language, too, or share the child's VOCA during an exchange. (See Simultaneous communication.) This makes the child’s use of AAC feel more natural, less stigmatizing. If possible, have the child meet other children or adults who have AAC. This allows the child to begin to see the use of AAC as a more normal situation, and also has the potential of providing additional communication role models for the child (Van Tatenhove, 1997).

• Ideally, formal instruction should occur frequently and for short periods of time. This is easier to do when teaching is integrated into daily activities and routines, including play time. (See The ecological approach: Focusing on participation and Naturalistic teaching methods.) Some methods of instruction are less demanding on a child and, thus, can occur for longer peiods of time. (See General naturalistic techniques, and Simultaneous communication.) A child experiencing frustration during a teaching episode suggests that teaching may be occurring too frequently, for too long a period of time, or that an inappropriate AAC system or teaching methods are being used.

Teach in natural settings, places in which the child is familiar and feels at ease. Focus on communication skills and vocabulary that fit into the activities that take place in those environments. Again, this is easier to do when teaching is integrated into daily activities and routines. (See The ecological approach: Focusing on participation and Naturalistic teaching methods.) For an infant or very young child this means teaching during such activities as mealtime (Morris, 1981), bath time, play time, etc. For the preschool or school-aged child this means teaching in an inclusive classroom setting (Halle, Alpert, & Anderson, 1984; Lowenthal, 1995).

This is not always possible, however. For example, it may be desirable to teach communication skills relevant to settings which are difficult to get to or to spend much time, such as in a doctor’s office or restaurant. In these situations, teaching may have to occur outside the real setting.

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

OTHER RESOURCES:

• Circle of Inclusion "offers demonstrations of and information about the effective practices of inclusive educational programs for children from birth through age eight" at circleofinclusion.org.

• "TWELVE FREQUENTLY ASKED QUESTIONS" about the inclusion technique called "circles of friends" at www.innotts.co.uk/~colinn/faq1.htm.

• For specific mealtime teaching strategies, see Morris, S. E. (1981). Communication/interaction development at mealtimes for the multiply handicapped child: Implications for the use of augmentative communication systems. Language, Speech, and Hearing Services in Schools, 12, 216-232.

• Get to know the child very well and then individualize goals and teaching methods. The more the child is seen as an independent and complete person, the more he or she will be automatically treated with respect and understanding. Ideally, objectives that are really meaningful to the child should be chosen, and taught with compassion and humor.

  Develop good rapport with the child. A child is more likely to want to work and communicate with someone with whom he or she feels comfortable and safe. With closeness comes the understanding of when to push the child and when to let go, when something is too hard and when the child is feeling lazy and just not trying.

  Getting to know the child can begin before or during the communication assessment. In addition, family members should be made to feel very much a part of information sharing and decision-making. They can provide invaluable information about the child that no testing could ever uncover, such as what the child likes and dislikes, what his or her learning style is, and how to make the child laugh and be happy. (See Forging an effective AAC team.)

• Allow the child to experiment in non-communicative ways with his or her AAC. When a child is first being taught AAC, especially if it is an external device (as opposed to an unaided method such as sign language), the adult may become worried when the child appears to use it in every way imaginable--except to communicate. However, this is how children learn about and begin to feel comfortable with their AAC, and has been compared to the experimental babblings of an infant or young child ("Survey," 1999).

• The child’s motivation is crucial. Early communicative exchanges should be centered around what is of interest and concern to the child. If a child is not motivated to communicate, a first step in the teaching process may be to figure out how to motivate the child. In some cases motivating a young child to communicate with AAC can be surprisingly difficult.

  Children are typically motivated by obtaining tangible items such as food or toys, gaining the attention of an adult, and/or getting away from disliked situations or people. (See Basic communicative functions, Requesting, Getting attention, and Rejecting.) Adults can tell what a child likes and dislikes by behaviors such as vocalizing, reaching, smiling, looking, crying or fussing, or becoming agitated. Some children with severe disabilities evidence very subtle cues such as changes in muscle tone or rate of breathing.

  Sometimes it is not known what the child enjoys, especially if the child has had little opportunity to indicate preferences. In addition, family and professionals may be unwittingly preempting the need for communication of needs and wants by over-controlling the child’s life or giving the child everything he or she needs and wants without expecting any communication on the part of the child. In these cases it is worthwhile finding out what motivates the child by setting up "testing" situations (which can also teach a child choice making at the same time). For example, one or more types of food or toys can be placed in front of the child and the child’s reaction observed (Reichle, York, & Sigafoos, 1991). Another method is to try to keep notes on when, where and with whom the child exhibits strong reactions such as smiling, laughing, crying or becoming agitated. A pattern may emerge indicating what the child likes and dislikes.

  For the more communicatively advanced child, motivation includes providing vocabulary that is appropriate and interesting to the child. (See Vocabulary selection strategies.) On a broader level, every child should be provided with activities and events that are interesting and engaging and can become the basis for topics of conversation. Although routines are often an important part of a communication intervention strategy, they can include fun activities such as regular outings to a fast food restaurant or the zoo. Nothing seems to do away with the need to talk more than a life that is monotonous and boring (Durand, 1993).

• Teach communication that is functional. This means messages that the child can use immediately to achieve something desirable. However, while practical goals are important, don’t fall into the trap of teaching only communication that adults feel is important, like asking for a drink of water or to use the bathroom. Goals should be functional, but play is the function of children. This also means selecting vocabulary and conversational topics that are of interest to the child. Examples include topics relating to favorite toys, activities, jokes, etc., as well as age-appropriate vernacular such as, "That’s cool! or "It sucked." (See Topic-setting strategies.) Teaching functional communication is easier when it occurs within the context of natural routines and settings (Beukelman & Mirenda, 1992).(See Naturalistic teaching methods.)

• Make sure that, very early in the teaching process, the child is able to communicate effectively and efficiently at least a little bit with his or her newly-learned skills. This clearly demonstrates the value of communication and increases the motivation of the child. Early success is one of the best predictors of future effort and diligence.

• Make sure that both the AAC system and choice of goals and objectives are developmentally appropriate. It is obvious that a child will fail if they are beyond his or her capabilties. For example, a child who does not understand symbols will not be able to use a picture-based communication book. What is less apparent, however, is when a child becomes frustrated and unsuccessful because the system, objectives or vocabulary are too easy. The resultant lack of use of AAC can look deceptively like behavior that occurs when the system and goals are too difficult.

• Honor the child’s current idiosyncratic methods of communicating and don’t replace them with more conventional modes unless there are good reasons to do so. Children are sometimes forced to use a new method of communication exclusively because the family or teacher is trying to be diligent in instructing the child. Unfortunately, this can undermine the value and benefits of communication. From the child’s point of view, he or she is being taught a new, more difficult way to communicate something that he or she is already able to communicate effectively. For example, a child who smiles and waves to greet people in the hallway may be forced to break eye contact with them in order to look down and press a button on a VOCA. This child may well choose to simply stop greeting others rather than make the additional effort that is being demanded.

  Nevertheless, there may be good reasons to teach the child more conventional modes of communication (Durand, 1993; Reichle, 1997):

  • If the old method is harmful to the child or others, as in aggressive or self-destructive behaviors, or reflexive behaviors that are causing injury to the child. (See Children with severe behavioral issues.)
  • If the old method is socially unacceptable or age inappropriate and stigmatizes the child.
  • If the replacement communicative behavior is easier for the child to perform. This may occur after the child has developed some fluency with AAC. For example, it may be easier for a child to point to a picture on a communication board than to attempt to say the words.
  • If the replacement communicative behavior is more effective due to being more readily understood by others. For example, if a child used one-word utterances to both make comments and requests. It would be worthwhile to teach the child to communicate more explicit two-word phrases that immediately distinguish requests from comments.
  • If the replacement communicative behavior is more efficient. For example, a child may point towards a loaf of bread and then have to listen to a complete listing of sandwich possibilities before being able to indicate which one he or she would like. On the other hand, just one or two button presses may indicate exactly what kind of sandwich he or she wants.

• Flexibility is essential in implementing goals and objectives, as well as teaching techniques. What works perfectly for one child may be completely wrong for another. Keeping records on the child’s progress can be key in determining the effectiveness of whatever program is used and indicating any modifications or additions necessary.

• In general, acknowledge what the child communicates, even when the child is communicating in an unacceptable way. This clearly indicates to the child that his or her communication is being received and is of value. For a child who is still at the pre-intentional stage of communication, this also teaches the concept of intentional communication. (See Normal speech and language development and The first goal: Intentional communication.) This does not mean that the child always has to get his or her way, nor does it mean that an inappropriate way of communicating has to be indulged. The child can, over time, be taught a more acceptable way to communicate the same message, and how to tolerate delay gratficiation. (See Children with severe behavioral issues.)

• Children often do not communicate simply because they don’t have to, are not expected to, or are not given sufficient time to do so. Therefore, frequent pauses and asking open-ended questions as opposed to yes-no questions can be effective. The child should be given clear signals that it is his or her turn to communicate, for example, stopping, looking at the child and waiting expectantly. In addition, the child requires a lot of time to initiate or respond. Young children in general will often take a very long time to say something, and a child with an AAC device needs even more time during which he or she is made to feel relaxed and unhurried. This can mean up to several minutes. If a child begins to communicate, don’t try to complete the sentence (unless the child is obviously finished communicating). Furthermore, expect a response from the child. Children will often pick up on and respond to such an expectation (Basil, 1992; Light, Collier, & Parnes, 1985).

• Children are mainly interested in playing. To maintain the child’s interest and attention, teaching sessions should be fun. Games and other play activities that are based on the child’s interests are typically motivating. Drill-and-practice techniques used outside of natural contexts should be avoided unless considered absolutely necessary. In general, toys that foster interaction and communication such as baby dolls, kitchen sets, board or card games, or trains, cars and other vehicles are preferable to toys that are played with independently. Adapt toys as necessary for children with physical or sensory impairments. Switch toys and simple computer programs are also useful in teaching communication and communication-related skills (Beukelman & Mirenda, 1992).

• Children love to be in control. Incorporate messages that allow the child to make choices and have some say over what happens to him- or herself, for example, selecting a video or TV program, or where to go for an outing. Even being able to tell Dad to put his hand on his head, roar like a lion and hop up and down on one foot can be highly motivating, as in the game "simple simon."

• Follow the child’s lead as much as possible (Beukelman & Mirenda, 1992). Let the child be the initiator of activities or topics of conversation and then have the partner be the responder. If a child repeats a verbal routine over and over—as children are wont to do—go with it. Studies have shown a child is able to communicate more when he or she has started the conversation, and when the pattern of words used is familiar (Yoder & Davies, 1990; Yoder & Davies, 1992a). (See Activities and routines as teaching tools.)

• Consistency is important, especially for children learning early communication and communication-related skills. All the people with whom the child communicates need to be made aware of this and, if necessary, trained in the particular techniques and responses being used. In some cases an alphabetical dictionary of the child’s communication, including how to interpret the child’s behaviors and respond may be helpful. An example entry might occur under the words "mouth," "eat" and "hungry," and state "When Mary opens and closes her mouth repeatedly, this means she wants something to eat. Get her picture board of food and slowly point to each item on it, simultaneously stating the food item’s name. Wait until she indicates what she wants to eat by pointing" (Reichle, 1997).

• It is a good idea to keep data on the effectiveness of the AAC program in order to be able to determine what to do next. This is required to be in the IEP if the child has one. Data collection must be reasonable and appropriate for the program as well as the persons expected to gather it. If it is a burden, it simply will not be done.

OTHER RESOURCES:

• "Functional Language Instruction for Linguistically Different Students with Moderate to Severe Disabilities" by Elva Duran at www.cec.sped.org/digests/e501.htm. Much of this article pertains to AAC users who can, in effect, be considered culturally and linguistically different.

• "Activity Based Instruction" at www.tr.wou.edu/train/ cdcbest.htm#ACTBAS.

• "Frequently Asked Questions" by Dr. James Macdonald offers information and suggestions on developing communication through play and early social interactions at www.oberlin.edu/~bmislin/cp/FAQ.htm.

• Linda Pratt's May 12, 1998 e-mail posting under "don't underestimate...." describes a child whose expressive abilities take a dramatic leaf forward when her AAC is reprogrammed with more advanced vocabulary. It is on the ACOLUG listserv archives at listserv.temple.edu/cgi-bin/wa?A2=ind9805&L =acolug&F=&S=&P=7181.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• "Communication Interactions: It Takes Two" is an overview of how to interact with children who are deaf-blind. This information is, however, useful for any beginning communicator. It is at www.tr.wou.edu/dblink/comm.htm.

• An excellent book with detailed descriptions of specific teaching techniques for children of different ages, with varying skill levels and impairments, see Blackstone, S. W., Cassatt-James, E. L., & Bruskin, D. M. (Eds.). (1988). Augmentative communication: Implementation strategies. Rockville, MD: American Speech-Language-Hearing Association.

• "Go Fish" at www.prentrom.com/ teaching/games.html, and "Clothing relay race" at www.prentrom.com/ teaching/fun.html are teaching tips from Prentke Romich Co.

Computers, toys, games, and AAC camps are excellent ways to teach communication and communication-related skills to children of all ages and abilities. They are motivating, can be designed to teach different kinds of skills, can serve to encourage interaction with peers, and can be used in many different settings (Beukelman & Mirenda, 1992).

Currently there is some debate over what the role of computers and television should be in a young child’s life. This discussion centers over the need for a child to experience mainly hands-on learning, and the fact that time with computer programs and television is time that is not spent manipulating objects and learning directly about the physical world. However, for a child with disabilities, especially one with motor disabilities, it may be extremely difficult to handle and manipulate objects. In this situation computers and television can become one important way of learning about the world. In addtion, children can work on fine motor, cognitive, communication and social skills utilizing specific computer programs. Computers and computer-based equipment, in many cases, will become the child’s primary means of communicating and controlling the environment. Thus, used with discretion, computers and television have the potential to play an important role in the life of a child with disabilities.

TOYS:
• "New products at toy fair have special applications" by Joan Tanenhaus at www.closingthegap.com/cgi-bin/lib/libDsply.pl?a=1037&b=5.

• The National Lekotek Center "Leading the way for Accessible Play" provides toy and software lending libraries and a Resource Helpline 1-800-366-PLAY among other services at www.lekotek.org.

• "Toys for Special Needs Children," a compilation of catalogs, at nncf.unl.edu/toys.html.

• Assistive Technology Fact Sheet on "Adapted Toys" describes how to adapt toys for children with different types of disabilities at www.arkansas-ican.org/fstoytxt.htm.

• Living with SMA (spinal muscular atrophy): The Joy Of Toys! by Lori Hungate at www.mdausa.org/publications/Quest/q23smatoys.html.

• Tech Tots is a network of technology lending libraries including toys, computers, peripherals, software, and other assistive technology devices at www.ucpa.org/html/innovative/techtots/index.html.

GAMES:
• Playing Around: Using Games to Facilitate Language Development of People Who Use ACC by Kristen Newman, M.A. CCC-SLP and Linda V. Klotz, M.A. CCC-SLP at www.dinf.org/csun_98/csun98_076.htm.

• Specific games and ideas that motivated one five-year-old by Merell Liddle on the Oct. 28, 1997 ACOLUG listserv archives under "Young children and AC devices" at listserv.temple.edu/cgi-bin/wa?A2=ind9710&L=acolug&F=&S=&P=24151.

• Using "magic tricks" to encourage communication by Laurie McArthur on the Dec. 10, 1997 ACOLUG listserv archives under "SLP seeks info on opinions" at listserv.temple.edu/cgi-bin/wa?A2=ind9712&L=acolug&F=&S=&P=8571.

• Forming a singing group by Anthony Arnold on the June 22, 1997 ACOLUG listserv archives under "Singing & ACOLUG" at listserv.temple.edu/cgi-bin/wa?A2=ind9706&L=acolug&F=&S=&P=12236.

• Games for a five-year-old by Colleen Yinger on the Dec. 6, 1997 ACOLUG listserv archives under "games on alphatalker" at listserv.temple.edu/cgi-bin/wa?A2=ind9712&L=acolug&F=&S=&P=5400.

• "Let's Play! Project looks to provide families with ways to play through the use of assistive technology" at cosmos.ot.buffalo.edu/letsplay.

COMPUTER ACTIVITIES:
• "Computer play for the very young: More than cause/effect" by Madge Bradley at www.closingthegap.com/cgi-bin/lib/libDsply.pl?a=1035&b=3.

• "Connections for success: Young children, computers and software" by Linda Benton at www.closingthegap.com/cgi-bin/lib/libDsply.pl?a=1033&b=1.

• "Computer Fun and Adapted Play: Strategies for Cognitively or Chronologically Young Children with Severe Disabilities Part I & II" by Pati King-DeBaun, M.S. CCC-SLP at www.dinf.org/csun_97/csun97_066.htm.

• "Keyboard Kids: A curriculum for Teaching Basic Computing Skills to Young Children with Disabilities" by Howard P. Parette, Jr., Ginny Heiple, Deborah Rudolph and Nancy Dunn at www.closingthegap.com/cgi-bin/lib/libDsply.pl?a=1038&b=6.

CAMPS:

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• "AAC Summer Camps" at www.prentrom.com/camps.html.

• Information on an AAC Camp in California called "Building Bridges" by Cassie Sementelli on the Feb. 22, 1999 ACOLUG listserv archives under "AAC camps" at listserv.temple.edu/cgi-bin/wa?A2=ind9902&L=
  acolug&F=&S=&P=21692.

• "AAC CAMP FROM A-Z" by Janie Cirlot-New, M.S., CCC/SLP, Bud Rizer, Ed.D. T.K. Martin Center for Technology and Disability, and Jan Shook, M.S, CCC/SLP DynaVox Systems Inc. at www.csun.edu/cod/conf2000/proceedings/0163CirlotNew.html.

OTHER:
• ContAACt is a listserv designed for kids who use AAC at web.nmsu.edu/~shstuart/address.html.

• Books on toys as tools used in teaching children communication at www.kidsource.com/Books/amazon%20info/The%20New%20Language%20of%20Toys.html.