For a comprehensive book with many detailed descriptions of specific teaching techniques for children of different ages, 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.

Children all start out as unintentional communicators; that is their behaviors are not intended as communication, but are interpreted by adults as being communicative. For example, crying is interpreted as if the infant were "telling" the parent of a desire for food, even though the crying is involuntary and would have occurred outside of the presence of the parent. Typically, the child next develops into an intentional, but still nonsymbolic, communicator. This is characterized by such actions as reaching, looking at, or pointing towards something to indicate a desire for it. Finally, the child develops symbolic communication skills, the most prevalent being spoken language. (See Normal speech and language development and Assessing intentionality, and the understanding of means-end, causality and symbols.)

For a child with disabilities who is not yet an intentional communicator, a communication program should first aim at teaching intentionality. Essentially, this means teaching the child that certain behaviors (i.e. communicative ones) get specific responses, and that, through these, the child can deliberately exert some control over his or her life. At this point the child is pre-symbolic, so pictures and other symbols are not appropriate. Furthermore, it is often recommended that behaviors already in the child’s repertoire be used, rather than teaching new behaviors in addition to new cognitive skills. For example, reaching, looking, pointing, or facial expressions may already be regularly used by the child. The objective, then, would be to assist the child in using them for the purpose of communication (Van Tatenhove, 1987). (See Eye gaze techniques.)

General recommendations for teaching a child intentional communication include the following.

• Become aware of how the child is currently communicating, even though it is still unintentional. Identify communicative behaviors over which the child could potentially develop control, such as movements, facial expressions, or vocalizations. Respond to these as if they were conscious actions. Responses should be as consistent as possible. The child will learn to connect the behavior with its response and begin to produce the behavior in order to elicit the response.

• Make statements that comment on what the child’s behavior is communicating. For example, say to the child "You are raising your arms. That means ‘up.’ I will pick you up" (Van Tatenhove, 1987). Besides helping the child to realize that raising his or her arms results in being picked up, this can serve to increase the child’s understanding of speech (called receptive language). It also helps the parent or teacher to be consistent in responding to the child’s communicative behaviors.

• Focus on communicative behaviors to which the natural response is something that is highly motivating to the child. For example, if the child enjoys attention, then a social response is good because it will prolong the interaction. Children may also request (unintentionally) toys or food, and be given it. The child is initially producing the behavior at random, but eventually should come to connect the behavior with its consequence or reward. (Schweigert, 1989).

• Acknowledge and respond to every communicative attempt by the child. Try to respond in a consistent manner even in different situations. This may mean having to inform others what a behavior or action by the child is communicating, and how to respond to it. A "dictionary" in which communicative behaviors and actions by the child, the situations in which they typically occur, and what the response should be are all written down can help different partners coordinate their interactions with the child (Reichle, 1997).

• Activities and routines can be very useful in teaching intentional communication. Create structured, predictable routines that can be centered around daily events such as mealtime, bath time, dressing, toiletting and bedtime. The idea is that the child will eventually begin to anticipate the different steps in the activities and routines. This may be indicated by facial expressions or movements that indicate pleasure, dislike or an awareness of what is going to happen next. Simple, repetition-based games which most young children enjoy are also excellent in developing early communication skills. Choose games that are short and easy, involve taking turns with a partner, and can be varied slightly. Examples of such games are peek-a-boo, or "Row, Row, Row Your Boat" in which partners sit facing each other, holding hands and rocking back and forth. While playing these games, pause periodically to see if the child in some way indicates a desire for more. (See Activities and routines as teaching tools.)

• Try to keep the child informed of who is present and what is happening. For children with dual sensory impairments (i.e. disabilities in both vision and hearing), or minimal environmental awareness, Beukelman and Mirenda suggest that whenever a new partner initiates a routine the following information should always be provided to the child through verbal, tactile, movement-based, olfactory, or other modes:
  • A greeting to the child by and identification of the new partner. (For example, an adult may always wear a large watch. Whenever this adult encounters the child, the adult can greet the child verbally and, at the same time, have the child feel the watch.)
  • Identification of the new routine. (For example, the child may always be given a wet washcloth to touch prior to being given a bath. This becomes the signal that it is bath time.)
  • Identification of available choices. (For example, make the child aware of the different options available using whatever signals have already been established with the child.

  The end of the routine should always include:

  • Indication that the routine is over.
  • Indication that the partner is leaving (if that is the case).

OTHER RESOURCES:

• "Expressive Communication How Children Send Their Messages to You" adapted from an article originally written by Kathleen Stremel at www.tr.wou.edu/dblink/express2.htm.

• "Early Interactions With Children Who Are Deaf-Blind" by Deborah Gleason at www.tr.wou.edu/dblink/early.htm.

• "Receptive Communication How Children Understand Your Messages to Them" adapted from an article originally written by Rebecca M. Wilson at www.tr.wou.edu/dblink/recept.htm.

A "scripted routine" is a method of teaching a child intentional communication through the use of routines (Beukelman & Mirenda, 1992). Routines present an excellent context in which to teach communication because the child is able to learn the steps that make up the routine. Once the child knows the steps, less cognitive capacity needs to be devoted to the routine, leaving the child more room to focus on other aspects such as communicating about the routine (Yoder & Davies, 1992a; Yoder & Davies, 1992b).

The scripted routine involves the following (Beukelman & Mirenda, 1992). Prior to each step in a routine, the adult provides the child with a tactile, olfactory, or movement-based cue that indicates what the next step is. At the same time, the adult narrates what is about to happen. Then the adult pauses for several seconds and looks for any signal from the child indicating that he or she understands what is about to occur. If the child responds positively, then the adult continues by acknowledging the response and continuing the routine. If the child responds and this response is interpreted as a rejection of what is to come, then the parent or teacher can honor the request by stopping the routine, skipping the step, or discontinuing the routine for a few moments and then trying again. If the child does not respond at all, the adult can repeat the tactile and verbal cues and again await a response, or continue with the routine.

An example of a scripted routine during hand washing would be to sprinkle a few drops of water on the child’s fingers (tactile cue) and say "Now we are going to rinse your hands in the water" prior to actually placing the child’s hands under the water. Acknowledging a response from the child might be, "You wiggled your fingers. OK, now here’s the water."

The scripted routine can also be simplified simply by not providing the initial touch/smell/movement cue. In this version the adult just pauses before each step to look for a signal of awareness from the child (Beukelman & Mirenda, 1992).

One comprehensive program whose purpose is to ready a child for learning symbolic communication is the Van Dijk method. The Van Dijk method was originally developed for children with vision and hearing impariments (dual sensory impairments), but is currently being used with children with a variety of disabilities. It is described in detail in Beukelman & Mirenda, 1992 and Westling and Fox, 1995.

The key to the Van Dijk method is the establishment of a very close and initimate relationship between adult and child. It is composed of six sequential steps, all of which are conducted as much as possible in the context of real activities, games and routines. Physical touch and movement are important components of this method.

• Nuturance. First the adult develops a warm and nurturing relationship with the child, and becomes very sensitive to the child’s signals. By getting to know the child well, the adult can recognize and respond to the unintentional communication of the child.

• Resonance. The adult begins by making physcial contact and moving with the child in a rhythmic manner. An example, would be moving a toy truck back and forth together. Periodically the adult pauses to see if the child will initiate a response such as continuing the movement independently. The adult acts upon any response from the child as if it were an intentional communicative act.

• Coactive movement. The next step is for the adult and the child to move together when they are not in physical contact. Initially cues are used by the adult and then gradually faded. The movements become increasingly complex, and objects are introduced. Anticipation shelves, also called calendar boxes, may be utilized at this stage. Anticipation shelves are a series of boxes in each of which an object representing an activity is placed. The boxes are arranged in order, and the child learns to remove the object from the box in the series which represents the upcoming activity. After completion of the activity, the child returns the object to its box, and removes the object in the next box. This begins to teach the child the concept of symbols (i.e. that an object can represent an activity).

• Nonrepresentational reference. The child develops an understanding of his or her own body parts through movement and the body parts of a doll. This provides the child with an awareness of his or her own body and self as separate from the adult.

• Deferred Imitation. The child begins to imitate familiar movements of the adult after the adult has ceased making them. Initially full body movements (standing up, sitting down) are used, followed by whole limb and then smaller hand movements.

• Natural gestures. The child is taught to communicate with gestures that are self-developed and already a part of the child’s repertoire of behaviors. This is the beginning of intentional communication.

OTHER RESOURCES:

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

• Writer, J. (1987). A Movement-Based Approach to the Education of Students Who Are Sensory Impaired/Multhandicapped. In Goetz, L., Guess, D., & Stremel-Campbell, K. (1987). (Eds.) Innovative program design for individuals with dual sensory impairments. (pp. 191-224). Baltimore, MD: Paul H. Brookes Publishing Co.

• Beukelman, D. R., & Mirenda, P. (1992). Augmentative and alternative communication management of severe communication disorders in children and adults. Baltimore, MD: Paul H. Brookes.

• Westling, D. L. & Fox, L. (1995). Teaching students with severe disabilities. Englewood Cliffs, NJ: Prentice-Hall, Inc.

• "What's A Calendar Box?" by Pam Schachter Educational Specialist at www.nfb.org/calbox.htm

Schweigert and Rowland developed a four-level program which they used with children who had dual sensory (both vision and hearing disabilities) and motor impairments. Each step depends on the child being able to communicate directly with the adult, or to activate a communication device directly or with a switch in order to communicate. In additon, it is important to use objects and activities that are motivating to the child. This procedure is an excellent one for children who do not enjoy social attention. (See Teaching a child to enjoy social encounters.)

• The first level teaches children how to get the attention of an adult. The child is taught how to interact directly with the adult or with a communication device. Every time the child does this, he or she receives (i.e. is rewarded with) the adult’s attention. If a child is not motivated by attention, then the child is initially reinforced with something that is motivating (e.g. a toy or food), along with the adult’s attention. By pairing the desired item with adult attention, the child begins to link the social attention with the desired object and begins to see both as pleasurable. Eventually the object is no longer used and attention becomes the entire reward.

• The second level focuses on making simple requests and expressing interests.

• The third level teaches expressing preferences.

• The final level introduces symbols. The child learns to make requests and express preferences with symbols instead of the objects and events themselves.

Visually cued instruction is based on what is called "symbol exchange," in which the child requests a desired object by presenting a picture symbol of it to the adult, and exchanging the symbol for the object. It teaches intentional communication, the use of symbols and requesting simultaneously. It is an excellent approach for children who are visually oriented, and who may not be exhibiting many of the social behaviors that underly effective communication, such as eye contact or orienting one’s face towards the listener. (See Teaching a child to enjoy social encounters and Children with autism or autistic-like behaviors.)

For detailed information on visually cued instruction go to:

• "Visually Cued Instruction" by Nola Marriner, Ph.D. at www.talklc.com/handout/Outline.html.

• The Picture Exchange Communication System (PECS), a commercial product that utilizes visually cued instruction techniques, at www.pecs.com.

Milieu teaching consists of naturalistic methods that have traditionally been used to encourage spoken language in children. These techniques have also been found to be effective in teaching children AAC and early communication-related skills (Yoder, Warren, Kim & Gazdag, 1994). (For a detailed description of these methods, see Milieu teaching.)

Applied behavior analysis (ABA), also referred to as behavior modification, behavior therapy, behavioral intervention, or behavioral treatment, utilizes behaviorist principles in teaching communication. At its core, ABA analyzes every interaction into three sequential components: the action or event that triggers the communication or behavior (called the stimulus), the communication or behavior that occurs in response (called the behavior or response), and the subsequent reaction to the communicative or behavioral response that just occurred (called the consequence). For example, upon seeing a toy (the stimulus), a child may point and initiate the statement "I want that" (the response), to which the adult says "Here it is" and hands it over (the consequence).

OTHER RESOURCES: "Applied Behaviour Analysis" at www.accessin.com.au/ ~paris/autism/aba.htm.

Any of these three parts can be manipulated through teaching of the child or the partners, as well as environmental adaptations. For example the initial event or stimulus may be manipulated so as to facilitate communication. An example would be placing a desirable object on a high shelf so that the child has to request it. The response being elicited, the request for the object by the child, can be encouraged through prompting. Finally, by making sure that the consequence to the child’s behavior or response is positive and consistent—in this case promptly giving the child the object—the child has incentive to continue to respond in that manner.

ABA is a component of many different types of instructional procedures. (See The Early Communication Process, Basic communicative functions, Milieu teaching, and Interrupted behavior chains.)

Making choices, requesting, getting the attention of an adult, and rejecting something that is not wanted are among the first aims of a child’s communication. These four functions give children control over their own lives. Besides increasing independence, they tend to decrease the incidence of behavior problems (Durand, 1993; Robinson & Owens, Jr., 1995). They make excellent starting points in teaching communication because they are highly motivating and cognitively easy to understand. Furthermore, after the child has mastered them, they can, in turn, be used in teaching the child more advanced communication skills. Which to teach first should be determined by what is most motivating to the child. For some children it may be the ability to choose or request toys or food, or to get the attention of an adult; for others it may be to let a partner know that an object or activity is disliked. Of course, more than one function can be taught at the same time.

Sometimes there is the fear that a child will abuse these skills by requesting items or attention on a constant basis, or rejecting items and activities that are medically or physically necessary. However, there are proven techniques that can be used to teach the child to delay the need for immediate gratification, and to tolerate activities and objects that are necessary but disliked. (See Children with severe behavioral issues.)

In summary, a child needs to have these four communicative functions in his or her repertoire because:

• The inability to communicate in an appropriate manner may result in alternative ways of communicating that are destructive to self or others.

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

• These functions are the most logical communication skills with which to begin a teaching program since they are easily understood and highly motivating. Moeover, the rewards for successfully communicating are immediate and natural. For example, the reward for being able to request for something is to get it.

• Teaching these functions does not depend on the child understanding the use of symbols. (See Assessing intentionality, and the understanding of means-end, causality, and symbols.)

• These functions can be used to teach the child more advanced communication and communication-related skills such as symbols, new vocabulary, scanning, or multi-word phrases.

• These functions result in giving the child immediate power over his or her life. This reinforces the value of, and motivation to, continue learning.

A general rule in teaching any of these four functions is to always respond precisely to the child’s communication. For example, if the child appears to choose a neutral or unwanted object over a highly desired one, give the child the neutral or unwanted object. The child may, in fact, have wanted the neutral or unwanted object, perhaps to examine it. Even if the child has made a mistake in choosing, not responding to the child’s explicit communication and insisting that the child to choose again contradicts what choice-making is all about. It merely indicates to the child that no matter what is communicated, he or she will eventually get a certain item. Likewise, if a child requests, instead of rejects, a typically unwanted object or activity, it is important to provide it. Either the child really did want it, or the child can learn from his or her mistake. The only way for a child to learn the power of communication, and the necessity to use it accurately, is by experiencing the consequences of his or her choices (Beukelman & Mirenda, 1992).

In teaching a child how to make choices, initially just one or two items may be presented to the child. The objective is for the child to communicate a preference by looking at, reaching for, or in some way indicating a desire for an object that is presented. Having communicated, the child is given the item. After the child has mastered this, the number of items can be increased, or, if the child is using an unconventional method of communicating, he or she can be taught a more conventional method of indicating his or her choice. Offering choices is also a good way to determine a child’s preferences if they are not known. What motivates a child is extremely useful information in teaching communication.

It is important to look out for, and resolve, particular problems that occur in teaching choice-making.

• If the child does not react at all, the child may not be aware of the items. Repositioning the items may allow the child to become aware of them. If the child is visually impaired, the child can be assisted in touching, smelling, tasting and/or hearing them. If the child still does not respond, it may be that the child is tired, or nothing is sufficiently motivating. In this case, different items may be presented, or the situation altered (e.g. if food items are being offered, pick a time when the child is naturally hungry). Finally, a child may not react if he or she does not understand what is being offered. For example, a child who does not understand symbols will not react to pictures. In this case, real objects need to be presented.

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

• If the child always seems to signal for the item in a certain position (e.g. the nearest), then the items need to be repositioned to make sure the child is aware of all of them, and can indicate each one with equal ease. If the child continues to react to the item in the same position, or indiscriminately grabs at any or all of the items, it may be that the child likes all the items. In this case, some can be replaced by neutral items (e.g. a piece of cardboard). It is also recommended that the placement of the items be frequently changed so that, if the child has one or two favorites, he or she has to find them in different positions. It is, however, generally not recommended that strongly disliked items be included since these can engender negative reactions on the part of the child that overpower the opportunity for a positive choice (Reichle, York & Sigafoos, 1991).

OTHER RESOURCES:

• "My son...has cause/effect...can play with toys, through a switch, but we don't know where to go after that..." by R. J. Cooper at www.closingthegap.com/cgi-bin/lib/libDsply.pl?a=1011&b=6.

One difference between choice-making and requesting is that making a choice requires that items be presented for selection, while requesting can be done spontaneously in or out of the presence of the desired item. Requesting is highly motivating to children since they are able to get what they want with it. For this reason it is frequently used in an initial teaching program (Beukelman & Mirenda, 1992; Goodman & Remington, 1993).

A request can be general (i.e. the word "want" can be used to ask for anything), or it can be specific, for example, "want a drink," or "want milk." Often a generalized request is taught first because it is the most powerful. The drawback to this is that it may be difficult for the partner to figure out specifically what is being requested. After having mastered a general request, specific requesting may be taught, although this sometimes generates confusion. When transitioning from the use of generalized to specific requesting, it is a good idea to acknowledge the child’s general requests while teaching the newer more specific ones. For example, "You are letting me know you want to eat something. Now tell me what you would like to eat" (Reichle, York & Sigafoos, 1991; Van Tatenhove, 1987). The move from generalized to specific requesting is sometimes a good way of introducing the concept of scanning. (See Direct selection and scanning techniques and Scanning.) Excellent naturalistic methods for teaching requesting include milieu teaching techniques, and prompting and prompt-free strategies.

After the child has mastered making requests in the presence of the desired item, he or she can be taught to request an item that is not visible. This can be done by removing familiar items and prompting the child to ask for them. It helps to provide clues that trigger the child’s desire for the object. For example, if a doll is ordinarily used along with a toy crib and some doll clothes, seeing just the crib and clothes may trigger the child’s desire to play with the doll.

Another method is to withhold an item that is necessary to a routine or activity from the child. The activity itself stimulates the child to ask for the specific item. (See Interrupted behavior chains.) Another technique is to choose a time or situation when the child is likely to be hungry, thirsty or cold, and then prompt the child to ask for food, drink or warmer clothing. (Reichle, York & Sigafoos, 1991).

Being able to get the attention of an adult is important, but difficult for some children. In addition, attention-getting skills are crucial for users of AAC devices that do not output sounds. For those who use speech or VOCAs, sending a message also gets the attention of a partner. However, for those who use silent methods such as gestures, sign language, communication boards, etc., the child must get the attention of the partner prior to communicating a message. In fact, visually-based AAC device users usually require a sound-based communication method for getting a partner’s attention, such as vocalization, a buzzer, a whistle, a clap, etc. (See Multimodal communication.)

Another reason for teaching ways of getting a partner’s attention is that sometimes a child does not understand that this is a necessary part of communication. For some children, a first objective is to teach intentional communication. (See The first goal: Intentional communication.) Thus, initial efforts aimed at helping the child make a connection between his or her behavior and adults’ responses often mean that every communicative attempt on the part of the child results in an immediate reaction. Such a child never has the need to get the attention of the adult prior to communicating, and, thus, does not understand that this is necessary. This can be offset by incorporating attention-getting strategies into an intentional communication instructional program (Reichle, York & Sigafoos, 1991). (See The Early Communication Process.)

Attention-getting can be taught using prompting and prompt-free strategies or can be included in routine-based teaching techniques.

Teaching a child how to say "no" to an unwanted object or activity is a sometimes neglected communication skill. Yet, the inability to say no in an appropriate manner is frequently associated with behavior problems. When a child is not able to indicate rejection, the child may find him- or herself suddenly in the midst of an undesirable predicament, resulting in immediate and forceful rejection behavior. (See Children with severe behavioral issues.)

Like requesting, rejecting can be taught initially in a general form that will serve in any situation, such as "no." When this is mastered, more specific forms can be taught, for example, "no milk" (i.e. I don’t want milk.") In teaching rejecting, it is often difficult, but important, not to remove an unwanted item or situation in response to an inappropriate behavior. This only serves to reinforce for the child that the quickest way out of the situation is to act out. By the same token, it is important to give the child a method of rejection that allows the child to escape from an unwanted situation in a quick, reliable and efficient manner. For example, vocalization, shaking one’s head, or waving a hand back and forth can be fast and easily understood by others, as opposed to locating and pushing a button on a voice output communication aid (VOCA).

In teaching a child to reject, the adult must learn to recognize early the child’s current manner of rejecting. For example, the child may begin with a frown, then wave his or her hands and whine, and finally start to cry or scream. As soon as the adult notices the frown starting to appear, the child should be prompted to communicate "no," and the offending object removed immediately. In fact, because a child’s self-developed way of rejecting can occur extremely quickly in response to an unwanted item, it may be necessary to teach the child the new rejection signal outside of an actual negative situation.

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

For example, initially teach the child to say "no," shake his or her head, or touch a "no" symbol through imitation or physical prompting. When the child is familiar with the form he or she can be taught to use it in the presence of an unwanted item or activity. As the child begins to master communicating a rejection, any residual prompting from the adult can be faded. (See Prompting and prompt-free strategies, and Fading prompts.)

Initially it may be important to honor the child’s newly learned ability to communicate a refusal at every opportunity, especially if it is replacing dangerous rejection behavior. This is difficult with regards to activities that are medically or physically necessary. If possible, remove the unwanted activity upon the request of the child, and then continue again after a pause, or break it up into smaller steps. After the child has mastered the new method of rejecting, he or she can be taught to delay the removal of the unwanted object or activity for longer and longer periods of time (Beukelman & Mirenda, 1992). (See Children with severe behavioral issues.)

In basic terms, a conversation has three parts, a beginning, a middle or body, and an ending. Each requires different skills. To begin a conversation, one has to get the attention of a partner and bring up a topic that is of interest to both parties. Maintaining the interaction requires such skills as taking turns, and being able to stay on the same topic or move smoothly to another topic of interest. Ending the interaction implies finding a point in the conversation in which it is okay to stop, and then informing the partner of one’s intention of terminating the conversation. Of these three, the first two are usually considered the more important. Children who use AAC may need systematic teaching and practice to master these skills. This is not only because they may be unfamiliar with the actual skills, but also because characteristics of AAC systems usually necessitate significant conversational adjustments by both child and partners.

A lot of focus has been placed on the conversational imbalance that occurs between persons with and without disabilities. Persons with disabilities are known to seldom initiate, to respond primarily with short statement such as yes and no, and, overall, to occupy significantly less of the conversational space than do their partners without disabilities (Calculator, 1997; Light, 1988).

This is, indeed, notable and disturbing. On the other hand, it is important to keep the entire interaction in perspective. Rather than just focusing on initiations and number of words spoken, it is worthwhile to look at the overall quality of such conversations: how long each one is, how often they occur, how engaged each party is, how much information is conveyed, etc. One study found that, in conversations between two individuals without disabilities, one of whom was asked to use AAC, the AAC users automatically became less of an initiator and more of a responder. The additional time and effort required to communicate with the AAC device caused the conversation to lose its natural timing and rhythm, and for the non-AAC partner to lose interest. For the sake of conversational flow, the AAC users naturally adopted a more passive role, relying on their partners to steer the conversation in an attempt to increase the pace. Speed of communication is, in fact, considered one of the most important factors in normalizing conversations. Studies have found that normal speakers use 150 to 250 words per minute, but that AAC users average less than 15 words per minute (Beukelman & Mirenda, 1992; Venkatagiri, 1995). In effect, conversational control and conversational efficiency appear to often be at odds with each other.

What this study suggests is that merely to focus on increasing the number of initiations or the number of words output by a child who uses AAC may not necessarily be helpful, and can even be detrimental to the overall interaction. What need to be identified are the obstacles that are impeding a particular child’s conversational ability. Obstacles may include the child’s own lack of confidence, learned helplessness, conversational inexperience or lack of interesting subject matter, or may be inherent to the child’s skill in using the AAC, such as slowness or a large number of mistakes. These specific issues need to be addressed if the overall quality of the interaction is to improve.

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

At the same time, much can be gained by increasing partners’ sensitivity to the characteristics and needs of AAC users. Partners can be taught to increase an AAC user’s conversational control by pausing for longer periods to give sufficient time to initiate or respond, using open-ended as opposed to yes-no questions, and following the user’s lead (Farrier, Yorkston, Marriner, & Beukelman, 1985).

OTHER RESOURCES:

• Mike Gregory 's Nov. 6, 1997 e-mail posting under "Communication Boards" describes issues in conversing with a communication board on the ACOLUG listserv archives at listserv.temple.edu/cgi-bin/wa?A2=ind9711&L=acolug&F=&S=&P=5764.

Children with communication impairments often have difficulty initiating a communicative exchange, which has instigated much research and debate. In one study, for example, families were taught a number of different techniques to facilitate communication with their AAC-using child. The results were positive; the children became substantially more communicative, and used longer, more sophisticated responses. Yet, they did not increase their rate of initiating conversations. Learned helplessness was one factor cited in explaining why these children remained non-initiators. This suggests the importance of early intervention in the prevention of learned helplessness in children with disabilities (Basil, 1992). (See Contacting an organization for services and support.)

To a large extent, initiating conversation comes with practice and self-confidence. To help a child who is not initiating due to lack of opportunity or apprehension, the following may be of assistance (Reichle, York, & Sigafoos, 1991).

• A child is more likely to want to participate in an activity in which other children are already involved and enjoying.

• Routines are excellent devices for teaching initiating since it is easier for a child to initiate if he or she is already well-acquainted with the activity. (See Activities and routines as teaching tools.)

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

• Many naturalistic teaching strategies are excellent for teaching a child to initiate interactions. (See Milieu teaching and Prompting and prompt-free strategies.)

• Put something new or unusual in the environment that will catch the interest of the child

• Do something that the child finds mildly objectionable to elicit a protest or rejection. (See Interrupted behavior chains.)

• Prompt the child. For example say, "Go ahead and ask them if you can join their game."

Beukelman & Mirenda (1992) stress the importance of providing the child with a means for bringing up new topics. This consists of providing and teaching relevant vocabulary, and giving the child an engaging way to introduce a topic of interest. They suggest collecting items that represent activities and events that are of interest to the child and putting them in a folder or book, or assisting the child in making collections of objects such as miniature cars, stuffed animals, etc. These props allow the child to introduce the topic easily and in an interesting manner. Even if the child still does not initiate, the partner, upon seeing the props, can easily bring up a subject of interest to the child by asking about them.

Sensitive partners are very important in maintaining a conversation with a child who uses AAC. Some of the main reasons that a child may not hold up his or her end of the conversation include the child’s own lack of confidence, or the slowness often inherent in using AAC, particularly among beginning users. Partners may find themselves with the urge to "help" the child by doing most of the talking themselves, asking the child only questions that are quickly and easily answered, such as yes/no questions, or even terminating the interaction because it appears to be too effortful for the child.

Instead, partners can make adjustments that allow and encourage the child to continue a conversation. First, it is important to have a conversation that is of interest to both parties. This could involve the exchange of new information, the discussion of a familiar story or topic, or it could be a game or routine that both parties enjoy. Without being rigid about it, partners can provide the child with longer pauses, ask more open-ended questions (i.e. questions that cannot be answered by just one or two words), and expect longer responses from the child. If a familiar story, game or routine is being used, the partner can add variations in order to expand the child’s repertoire. Finally, the partner can follow the child’s lead by allowing the child to set the topic and then following along. Children are known to have a greater attention span and to communicate more on topics which they, as opposed to their partners, have introduced (Calculator, 1988b; Yoder & Davies, 1990; Yoder & Davies, 1992a).

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

A specific strategy that encourages a child to continue a topic of conversation starts by encouraging the child to initiate a subject of interest through the use of pictures, props or other means. (See Topic-setting strategies.) The partner responds to the child’s initiation, and then adds a question or comment about the topic, to which the child is expected to respond. After the child responds, the partner follows up in the same manner (Beukelman & Mirenda, 1992; Westling & Fox, 1995)

OTHER RESOURCES:

• Phil Lawrence's Dec. 17, 1997 e-mail response under "Social interacting with AAC" discusses the importance of AAC users being able to make "small talk" on the ACOLUG listserv archives at listserv.temple.edu/cgi-bin/wa?A2=ind9712&L=acolug &F=&S=&P=19013.

After a child has mastered basic one- to three-word phrases, it may be time to begin encouraging the child to start using more complete sentences. Sometimes this involves introducing a new, more advanced AAC system. For example, communication boards may not facilitate the use of grammatically correct sentences, whereas sign language or a voice output communication aid (VOCA) will. Essentially, the type of AAC and symbol system used will have an affect on how the child is taught sentence structure. If a VOCA is used, choice and organization of vocabulary become crucial in this endeavor. (See Vocabulary selection strategies and Organizing vocabulary for speed.)

OTHER RESOURCES:

• "Field of Dreams: Sowing Language and Reaping Communication" by Gail M. Van Tatenhove, PA, M.S., CCC-SLP discusses the importance of developing increasingly sophisticated language at http://kaddath.mt.cs.cmu.edu/scs/95-gvt6.html.