In choosing which instructional techniques to use in teaching a child, the following considerations are important:

• Ideally teaching should take place at home as well as at school or in therapy. This speeds up learning as well as stresses the value of communication in many different environments. While this presumes that family members must be teachers as well, it does not mean that that they must endure daily rigid teaching sessions that are time-consuming and disruptive. In fact, the manner in which a child’s AAC is used at home must fit into the family’s lifestyle if it is to be successful there. Examples of what might be practical at home are:
  • Following up with communication skills and vocabulary introduced at school.
  • Reading or telling stories to the child.
  • Talking to the child as much as possible, using language that is at or just barely beyond what the child understands, and pausing frequently to allow the child to respond. Family members may or may not also use their child’s AAC system to highlight key words as they are spoken. (See Simultaneous communication.)
  • Programming vocabulary used at home into the AAC device so that it is reinforced at school.
  • Playing games with the child that require communication.
  • Encouraging siblings and others to communicate with, and expect to be communicated with, the child using AAC.

• For their part, teachers should be aware of and follow up in the classroom with what the child is learning at home. Many family members are willing and able to spend a great deal of time working with their child. There may be cases in which they know much more about their child’s AAC than the classroom teacher or school communication professional. This is particularly true when the child begins school or moves to a different class and gets a new set of teachers and professionals. In these situations, the teachers and professionals should acknowledge the experience and expertise of the family, and design interventions for the classroom based at least partly on what has been done at home. Unfortunately, a lot of backtracking occurs when a new teacher does not continue with an AAC plan already in place but, instead, starts a new and different communication program.

• It is important that there be a data collection system in place to determine the effectiveness of teaching. This does not have to be a complicated and meticulous system; in fact, if it is too demanding, chances are it will not be carried out at all. Ideally, the information collected should be based on fact and not opinion, and indicative not only of whether a plan is working, but also, if it is not, the reasons why it seems to be failing. This information is crucial in determining how an existing instructional plan can be added to or modified.

• Specific characteristics of the child should be taken into consideration. These include such attributes as:
  • The child’s learning style (i.e. visual, auditory, tactile).
  • Whether or not the child has a tendency to become dependent on prompting by an adult. (See Prompting and prompt-free strategies.)
  • Whether or not the child will imitate.
  • What motivates the child.

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

• The type of AAC system being used has implications regarding how it is taught. For example, physical guidance can be used with gestures and sign language, as well as graphical systems like communication boards and VOCAs. It cannot, however, be used with speech. Speech requires that the child be able to imitate. (See Teaching different modes of AAC.)

OTHER RESOURCES:

• For 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.

In the past, a communication intervention often meant placing a child in a separate therapy room and using drill-and-practice techniques to teach specific responses to questions or statements. Nowadays, it is strongly recommended that a child be taught communication (and other skills) in the midst of real-life settings and activities (Leister, Koonce, & Nisbet, 1993). This follows a general trend in which children with disabilities are no being longer removed from their peers and taught in isolation, but integrated into the regular classroom. Studies have found the following to be true about learning in natural environments, typically the regular education classroom:

• Because the settings and activities are real, the communication skills being taught are practical and meaningful, and, as a consequence, more motivating.

• Peers are available as models. Children with disabilities not only learn new vocabulary, but are being clued into the entire social routine surrounding a communicative exchange. A child can have mastered a large number of messages—and many became experts at outputting messages upon demand in a one-to-one therapeutic situation—but have no idea how to communicate with them in real circumstances. For example, a child may learn to say "I am fine" to the teacher’s "How are you?" but when approached by a smiling, waving peer in the hallway who says "Hey, how’s it going?" be at a loss as to how to respond (Westling & Fox, 1995).

• Children tend to learn more efficiently by using communication to accomplish things, rather than being taught about the messages (i.e. receiving a description of what a word means and how it is used). In other words they learn what messages mean by using them, even though, at times, they may not even be exactly sure what the words mean. (This is called the pragmatic approach.) (Light, Collier, & Parnes, 1985).

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• Because children are learning the general circumstances under which communicative exchanges occur, they are better able to use their knowledge even when faced with a completely new situation. (This is called generalization.) For example, a child learning to communicate while playing at school, may, then, be able to successfully use these skills while playing at home or at a friend’s house. Children who learn through drill-and-practice are often unable to transfer their knowledge anywhere outside the therapy room because the surrounding factors are so different.

• With training and support, peers can be included in an AAC program. Peer-mediated communication interventions can be very effective (Romski, Sevcik, Robinson, & Bakeman, 1994; Romski, Sevcik, & Wilkinson, 1994).

A collection of naturalistic techniques, generally based on how parents communicate with their normally developing infants and young children, is recommended for youngsters with disabilities. These techniques are unintrusive, loosely applied and feel natural, making them easy for parents to use at home without disrupting family life, and for teachers to use in the midst of regular classroom activities. Naturalistic techniques include the following.

• Talking to the child as much as possible and/or providing a model for the child to imitate by using the child’s AAC to simultaneously highlight key words while speaking. (See Simultaneous communication.) This should occur naturally, utilizing statements that are at or just ahead of the child’s current ability to understand language. This means using simple vocabulary, shorter statements and a slower rate of speaking. One way of accomplishing this is to narrate what is occurring. For example, "Sock." (Point to or hold sock up.) "Sock on." (Put the sock on the child’s foot.) "Other sock on." (Put the other sock on.) In addition, frequent pauses, while looking at the child and waiting a sufficient length of time (even up to a minute or two) allows the child to respond or initiate communication. This technique increases the child’s receptive language comprehension as well as provides opportunities for communication (Light, 1988; Reichle, 1997; Romski, Sevcik, Robinson, & Bakeman, 1994).

• Paying attention to what the child is interested in (as opposed to the adult directing the child’s attention towards something else). Ways of doing this include noting what the child appears to be focusing on, and then talking about it or including it in interactions with the child, or imitating what the child is doing. If the behavior being imitated is one that is not desirable, such as finger watching, the adult can begin to modify it into a more socially acceptable behavior, such as a peek-a-boo or waving game once the child is engaged in the interaction. This is especially useful for children who do not enjoy interacting with other persons (Reichle, 1997).

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• Responding to the child’s communicative attempts. A child is more communicative if the adult does not introduce a new topic but continues one that was introduced by the child by asking questions or making comments about it (Yoder & Davies, 1990). Even if the child’s communications are unintentional, acknowledge what they appear to mean and respond accordingly. (See Assessing intentionality, and the understanding of means-end, causality, and symbols and The first goal: Intentional communication.)

OTHER RESOURCES:

• "The Caring Connections... That Help Children Communicate"by Ayala Manolson, Helen Buck and Claire Watson describe a natural, intuitive approach to teaching communication at www.hanen.org/carconn.html

Simultaneous communication, also called total communication or aided language stimulation, is a technique whereby the adult speaks normally, simultaneously using AAC to stress important words. For example, "Let’s play ball," would be accompanied by the words "play" and "ball" in the AAC mode. This technique is used with children who are learning AAC, or AAC and spoken language at the same time.

Basically, simultaneous communication exposes the child to a model of AAC use, in as natural a manner as possible. When designing the AAC system with simultaneous communication in mind, it is necessary to include vocabulary that the adult will need along with the child’s vocabulary since the adult will be using the system too.

The benefits of simultaneous communication are numerous (Beukelman & Mirenda, 1992; Goossens', 1989; Goossens' & Crain, 1987; Romski & Sevcik, 1993; Romski, Sevcik, Robinson, & Bakeman, 1994; Romski, Sevcik, & Wilkinson, 1994).

• The child may be learning to understand speech (called receptive language) at the same time. Many teaching techniques have as their goal expressive language (i.e. the child's ability to communicate to someone else) rather than receptive language, even though receptive language has been linked to progress in expressive communication (Remington & Clarke, 1993a).

• It is an excellent method for children who are learning both AAC and speech at the same time. In fact, studies have shown that, when exposed to simultaneous speech and sign language, both children with and without disabilities have been able to learn natural speech faster. (See Does AAC impede the development of natural speech?—and other fears.)

• If the child already understands the spoken words, he or she can infer their AAC equivalents, thus, increasing the speed at which the corresponding AAC terms are learned.

• Learning takes place in natural circumstances. Not only is this more motivating, but children are able to immediately use their new vocabulary in real situations. This has been found to be a more practical and successful mode of learning than drill-and-practice methods.

• This method can be utilized during any activity or routine, at any time of day. It lends itself to child-directed (as opposed to adult-directed) learning. Teaching that occurs when following the child’s interests results in increased attention span and motivation on the part of the child (Yoder & Davies, 1990).

• Simultaneous communication does not depend on or require the child to make a specific response, or even to respond at all, although responses may be encouraged. This form of teaching is, therefore, error-free; the teaching session does not have to be discontinued if the child is not responding, nor does the child have to be prompted or corrected.

• It can easily be used along with other teaching techniques.

However, simultaneous communication techniques may not be for all children. Research has shown that some children only pay attention to the visual (e.g. the AAC) part of the message, and disregard the spoken words. These are likely to be children who are visual learners or who prefer less transient modes of AAC. (Transience refers to how long a message or symbol is available. Speech sounds are the most transient; a sign can be made visible for a longer period of time but disappears when the next sign is made; and pictures, which are permanent, can be examined at length.) (See Children with autism or autistic-like behaviors and Aided vs. unaided AAC systems.)

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

A child who is only attending to the visual aspect may not be learning to comprehend the corresponding speech. Because it is important for a child to understand spoken language, in these cases it may be worthwhile to explicitly teach the child the meaning of spoken words (i.e. teach receptive language) by sometimes using speech exclusively. This may be in addition to utilizing simultaneous communication to further the goal of fostering the child’s ability to communicate with others (i.e. expressive communication) (Remington & Clarke, 1993a; Remington & Clarke, 1993b).

OTHER RESOURCES:

• "Aided communication intervention before assessment: A case study of a child with cerebral palsy" by Carol Goossens’ (1989) is a case study of a six-year-old taught how to use eye gaze communication through aided language stimulation (i.e. simultaneous communication).

Milieu teaching techniques are thus called because they are used in the midst of regular activities during the day. The most prominent are incidental teaching, mand-model and time delay. Milieu procedures are typically used to increase the frequency of a child’s communicating a specific request, although they may be used to teach new communicative forms or vocabulary. Milieu techniques necessitate that the environment be arranged in such a way that the child is encouraged to initiate interactions. This ensures the child’s motivation, increasing the likelihood of success.

Milieu teaching methods are based on principles of behaviorism, including rewarding a child for successfully communicating a target message. However, because teaching takes place in natural settings and activities, rewards are natural positive consequences (i.e. the child gets the item that he or she requested). This means that after the skill has been mastered and formal teaching is discontinued, the child will still get the same natural rewards for communicating a request. This eliminates the need to fade out artificial reinforcers. (See Fading prompts.)

The three most well-known milieu teaching procedures are incidental teaching, mand-model teaching and time delay. They are very similar and, with slight variations, consist of the following steps (Beukelman & Mirenda, 1992; Kaiser, Ostrosky, & Alpert, 1993; Kozleski, 1991; Reichle, York, & Sigafoos, 1991; Westling & Fox, 1995).

• A target skill is chosen, usually a request. Typically it is one that the child is familiar with, but is still learning to master.

• The environment is arranged or an activity organized in a way that encourages the child to make requests. This might be placing favorite toys visible but out of reach, presenting the child with a new activity, or "forgetting" to provide a key component of a familiar activity.

• When the child appears to want the item, the adult makes eye contact with the child. The adult may simply look expectant, anticipating the child’s asking for the item. If the child makes the request (i.e. is able to produce the target skill), then he or she is praised by the adult and receives the item along with social praise. If he or she does not respond appropriately, then the adult may try one or more of a variety of prompts, usually starting with the least intrusive. These include: providing the child with a natural prompt ("What do you want?"), explicitly asking the child to make the request ("Make the sign" or "Point to the picture"), modeling the request for the child (adult uses the child’s AAC to make the request), or physically guiding the child in making the request (adult physically assists the child in using AAC to make the request). (Note that physical guidance can not be used with speech, or if the child dislikes being touched. See Teaching different modes of AAC.)

  When the child has produced the target skill using whatever assistance was necessary, he or she receives the item along with social praise. It is usually not a good idea to use too many prompts because this can confuse the child, or make the child prompt-dependent. (See Prompting and prompt-free strategies.) Milieu techniques are often referred to as errorless teaching methods because the child successfully performs the skill at every session, albeit sometimes with assistance.

• The main difference between incidental and mand-model procedures is that, with incidental teaching, the adult’s first reaction is to simply look expectantly at the child, while, with mand-model teaching, the adult begins by specifically asking (i.e. manding) the child to make the request: "What do you want?"

• Time delay utilizes predetermined periods of waiting for the child to respond. Time delay also starts with the adult looking expectantly, however, the ensuing waiting period is carefully chosen. Prompts may be used if the child does not respond correctly after the designated time, and the time delay used at the next session may be increased. For example, the adult may start with a waiting period of 10 seconds. If the child requires prompting, at the next session the adult may add two seconds so that the waiting period is now 12 seconds long. At each session following one in which the child did not respond correctly, the waiting period may be lengthened, or kept the same, depending on the schedule determined in advance.

  If the child seems to be getting overly frustrated (i.e. frustration is beginning to interfere with learning), the wait period can be reduced, before starting the progressive increases again. Correct responses are dealt with by praising and giving the child the desired item. Incorrect responses usually are followed by a single physical guidance prompt before the child is offered the item, although additional prompts may being given. Even though the wait period may seem to be growing very long if the child does not respond correctly over many trials, once the child "gets it," the delay often dramatically shortens. When only a single physical prompt is used as needed, time delay is an excellent way to prevent a child from becoming dependent on prompting, or to wean one who has already become overly prompt-dependent. (See Prompt-free and verbal prompt-free strategies.)

  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 is not making progress, it may be because the items are not sufficiently motivating, the skill is too difficult, or too many prompts are used making the child give up or become too frustrated.

The following is an example of an incidental teaching procedure. A toy train is placed so that it is visible but on a high shelf. The child begins reaching for it. The adult looks at the child expectantly. The child, however, continues to reach. The adult then asks, "What do you want?" The child simply continues to reach. Finally, the adult physically takes the child’s hand and guides the child in pressing the button on the VOCA that says "Train." Then the adult smiles and says, "You said 'train.' Okay, here it is," and gives the train to the child.

Activities and routines figure prominently in children’s lives, whether they are a part of life’s daily necessities or games enjoyed with a partner. Routines are excellent teaching devices because, as their components become more and more familiar, the child can devote less and less attention to the actions that comprise them, and focus more on communicating within the routine (Yoder & Davies, 1992a). Thus, routines should occur on a regular basis and be performed in a highly consistent manner. Once the child is well-versed in a routine, variations can occur, adding an element of interest and surprise.

Suitable routines can be games and fun activities that involve repetition, such as peek-a-boo or "Simon Says," or activities that occur on a daily basis, for example, mealtime, bath time, bedtime, story time, etc.

OTHER RESOURCES:

• For a detailed description of objectives and techniques that can be used during mealtime, see Morris, S. E. (1981), "Communication/interaction development at mealtimes for the multiply handicapped child: Implications for the use of augmentative communication systems."

The scripted routine is a method of teaching intentional communication to a developmentally young child. (See Assessing intentionality, and the understanding of means-end, causality, and symbols and The scripted routine.)

An interrupted behavior chain is a teaching technique based on the interruption of a routine, such as when the adult intentionally leaves out a step or a necessary item, or somehow prevents the child from continuing a familiar routine. The child’s motivation to communicate comes from his or her own desire to finish the activity or routine. This is an excellent way of encouraging initiation since the child will often spontaneously protest or make a request in order to remedy the situation. The following steps are involved (Beukelman & Mirenda, 1992; Mirenda & Iacono, 1990):

• An activity or routine that the child is familiar with and enjoys is chosen. This activity is broken down into component steps and one or more steps which, if withheld, would be likely to elicit a response from the child identified. It is important, however, that the child not become overly frustrated so that he or she is unable to learn.

• An appropriate communication skills is targeted. Often oen is selected that the child already knows how to produce and is being encouraged to use; however, it is possible to teach the child a new skill using this procedure.

• The routine or activity is interrupted at the previously determined steps. Examples of ways interrupting include failing to provide a necessary object (the object may be left in or out of view), physically obstructing the child from continuing, or allowing an external interruption to occur.

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

• The adult then waits expectantly for the child to communicate a protest or request. If the child responds appropriately, the problem can be remedied and the routine continue. If not, then one or more prompts may be used, such as providing the child with a natural prompt ("What do you want?"), explicitly asking the child to make the request ("Make the sign" or "Point to the picture"), modeling the request for the child (adult uses the child’s AAC to make the request), or physically guiding the child in making the request (adult physically assists child in using AAC to make the request). If the child still does not respond correctly, the routine may be terminated and a new activity begun, or physical guidance may be used so that the child successfully produces the target communication and the routine can be continued.

Because routines are based on repetition, simple, homemade AAC devices are ideal for use with them. Loop tape cassettes, in which the tape plays a single message over and over again, are simple to use and can easily fit into a routine. For example, during circle time at school, the child can greet others, or play the daily song as the rest of the class sings along. At home, the child can lead the rest of the family in a mealtime prayer or help read a favorite story (Beukelman & Mirenda, 1992).

Calendar boxes are used in the Van Dijk method with children who have not yet developed intentionality. (See The Van Dijk method: Nurturance and movement.) Calendar boxes assist a child in learning to anticipate the activities and routines that make up his or her day. Essentially, objects that represent the day’s activities are placed inside a series of boxes.

Prior to the commencement of an activity, the child removes the object that represents that activity and places it into another box (with or without promtping and/or assistance). If the child reacts in any way, either positively or negatively, this indicates the child may be mentally connecting the object with the upcoming activity, an indication that the child is beginning to understand symbols. The adult should acknowledge the child’s reaction. (Note that if the child exhibits a negative reaction, the adult may decide to honor it by terminating the activity, or simply wait a little and then continue with the activity.) Calendar boxes can also be used to allow a child to choose an upcoming activity. For more advanced children, pictures or other symbols can be used instead of objects (Beukelman & Mirenda, 1992).

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

• "Packing your simple technology survival kit" by Mollie Wise offers suggestions on how to use simple gadgets and devices to facilitate communication at www.closingthegap.com/cgi-bin/lib/libDsply.pl?a=1051&b=5&c=1.

• "Adaptation of Radio Shack Talking Photo Frame" by Linda J. Burkhart at www.lburkhart.com/pframe.htm.

• "Visual schedule systems" at www.setbc.org/projects/ vss/default.html.

• "Communication Devices" at www.enablingdevices.com/ comm/index.html.

Prompts (sometimes called instructional prompts) and cues help a child remember what to do in a given situation. (In technical terms, prompts are when an adult directly helps a child to make the correct response, such as physically assisting a child to touch the correct picture, whereas cues are signals used to indirectly help the child, for example redirecting the child’s attention to the juice so that the child will ask for some.) In general, prompts and cues are important to the teaching process and used frequently. (See Milieu teaching.) However, care must be taken since prompts can be detrimental when a child becomes too dependent on them. (See Prompt-free and verbal prompt-free strategies.)

A prompt may be given by the child’s partner when it is obvious that the child needs assistance in remembering what to do. For example, if the child wants a toy that is out of reach, the adult might wait expectantly for the child to make on overture, and, if nothing happens, prompt the child to ask for it.

The following list includes different types of prompts given by an adult in the order of least to most intrusive.

• Natural verbal prompts (e.g. The adult says "What do you want?")
• Verbal mands (e.g. The adult says "You want the doll. Push the ‘doll’ button on your talker.")
• Modeling (e.g. The adult makes the sign "want baby" so that the child can repeat it. Modeling requires that a child be able to imitate.)
• Gestural (e.g. The adult points to the button that the child is supposed to push.)
• Physical assistance (e.g. The adult gently nudges the child’s hands toward the symbol that the child needs to touch. Physical assistance cannot be used in teaching speech, nor can it be used with children who dislike being touched.)
• Physical guidance (e.g. The adult physically assists the child to make the sign or push the button on the VOCA. Physical guidance is an error-free approach because the child always produces the target skill, although not independently, guaranteeing the child’s success. However, it cannot be used in teaching speech, nor can it be used with children who dislike being touched.)

Sometimes it is helpful to highlight specific symbols in order to focus the child's attention on them. In order to do this, the size, shape or color of visual symbols, or the pitch, speed or loudness of auditory symbols can be altered in order to emphasize them. For example, in teaching a child to touch the "no" symbol, that symbol might initially be twice as large as the "yes" symbol, and drawn in bolder colors. In reciting a list of choices (called auditory scanning), the correct choice may be said in a louder and slower voice (Reichle,York & Sigafoos, 1991).

When prompting is used, the goal is always that the child will master the skill and no longer require the prompting. In order to accomplish this, prompts often must be methodically faded so that they become less and less obvious, until they are no longer used.

One way to systematically fade prompts is to use the least invasive prompt first, and moving on to more intrusive prompts only if necessary. This is called using a "least-to-most prompt heirarchy." Essentially, the adult starts with the least intrusive prompt and then pauses to let the child respond. If there is no or an incorrenct response from the child, a slightly more intrusive one can be used. For example, a child may be given a verbal prompt, "Touch the 'more' symbol." If this doesn’t work, the teacher may tap the communication board and repeat the statement. Finally, the teacher may take the child’s hand and physically assist in pointing to the correct symbol stating, "You are saying ‘I want more.’ OK, here is some more." The idea is that the child will respond with prompts that are less and less intrusive, and, eventually, no longer need prompting at all. (For a list of different types of prompts, see Prompts given by another person.)

Some children may become frustrated or have too limited an attention span to tolerate more than one prompt. In these situations, the "most-to-least" prompt hierarchy can be used. This means starting with the least intrusive prompt that seems guaranteed to get the child to respond correctly. Physical guidance, of course, is the most dependable, and the most intrusive. As the child begins to master the skill, a less intrusive prompt that still ensures the child’s success can be used. The difficulty encountered with this method is deciding when the child is capable of responding to a less invasive prompt.

AAC-based prompts, that is those designed into the AAC system itself, are easily faded by reducing the intensity of the characteristic of the symbol that is being exaggerated. For example, an extra large symbol can be gradually reduced in size. A louder auditory symbol can be made softer.

Similar to the concept of fading AAC-based prompts is the idea of gradually transforming the message form. This is one way to help a child advance to a more sophisticated symbol type. For example, the transition from pictures to line drawings can be accomplished by gradually altering the pictures, for example, first fading the colors until the pictures are black and white, then reducing the number of lines until a simple line drawing remains. This method can also be used to transition a child from real objects to symbols (Reichle,York & Sigafoos, 1991).

Some children have a tendency to become "prompt-dependent," that is they always wait for a prompt or cue from an adult before attempting the target skill even when they have already mastered the skill. Prompt-free, or verbal prompt-free strategies (strategies in which verbal prompts are not used, but physical prompts are), may be used in these situations.

Prompt-free interactions are typically child-initiated since prompts are not used to begin the encounter. For this reason, prompt-free techniques are often a teaching strategy of choice because of their tendency to encourage initiating communication. The environment may be organized or activities and objects of interest presented so as to encourage the child to intiate an interaction. The child's partner must pay close attention so that whenever the child spontaneously communicates, whether purposefully or inadvertantly, the child can be responded to immediately. For example, if a child touches the toy car picture on his or her communication board, even if by accident, he or she would immediately be given the toy car, along with the explanation, "You touched the picture of the car. Here is the car." In addition, the communication board should be positioned so as to optimize the child’s seeing it when he or she touches it so that the child can begin to understand that touching the picture of the car gets him or her the car. This is particularly important if the child is touching the picture by accident. One potential problem with this method is if the child incorrectly associates a coincidental behavior with getting the item. For example, the child may think that banging the communication board is what resulted in getting the car. The child may begin banging it in order to get the car. In this case, the entire set-up should be changed so that the mistaken connection can no longer be made (Mirenda & Santogrossi, 1985).

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

If a child is not an initiator, then it may be necessary to use physical guidance to help the child in initiating an interaction. (This would be considered a verbal prompt-free approach.) For example, the child’s hand may be physically assisted in touching the picture of the car. Then the car can be given to the child along with an explanation that he or she gets the car because he or she touched the picture. After a few trials, the child may have learned to independently touch the picture in order to get the car (Mirenda & Dattilo, 1987; Mirenda & Iacono, 1990; Reichle, York, & Sigafoos, 1991).

Time delay procedures are another excellent method for teaching a child using only nonverbal prompts (Berkowitz, 1990). (See Milieu teaching.)

There is no hard line between what constitutes naturalistic teaching versus direct instructional techniques. The more the environment and activity deviates from where and what a child would normally be doing, and the more artificial prompts and rewards are used, the further along the continuum towards direct instruction the teaching is.

Although naturalistic teaching techniques are considered best practice, in some situations, they may not be sufficient. This may occur when:

• What is being taught cannot be taught in daily settings and activities. For example, communication regarding a community event or a doctor’s visit may have to be taught prior to the event itself.
• The child does not initiate communication frequently enough to provide a sufficient number of teaching opportunities.
• The child does not seem to be progressing quickly enough using naturalistic methods.

Direct instruction has traditionally meant setting up a one-on-one teacher-child situation in which a single teaching objective is the focus. Usually the child is presented with a question or situation, taught the appropriate response, and rewarded in some way for responding correctly. A child who is able to understand abstract explanations and is highly motivated may be able to transfer skills learned in this manner to real life settings. (This is referred to as generalizing the skill, that is when a child learns a skill under certain circumstances and, without additional teaching or assistance, is able to use the skill in a different situation.) Unfortunately, a child who is taught in this manner is not always able to generalize the skill in a real-world situation.

In order to optimize a child’s ability to generalize a skill learned through direct instruction, it is important to utilize as many naturally-occurring events and prompts as possible.

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

• Make the direct instruction situation as natural and lifelike as possible.
• As much as possible, use the settings where, and the people with whom, the skill would naturally be used anyway.
• Start off by teaching the child a skill using direct instruction, and then continue instruction using increasingly naturalistic methods.
• Use a natural reward in addition to artificial reinforcers. For example, in addition to a tangible object such as a toy or food, learning to say hello can be rewarded by a great big smile and lots of attention, which is a natural consequence to greeting a friend. Over time, teh artificial reinforcer (i.e. the food or toy) can be faded, (i.e. progressively smaller amounts can be used until they are not being used at all), whereas the smile and attention will always be there (Noonan & McCormick, 1993; Reichle, 1997).

A child’s peers can be a very powerful part of an AAC intervention. To be included among peers is frequently highly motivating to a child—and communication is the foundation for fostering relationships with peers. Here are some suggestions for developing a program to facilitate interactions between a child and peers.

• Explain to both the child and his or her peers what and why you are trying to accomplish. It may make sense to target a few peers initially, those who would seem likely candidates for making friends with the AAC user. For example, talk about the importance of friendship, and the fact that some people are different and may have more difficulty making friends.

• Make the AAC user less of a mystery by describing how the child communicates, and how his or her AAC works. It may make sense to let the other children experience the AAC by trying it out.

• Describe in detail what the children are expected to do in specific situations (e.g. when approached by the AAC user, or upon seeing the user alone on the playground). Role playing, prior to actual use, is a good way to get children to practice these skills. When teaching and role playing the new skills, include examples of inappropriate behaviors and unacceptable interactions that might occur, how they would make a person feel, and what should be done instead (Haring & Lovinger, 1989).

• Prompts may be used to facilitate these interactions. At suitable moments, adults may prompt peers to interact with the child, and, vice versa, the child may be prompted to interact with peers. A suitable moment might be when a peer is looking for another child to play with, or when there is an open position in a game. If the AAC user interacts with an adult, the adult can also redirect the child to a peer. (For example, "Show that to Sarah. She would be interested in it.") (Haring & Lovinger, 1989; Schuele, Rice, & Wilcox, 1995).

• The children can be rewarded for interacting with each other. A reward may be verbal praise or a positive statement like "Look how much Joanna [the AAC user] is enjoying herself," or it may be an object or free time.

• Arrange the environment and offer activities that facilitate interaction among children. Provide toys and materials, and organize games that are interactive and can be adapted so that the child with disabilities can participate in a meaningful way. For example, the child with disabilities may be score keeper, or games with partners can be played.

• Be prepared to continue prompting and positively reinforcing the children over time as necessary. Put up posters as reminders of the behaviors that are being elicited. Also plan periodic "pep talks" to encourage the children to continue. Support and reinforce the relationships that do develop (Goldstein, English, Shafer, & Kaczmarek, 1995; Goldstein, H., & Ferrell, D. R. (1987).

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

• "Encouraging Friendships Among Children With Disabilities: Circle of Friends" at www.cesa5.k12.wi.us/skip/CIRCLE.HTM.

• Cynthia Cress' Dec. 10, 1997 e-mail posting under "SLP seeks info on opinions" discusses ways to increase peer interactions on the ACOLUG listserv archives at listserv.temple.edu/cgi-bin/wa?A2=ind9712&L=
  acolug&F=&S=&P=8495.

• Beth Sinteff's Dec. 10, 1997 e-mail posting under "SLP seeks info on opinions" gives tips on how to deal with peers who are curious or insensitive on the ACOLUG listserv archives at listserv.temple.edu/cgi-bin/wa?A2=ind9712&L=acolug&F=&S=&P=8709.