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The following questions are often asked by Parents and Carers. We have provided our responses and hope you find them useful. Please click on each question to view our response. Alternatively you can contact Liberator at any time as our knowledgable AAC staff are always willing to assist you.
Before we look into AAC, it is useful to consider the importance of communication.
Communication is considered to be a basic human right and essential to our quality of life. We communicate for a wide variety of reasons, such as giving an opinion, making a choice, asking a question, sharing our feelings, agreeing or disagreeing with someone and making friends. We later go on to develop skills such as negotiating, complaining, complementing and expressing humour.
We often take the ability to communicate for granted but it is estimated that 10% of children and young people in the UK have long-term difficulties with speech, language and communication. Of these children, 1% have the most severe difficulties and struggle to express their most basic needs. These children may benefit from additional help in the form of AAC.
The term AAC (Augmentative and Alternative Communication) covers a wide range of techniques and strategies that support or replace spoken communication. Such techniques include use of gesture, signing, symbols, writing and voice output communication aids (VOCAs). We all use AAC to some degree for example, using facial expressions to help clarify meaning, or using gestures to emphasise a point.
People with severe speech problems rely on AAC to supplement existing speech and communication strategies. Systems such as picture and symbol communication boards and electronic devices are available to help people express themselves. This will increase their social interaction, school performance, and feelings of self-worth.
The range of strategies include:
Unaided communication systems: are methods of communication which do not involve additional equipment, such as signing, gesture, eye pointing, facial expression and body movements. We all use unaided communication to support our speech.
Aided communication systems: are methods of communication which involve using additional equipment, such as paper and pencil, picture or symbol boards/ books, letter or word boards/ books and technology-based systems such as voice output communication aids. These methods are likely to be used alongside unaided communication strategies.
Low-Tech communication system: a low-tech system is a paper-based system which may consist of pictures, symbols, photographs or words and may take form of a communication book or board. Light tech communication system: an electronic system that is relatively simple and will speak pictures or words when pressed by a child.
High-tech communication system: a sophisticated electronic system that can store and retrieve words and messages. They are often referred to as Voice Output Communication Aids (VOCAs). VOCAs can be accessed in many different ways and are highly flexible depending on individual requirements.
People of all ages with severe speech and language difficulties use a range of AAC methods to assist them in communicating their wants, views and needs. AAC may be considered for your child if he or she has significant difficulties with the production of speech. This may be due to an associated condition such as Cerebral Palsy, Autism Spectrum Disorder, learning difficulties, genetic syndromes or a range of other conditions. There also may be no diagnosis associated with the communication difficulty.
Children with such difficulties will need alternate ways of developing their communication, using a range of AAC systems.
In addition to children with developmental conditions, some adults require AAC when they are older. This may be because of an acquired condition, such as a head injury or stroke.
Being able to communicate is the most important skill we need in life. Almost everything a child does involves communication – everyday activities such as wanting a cuddle, expressing a choice, playing a game, making friends and having fun all rely on children’s ability to communicate with each others. For this reason, AAC can be introduced at any age. It is never too early to start. Research shows that early intervention is one of the keys to success. Some of the benefits of early intervention include:
A common AAC myth is that the child needs certain skills before starting. This is not the case with AAC; the skills can be taught during AAC instruction. Children as young as 6-9 months have successfully been introduced to some forms of AAC.
If you have an older child, don’t worry – it is never too late. AAC can be introduced at any age from babies to the elderly.
No. This is a common concern of parents and many professionals who are working with non-verbal children or those with speech that is difficult to understand. Research over the last 30 years shows that use of AAC typically leads to increased communication skills and reduces frustration. While many individuals rely on AAC for life, many also develop strong speech skills while using their AAC systems.
There is no evidence that use of AAC adversely affects a child’s development of speech and the most important thing is that the child is able to communicate, whatever form that might take!
A study in 2006 indicated that 89% of the participants demonstrated increased speech production following AAC intervention. Ref: Millar, D., Light, J., & Schlosser, R. (The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech Language Hearing Research, 49, 248-264)
Even though you may understand your child, other, less familiar people may not. This may include family members who see your child less often, or people in school such as friends or teachers. Children frequently look to the parent to ‘translate’ when less familiar people have not understood. You won’t always be there and your child needs to be an independent communicator, or may develop passive behaviours which can be difficult to break. We always encourage children to be active in their learning and a passive child can develop habits that allow others to over interpret their intentions.
Communicating with the adults and peers your child meets each day is an important part of his/her life. Independently communicating with new people and sharing interests helps us to make new friends and increase our self-esteem.
Learning to use AAC can be a challenging but rewarding task. Some systems seem quicker than others and all require ongoing support. Learning to operate a system can be fairly straightforward. It is the ongoing development of conversation skills that takes time. The best way to learn any system is to have lots of opportunities to use it and to see others using it. Allowing a child to explore, to practice and to build confidence are all required for successful communication.
We don’t put a time limit on learning AAC. Communication is for life and people using AAC (like all communicators) never stop learning how to express themselves with increasing fluency and confidence.
Any AAC system should be usable for many years and should be able to grow and develop with the child rather than become too simple as the child's language and communication skills develop.
Training and support are vital in the selection and implementation of an AAC system. Local support varies from area to area so always check out local services to see what is available to you. For a young child this may be Portage or Early Support teams. Speech and Language Therapists are employed by NHS Trusts to support people of all ages with communication impairment. Nurseries and schools can also point you in the right direction. There are also independent Speech and Language Therapy services available to help. Ask if the Speech and Language Therapist is experienced using and introducing AAC. Find an independent speech and language therapist on www.helpwithtalking.com
Parents often say they don’t know where to start. The best advice is start as you mean to go on – as a team. Team meetings regarding your child are beneficial to the child, family and professionals involved in your child’s care. Team input can ensure that everyone can discuss and perhaps set goals with your child’s best interest at heart. Different people will bring different knowledge and skills to the table. Parents and carers should be involved at every step of the way, from identifying an AAC system, through to everyday use in the child’s environments from school, to home, to social clubs and other appropriate environments.
For a child using a VOCA, help and support is also available from companies that supply the VOCA who also have expertise to offer in terms of the equipment itself.
You can help support your child in every step of the journey. There are “good practice” techniques that AAC teams may discuss with you.
Here are 5 top tips for working with your child using an AAC system.
1. Modelling – this means that you are using the child’s communication system alongside them. Point out pictures or symbols in their communication book or communication device alongside your verbal language. This helps your child to learn that communication is interactive and helps them to learn the location and navigation of how to say certain things. Additionally modelling teaches children that language is not an activity to be done at particular times, and that communication has real purpose.
2. Use core vocabulary – core vocabulary is defined as a small number of simple words used for the majority of communication. Around 85% of communication is made up from a relatively small number of words (around 250). Core words are familiar and often fairly short. Some examples include, I, you, want, like, don’t, eat, come, more, get, go.
Let's take an example: if the word "banana" is taught, the child may only have a few opportunities a day to use it; the core word "more" will provide many more opportunities to be used on a daily basis and in many different situations.
3. Set small and realistic targets – your child’s team will help you set these. Instead of wondering how long it may take your child to become a fluent communicator, set small targets such as having the system available all day and modelling the use of “more” and “stop” at every opportunity.
4. Don’t limit communication – it is easy to think that you should introduce a few words and wait until your child has mastered them before introducing more. New concepts and words should be taught by using them (modelling) and having them available not by expecting a child to first demonstrate understanding of them. Think of a child with normally developing language – they will have heard a word hundreds of times before they are expected to use it. They start using the words that they hear being used around them all the time. By using these words they hear, the meaning of those words begins to develop. They receive feedback from communication partners and start to receive experiences that make the words’ meaning more powerful. This is what we are aiming for in AAC. Think back to tip 1, modelling – how will you model a conversation if you have a very limited vocabulary – aim high and do not limit your expectations.
5. Active learning is key – many children with complex communication difficulties can easily become passive. Things happen to them or with them with little participation by themselves. It is proven that learning is less likely to take place when a child is in a passive role. Children need to see a reason for doing something and it is up to us, their communication partners to give them the reason and opportunity to become an active learner.
There are many ways to help your child take more of an active role. Here are a just a few
At the moment funding, like support, varies from area to area. Some areas in the UK have designated funding for high-tech AAC devices and some don’t. All will have specific criteria and this can be discussed with your local team of Speech and Language Therapists and Education teams. Additionally, there are charities that welcome funding applications for communication equipment. Some will be local to your area and some are nationwide (e.g. The Sequal Trust, The Aidis Trust, The Variety Club)
Funding can often take several months especially if your child is trialling a variety of AAC devices. Be patient and persevere.
In 2012-2013 the DfE (Department for Education) provided funding for a one year project to develop proposals for a model of AAC service provision for the future.
The outcome of the project was that from April 2014, NHS England will be responsible for funding specialised AAC services in England. These services will provide assessment, training and equipment for children and adults with complex communication needs. The overall purpose is to provide equitable national specialist AAC services across the country for children and adults needing high tech AAC. As yet, few organisations have received advice around referral and this will be an area to carefully monitor within the coming months.
All children are individual and because of this there is no ‘one model suits all’. Children have different strengths and challenges which all need to be considered with regards to AAC. Looking at different products can be daunting as a parent who is new to this field. There are devices that have recorded (real) speech and devices that have digitised speech. VOCAs have different symbol sets, different ways of retrieving messages, and different operating systems. To help find the right device for your child, always involve your team. Team decisions are the most effective and professionals within the field of AAC can help guide you towards the right type of VOCA for your child.
Remember, the system itself is crucial, but how to use and teach the system is equally important. Long term support and learning in the implementation of the system cannot be under estimated.