The Southern California Augmentative and Alternative Communication Network... a support group for professional development, problem solving, leadership, mentoring, and training in the use of augmentative and alternative communication (AAC) to develop communication in non-speaking and minimally verbal individuals in the Southern California Region.

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Monday, August 27, 2012

Grad Course Curriculum: AAC in Autism

In her preparation of curriculum for a 7-week, graduate level course on AAC, Tami Brancamp, Ph.D. (Univ. of Nevada, Reno) asked the ASHA Community SIG 12 for input on the content of her course. I couldn't resist! and would like to share my personal soap box shpeal with you, too...

(From Gwendolyn Meier, Pasadena, CA)
I hope that you will dedicate at least one class session entirely to AAC in autism.  I recognize two primary issues that are of great importance when teaching nonverbal and minimally verbal folks with autism to use AAC: 1) expanding pragmatic functions right from the start, and 2) de-emphasizing symbol recognition and association in exchange for emphasis on motor patterns for expressive communication. 

It is my experience that much graduate instruction as well as continuing education courses focus on providing AAC to persons with intact social communication desires (i.e., disabling conditions other than ASD). In autism, as I'm sure you have also experienced, early pragmatic functions of communication are restricted by the lack of intrinsic motivation to communicate socially. In addition to teaching learners to make requests and to protest using AAC, I find that even at the 1-word/hit language stage, the functions of commenting, interjecting and sharing opinions can be very powerful when sufficiently modeled in motivating interactive contexts. Some examples of content follow:

Early Non-Verbal Language Stages
1.       One word/picture card/button/hit at a time
- Cause-and-effect, One-word/hit requesting (More, Mine, Want, Go, Turn, Open, In, Out, object or action labels)
- Rejecting/Protesting (Stop, No, All done, Break)
- One-hit comments, interjections, sharing opinions, greetings (taught through modeling; Oh man!, Oops, Sorry, Help, Be careful, Funny, I like it, I don't like it, Cool! Hi, Bye)
2.       Two- and three-word/picture/button/hit phrases
- Specified requests ("I want" + item/action, "More" + item/action)
- Specified protests ("No" + item/action, "All done" + item/action)
- Directing others' actions using core vocab (Help This, Give Me, I Go, You Go, Put in, Open it, etc.)
3.       Building phrases and early sentences (3+ words/hits), moving toward grammar, morphology, etc.....

In addition to this content, I think it is important to emphasize that when teaching learners who have complex communication needs, with our without autism, receptive symbol recognition should not be considered prerequisite to the teaching of expressive language concepts through modeling in meaningful interaction.  In the teaching process, consistent location of motivating vocabulary can reduce the learner's reliance on visual recognition, symbol iconicity and metaphoric association - particularly learners with autism. Learners don't need to be able to recognize/"point to"/"give" a symbol that is named before they can use that symbol to get something done in the world. This concept may seem counter-intuitive to some, but is supported by the fact that nonverbal individuals with autism and related disorders have inherent challenges in abstract association of meaning and, in general, their motor systems are relatively more intact than their conceptual and linguistic systems.

Picture communication books or other Velcro-based displays often lack a consistent placement of vocabulary from one use to another, which can put a strain on the cognitive demand of communicating any particular message. If clinicians and teachers capitalize on the benefits inherent in consistent motor patterns when creating and maintaining visual displays for communication in different settings or activities, motor learning will reduce the associative demand. In fact, for all learners, motor planning plays an important and often overlooked role...This is not to say that receptive identification of photos, drawings, etc. is not an important skill to teach! It just may be less important than we think when teaching use of a visually-based expressive communication system.

The Center for AAC and Autism's LAMP program (Language Acquisition through Motor Planning) talks more about this. There is also a wealth of practical and well-organized information on the evidence base for speech generating devices in autism at this site:

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