Exam 3 Flashcards
Components of AAC Intervention
- Selection and personalization of AAC for effective communication
- Instruction in strategies and skills to effectively use AAC for communication
- Instruction for family members and other important communication partners
- treatment plan can/should include goals on training the family
- need to determine if what we select will be utilized over time
Principles of AAC Intervention
Long term success of an AAC intervention plan may involve:
- Interventions that utilize environmental adaptations - need to consider space and location of where they use the device and any barriers that may be present - need to ask ourselves: can they access the system easily?
- Interventions designed to increase natural capabilities
- Interventions that incorporate AAC strategies and techniques
What factors should be considered when determining goals?
- Strategies and skills that are most important to the individual who relies on AAC
- Those that are valued by the family, friends, and community
- Those that can be used regularly in the real world
- Those that are most likely to be learned successfully
What should goals for AAC include?
- The targeted skill or strategy
- the means of communication
- the partner(s) and environments(s)
- the targeted criterion
goals are written to support communicative competence
What instructional methods have been shown to be effective and what are they?
- Responsive Social Pragmatic Intervention
- AAC Modeling
- Explicit Instruction
- Milieu or Incidental Teaching
Responsive Social Pragmatic Intervention
- Parents and other communication partners are taught to fulfill communicative attempts and to model target skills
- Used in naturally occurring interactions
- Kent-Walsh, Binger & Hasham in 2010 trained parents:
- Read + provide an aided AAC model;
- Ask a wh-question + provide an aided AAC model;
- Answer the wh-question + provide an aided AAC model
Responsive Social Pragmatic Intervention Example:
Child: {chooses a picture}
Adult: Tell me what happened that day.
Child: birthday
Adult: Whose birthday?
Child: I
Adult: Oh! This is your birthday.
Adult: So to make that a little bit more clear, we need a few little words, right? Because it happened in the past you can say: “THIS WAS MY birthday.” Can you tell me that?
Child: This was my birthday.
AAC Modeling
Communication partner uses unaided and/or aided AAC in conjunction with spoken input
- Total communication uses manual signs with spoken input
- Key word signing provides selected models of manual signs with speech
- AAC symbols paired with spoken input
need to remember to model WITHOUT expectation
Explicit Instruction
Based on principles of applied behavior analysis
- Stimulus- Hold up a cookie, What’s this
- Cue- Clinician points to the picture of a cookie from an array of two photograms
- Correct response by the learner- Points to cookie photo
- Reinforcement- Yes that’s a cookie
Occurs in less natural situations
Need to address avoidance of prompt dependency
Ex: teaching hand shapes for signs to a preschooler
Milieu or Incidental Teaching
Explicit instruction is paired with milieu or incidental teaching to promote generalization of skills to the natural environment
- Manipulating the arrangement of the natural environment
- Targeting specific communication goals in natural context
- Utilize prompt techniques to elicit the target skill
- Respond to the individual’s communicative attempts
What methods can be used for evaluating intervention?
- Goal attainment scaling
- Functional communication measures
- Participation inventory
- Consumer Satisfaction
Can also use ASHA’s functional communication measure - the resting scale to determine any improvement over time
What does pre-intentional mean?
the natural and involuntary behaviors children display to show how they are generally feeling. Although they are not intentionally communicating, these behaviors are observed and interpreted by parents and caregivers to determine what the child may want or need
What do pre-intentional communicators assess:
- Behaviors that are within the individual’s repertoire
- Antecedents to these behaviors
- Consequences of these behaviors
- Evidence of intentionality
Steps to build intentionality:
- Establish routines focused on motivating activities
- Initiate the interaction
- Pause and wait expectantly
- Watch carefully for the signal
- Respond immediately to the signal as if it were intentional
- Repeat this sequence
What are the key goals for pre-intentional communicators?
- Develop intentional communication
- Identify appropriate signals to indicate acceptance and rejection
Signals for yes and no
What are potential indicators of intentional communication?
- Eye gaze - looking at partner or object, often accompanied by facial expression or vocalization
- Facial or head orienting - postioning one’s face or head toward a partner or object with or without vocalization
- Vocalization - producing a sound aimed at a partner or object
- Facial expression - using facial muscles to produce a countenance directed toward a partner or object
- Physical actions - producing movements of the upper or lower extremities directed toward a partner or object
- Body posturing - positioning one’s body toward or away from a partner or object
What is intentionality?
To do something “intentionally” means to do it on purpose. And for children at the beginning stages of communication, a big developmental step happens when they learn to send intentional messages.
“Intentionality” refers to a child’s ability to send messages on purpose, directly to someone to achieve a specific goal.
Evidence of intentionality:
- Persistence of the behavior until the goal is achieved
- Cessation of the behavior when the goal is achieved
- Substitution of another behavior or act if the first means is not successful
- Change in the quality of the act if the first attempts are not successful
What are key goals for intentional but pre-symbolic communicators?
- Communicate choices
- joint attention
- Use consistent signals to express acceptance/rejection
- Take turns consistently in social interactions and develop social closeness
Developmentally appropriate is going to be more wants/needs
EX: What’s the most developmentally appropriate type of yes/no question?
- Answer: Do you want goldfish?
Teaching clear signals for acceptance and rejection
Label meaning of signal
Fulfill intent
Model a more conventional symbol
Teaching communication of choices
Identify opportunities to communicate choices
Determine how to represent choices
Determine how to present choices
Select instructional technique
Teaching how to request objects and activities
Initiate after skills for communicating choices are addressed
Most appropriate for beginning communicators transitioning from pre-symbolic to symbolic communication
Teaching how to take turns
Learning to take turns in social interactions is the foundation for building social closeness
Focus on the communication partner
Develop joint attention
Reduce attentional demands when teaching joint attention by gluing symbols into a book or object you are using to help; or you can hold symbols near your face.
What are key goals for developing symbol communication (early symbol)?
- Develop diverse vocabulary
- Initiate requests for objects and activities
- Make comments/answer simple questions about ongoing activities
- Ask simple questions
What are factors to consider for developing vocabulary skills?
- Choose concepts
- Select appropriate representations
- Teach in meaningful contexts
- Provide Input via Speech and AAC
Aided language stimulation, augmented input, natural aided language, aided language modeling
How can you teach initiating requests for objects and activities?
- Teach generalized requesting
- Teach the Picture Exchange Communication System
- Teach conditional requesting
What should you consider when teaching how to comment and to ask questions with symbols?
- Reduce joint attention demands
- Provide instruction to teach commenting
- Teach how to ask questions
What are key goals for those combining symbols?
- Continue to develop diverse vocabulary
- Express a greater range of communicative functions
- Combine symbols to communicate
- More complex comments about ongoing activities
- More detailed responses to questions
- More specific requests for objects or activities
- More explicit protest or rejection
- More complex questions
What are the domains of communicative competence?
- Linguistic (comprehension, expression, semantics, syntax, morphology)
- Operational
- Social
- Strategic
Linguistic skills:
Comprehension
- Understanding vocabulary
- Improving understanding of sentence structure
- Increasing understanding of morphosyntactic structures
Expression
- Natural speech
- Code of AAC system
- Language of family and community
Semantics, Syntax, Morphology
Develop skills in the native language(s) spoken and written in the home and broader social community
Linguistic skills: Developing skills in the native language(s) spoken and written in the home and broader social community
- Understand spoken single-word vocabulary that represents a wide range of concepts
- Understand a wide range of simple and complex sentence structures (e.g., wh- questions, directions)
- Understand morphology (e.g., plural, past tense)
- Develop as many expressive skills (content, form, and use) in the spoken language(s) of the home and broader social community as appropriate
- Code switch between different language(s) and cultural norms as required
- Develop literacy skills to understand and use the written language(s) of the home and broader social community; code switch between these written language(s) as required
- Develop knowledge of a rich and varied vocabulary; know the AAC symbols used to express these concepts, including both content and structural words
- Develop morphosyntactic skills to express more complex meanings via AAC
- Choose appropriate AAC modalities to meet the needs in different cultural/ linguistic environments
- Demonstrate appropriate linguistic conventions (content and form) for different communication media, including face-to-face, written, and digital communication media
- Core vocabulary plus vocabulary to support language learning
Operational skills:
- Develop the skills needed to produce the unaided AAC
- Learn the skills to operate low tech or high tech aided AAC
- Range of learning demands- motor, sensory, perceptual, cognitive, and linguistic
- Personalization of system should address minimization of demands
- Operational skills will still need to be learned
- Produce unaided symbols as appropriate
- Operate low-tech and high-tech aided AAC accurately and efficiently
- Operate digital communication apps and other mainstream communication tools
- Goal is to promote accuracy and efficiency and to reduce effort and fatigue as much as possible
- Interventions typically involve demonstration of the skill, repeated performance, and feedback
- Approaches can involve explicit instruction or a cognitive developmental approach
Social skills challenges:
- Disability associated with specific impairment in social interaction
- Difficulty developing orientation skills to focus on partner
- Limited social circle
- May have few meaningful opportunities to interact with a diverse range of partners
Strategic skills:
Compensatory strategies to overcome language, operational, and social challenges
Intervention to build strategic competence:
1. Teach introduction strategies
2. Teach use of humor
3. Teach use of regulatory phrases
4. Teach use of conversational repairs
Challenges for developing Semantic skills:
- Need to learn spoken words and corresponding AAC representations
- Words in system may not reflect internal lexicon
- Individuals who use AAC may not receive feedback about their vocabulary
- Development compromised if only access to a limited range of concepts
Core vocabulary plus vocabulary to support language learning
Language skills:
Knowledge and skills in vocabulary, syntax, morphology, narratives, and other genres (e.g., expository, persuasive)
