Even with the many AAC resources out there, the pathway for those with complex communication needs is not always clear cut.

 We all want our clients who use AAC to make that leap to becoming proficient communicators. Understanding more about how they learn is one way to help them progress, and that’s what this episode is about. It covers:

 •    Core and fringe vocabular

•    Stages of motor learning

•    Meeting sensory and language needs simultaneously

•    Descriptive teaching

 By the way— descriptive teaching is awesome—even if you don’t have clients who use AAC! 

— Useful Links —
Stage One Sentence Types 
Understanding Motor Learning Stages Improves Skill Instruction by J Huber
The Center for AAC and Autism
Sensory Books by Lizzie
Descriptive Teaching
Ready, Set, Go! with AAC
Get Set with AAC: Mythbusting
Everything Has a Name
Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Denise: Welcome to the Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech language pathologist of 30 plus years. I’m closer to the end of my career than the beginning, and along the way, I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas. As SLPs, I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness.

Hello and welcome to episode 86 of the Speech Umbrella podcast. Today’s topic is about ways to understand and better support AAC users. I did a three-part series on AAC a while back. That’s episodes 20, 21 and 22, but there’s always more to add to the conversation. There’s always more to learn, and I recently attended a webinar on AAC, sponsored by the Center for AAC and Autism. I learned some really cool things that I look forward to sharing with you.

This episode is called Four Ways to Support AAC Users. This is a really big topic in our field because no matter how many AAC guidelines and procedures we have, it’s been my experience that the pathway for those with complex communication needs is not always clear cut. So I was really excited to learn some more techniques for my SLP tool belt. Hopefully today you’ll hear a few things that you too can put into practice. Here’s the four things we’re covering today: core and fringe vocabulary, stages of motor learning, meeting sensory and language needs at the same time, and descriptive teaching. So let’s talk about core and fringe vocabulary. You all know core, those words we use so frequently and which are so useful because they can apply to so many situations.

Core vocabulary importance has been emphasized so much for AAC users that any SLP worth their salt would sooner crawl under a rock than not use core vocabulary. However, one of the webinar presenters made a really good point, and this is a direct quote. He said, don’t be cuckoo for core. Fringe vocabulary is equally important.

So what is fringe vocabulary anyway? Fringe words are specific words, and they have a more narrow meaning than core words. Nouns are fringe words. So I think it’s a really curious description for a category as substantial as nouns to call them fringe. I’ve been thinking a whole lot lately about how important nouns are.

Marge Blanc, who writes and teaches about natural language acquisition on the autism spectrum, opened my eyes to the role nouns play in the development of language. Don’t get me wrong, I’m not dismissing core words. I’m saying let’s look at the whole picture. If you’ve been listening to the speech umbrella for a while, you might have heard me talk about how much I love stage one sentence types. The very earliest word combinations are what we call stage one sentence types. They appear before grammatical morphemes, and they’re critical to developing word relationships. And what do stage one sentence types have to do with fringe vocabulary? For starters, they are packed with nouns. Take the classic example of mommy sock.

Those are both nouns. How about ball table, which is an entity, locative semantic relation, saying the ball is on the table. Those are both nouns. I could go on and on, but you get the picture. Nouns are as developmentally critical as core vocabulary, even though semantically speaking core sounds way more important than fringe. It’s the combination of words into stage one sentence types that is the beginning of combining ideas, and this is true for both typical and atypical language learners. So give fringe vocabulary its due along with core. Remember word combinations that represent semantic relationships are incredibly important no matter if they are fringe or core or both.

Another thing I found fascinating was the stages of motor learning. By now as a profession, I think we’re pretty much aware of how important it is that icons on an AAC board stay in the same place so the client doesn’t have to remember a new motor plan because a word changes places. And this has really been brought home to me because we’re in the middle of a remodel of my house and some things are not where I expect them to be.

And one night when I managed to find my toothbrush, I remember the toothpaste was on another level of the house, and I seriously contemplated just skipping the toothpaste. And then I couldn’t find my glasses, which I have to have before I take my contacts out or I can’t see anything at all. It was all very frustrating until I got used to things being in a different place and I can see why someone might give up on communicating if what they wanted to say wasn’t where they expected it.

And when you’re talking about motor learning and AAC users, one of the presenters said the hand is the articulator. This is assuming someone is using their hand to uh, touch the icons, which most AAC users do. And I thought about that. So when we learn to say a word, we learned the motor plan and we don’t have to think about how to say the word once we learned how to say it, it is just automatic.

And so someone who is using AAC device needs to reach that level of automaticity. That would be our preference that they would. And the hand is the articulator, just like our jaw ellipse and our tongue. And I just hadn’t never thought of that before. I think that’s really, really interesting. So given that motor learning is so important, it was really helpful for me to learn about the three stages of motor learning and how they apply to AAC.

Now, I know there are stages of learning for AAC, and you can find that on the ASHA website in various places. This is not those stages. These are the three stages of motor learning that anyone would go through if they were learning a motor skill. The three stages are cognitive, associative, and autonomous.

I went searching on the internet to find some really in-depth definitions of motor learning. And so I’m going to quote Jeffrey Huber here. He’s talking about the cognitive stage. For the new learner, the problem to be solved in the cognitive stage is understanding what to do. It would be extremely difficult for someone to learn a skill without receiving any prior knowledge about the skill, whether that knowledge is visual or verbal.

Let’s talk about what the cognitive stage looks like with AAC, and that is hitting lots of buttons. It seems random, it doesn’t seem intentional. You’ve probably all been there and you’re thinking, what is this kid doing? Are we going any place? That’s what I used to think, but this is the cognitive stage. It’s an exploratory stage, and it’s a stage to celebrate. And here’s a key thing I learned. Pay attention to where they stop touching, because that is often when they find the button that they want and that’s what they’re communicating. They stop when they found the right button. In the past, I didn’t recognize the value of the cognitive stage, and I couldn’t wait to get clients to the point where they were more intentional.

And I love the fact that I now know two things, to celebrate the cognitive stage and to pay attention to when they stop pushing the buttons. Moving on to the associative stage. This stage is also called the motor stage because the problem to be solved in the associative stage is learning how to perform the skill. The learner is transforming what to do into how to do. So in the associative stage for an AAC user, they know where to find it. It is a great day when a client moves into the associative stage. I love that day. In fact, I have a couple stories about that in episode 22, if you wanna take a listen to it. It’s called Everything Has a Name.

I love the idea they are transforming what to do into how to do. I think that’s great information to share with parents. Obviously this stage is going to take a while for most of our clients, but when they know where to find an icon, it gives them an impetus to know where to find more, and it just snowballs from there. The power of communication really takes off in the associative stage.

Finally, we have the autonomous stage, and this is where motor performance becomes largely automatic. Cognitive processing demands are minimal and learners are capable of attending to and processing other information. This made me think about how someone in the autonomous stage would be much freer to pick up on cues around them and respond outside themselves because they don’t have to use so much cognitive space as they would in the associative stage or in the cognitive stage.

When we recognize what stage in AAC user is in, we know better how to support them. That covers the stages of motor learning. Let’s talk sensory now. It’s no secret, most AAC users have unique sensory needs. So what is there to add to the conversation that we haven’t already heard? Here’s three takeaways.

It concerns readiness to learn. When sensory needs are met, then the child feels safe, their body feels calm, and they are ready to learn. And sensory experiences create memories which enhance learning. The third takeaway I really, really love. There’s an awesome speech therapist named Elizabeth Eskow Bortz, I hope I’m saying her name right, but she’s written a series of books called Living in the Land of Sensory. You can find them at sensorybooksbylizzie.com. Her books have names like Abby, the Alligator Needs Hand Squeezes, and also The Octopus Needs Arm Squeezes. It gives you a clue what it’s all about.

They’re designed to be read with the client while delivering sensory input. And one of the things that Elizabeth talked about is that some behaviors are indicators of what kind of squeezes clients could benefit from. For example, does your client head bain? Or do they need deep pressure? Head squeezes are good for that.

Hand squeezes are effective for clients who are constantly touching things, biting their hands, grabbing, pulling, pinching, feeling stressed. I really, really love how Elizabeth talks about setting that by communication expectation, by always delivering the squeezes in the same way and teaching everyone who works with the child to do the same.

So what she does is she uses a squeeze and release rhythm to the count of 10. So, for example, if you’re delivering hand squeezes to the child, you would squeeze while you count one and release while you count two and squeeze while you count three, release while you count four, till you get to 10. And when you get to 10, you can ask if they want more, if they want you to stop.

And when you set up the communication expectation, this way they have the opportunity to anticipate it. They can start thinking about it ahead of time, and they can indicate with the AAC device if they want you to stop or go or push again or push more. There’s lots of ways to respond and build joint engagement.

I tried this a couple weeks ago with one of my young preschool clients who has a lot of sensory needs. He likes touch, he likes lots of touch. So I started doing shoulder squeezes on him and he had his hands over his eyes. He was peeking through his hands of the light cuz he has that visual sensory need too. And so I just initiated a peekaboo game after I did the shoulder squeezes and he responded. He reciprocated, he started playing peekaboo back with me, which is new, a first thing. But what I really noticed is, an intangible thing I can’t really describe or quantify, but it seemed to really build trust and he seems to trust me more now, ever since that session when I started doing squeezes. So that’s cool. I’m gonna keep doing that.

Last but not least is descriptive teaching. I know I keep saying that I love everything, but I really do. I love descriptive teaching too. In case you haven’t heard of it and I hadn’t. This is what descriptive teaching is. I’m quoting Van Tatenhove, again, I hope I’m saying that right. In referential teaching, the focus is on memorization of terms and their definitions. This gives little scope for creative thinking and participation by learners with special needs. Descriptive teaching, on the other hand, uses primarily core words. The teacher mentions and references the context specific words, then teaches concepts behind the words, using high frequency, reusable common words.

The teachers explain a term using common words that they know are already in the communicator’s AAC system. That’s a lot to process, but I’m gonna read you the examples and then you’ll get the hang of it. These examples really help me understand what they’re talking about with descriptive teaching. So for example, in the referential method of teaching, you might have a question, what energy does water give?

And the answer is hydro energy. With the descriptive method, you would say, tell me about hydro energy, and the child could answer water give. So two very core, frequently used words. Back to the referential method. You could have this question, what kind of animal eats either animals or plants? The answer is omnivores. That same question in the descriptive method is what are omnivores? And they can answer animal that eats animals and plants. Back to the referential method. Name the polygon with five sides. The answer is pentagon. Under the descriptive method, what do you know about a Pentagon? The answer is five sides.

So with descriptive teaching, children can show their competence. It allows children to focus on the concepts rather than expending their energy finding the right vocabulary in their system. Well, I think anyone who teaches could do more descriptive teaching and less referential. I think that’s fantastic for all kinds of teaching.

Now, I don’t know if you picked up on this, some of these answers in the descriptive methods sound like stage one sentence types almost. Like water give, that’s entity action. It makes sense because if the semantic relationship is there, the concept can be there.

Well, that’s it for what I have today for episode 86, but let’s just summarize here about core and fringe vocabulary. Give them equal weight. Just because we call nouns fringe doesn’t mean they’re fringe. Recognize the stages of motor learning, cognitive associative, and autonomous use sensory experiences for learning, readiness and engagement. And I might add to build trust. And use and teach teachers to use descriptive teaching.

Thanks for joining me today on The Speech Umbrella podcast. Transcripts and links for this episode are located at thespeechumbrella.com slash blog. Now while you’re there, be sure to sign up for my free resource library where you have access to over 25 therapy and clinic resources for free. Those are at thespeechumbrella.com slash free.

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