Supporting early communicators

>> Female narrator: Welcome to this video about Augmentative and Alternative Communication, often shortened to AAC.

By watching this video, you will:

• gain an overview of what AAC is
• learn what our top tips are for using AAC

AAC can come in lots of forms.

A Speech and Language Therapist may recommend using:

• individual symbols 
• signing 
• objects 
• activity boards
• core boards
• communication boards 
• a communication book
• switches
• a Voice Output Communication Aid, often shortened to VOCA

We need to learn with the AAC user

When we use AAC, we have to learn what the symbols or signs mean as well as the individual. It is almost like learning a different language!

Look at this picture; do you know what these symbols mean?

It is our job as a communication partner to model the words alongside the symbols or signs.

Did you know what the symbols meant?

[pause]

The research tells us that 89% of children and young people had an increase in using language, that is, talking, after implementing AAC. None of the AAC users involved in the research lost any of their spoken language skills.

AAC does not stop verbal communication. People will use verbal communication if they can, as this can be the most efficient way of communicating for those who have functional skills. AAC augments communication, which means it adds to it; it does not take away any other skills.

Now we are going to look at our top tips for using AAC.

Firstly, AAC needs to be seen and heard.

An AAC user will have to hear words, and see you pointing to the symbols, or using signs lots of times, before being able to use them themselves.

It is important that we show individuals how to use symbols and signs lots of times, in lots of different situations.

We should be modelling for at least 18 months before expecting them to start using their AAC more effectively.

The more someone hears and sees a word or symbol or sign being used, the more likely they will use it themselves.

Talk and use AAC

It is important we keep talking whilst using AAC.

For example if we are signing to child or young person and want to sing a song, we should pick out the key words to sign as we sing.

If you are using symbols, remember to talk and point. Again, pick out the key words. You can start with one word. For example, if you are at the park, you can say “Look a duck!” and point to the ‘look’ symbol. The actual duck is already there for you to point to!

When you are using AAC, pause to see if the individual wants to communicate with you. This does not have to be by using AAC; it could be a different communication method such as a smile to show enjoyment, or pointing to something.

It is important we do not put pressure on someone to use AAC. This can make it feel like work or stop them from wanting to use it for fun and enjoyable interactions. Remember, it should be a conversation, not a test, so try not to ‘force’ them to point to or sign things.

Like we said before, it can take some time for someone to feel confident to use AAC, so if they do not initially respond, keep modelling!

Communicating is more than requesting.

Use the AAC for more than just requesting things. We communicate for lots of different reasons for example:

• Greeting
• Commenting
• Protesting
• Questioning
• Describing

Make sure the AAC user is hearing and seeing these types of language use.

Use a variety of AAC

We can use AAC alongside other forms of communication, and it is really useful to do so. If someone speaking cannot find the word they want to use in their head, they often use other strategies such as pointing or gesturing. This is the same for an AAC user.

Some example of other types of AAC include:

• Pointing
• Gesturing
• Using objects
• Photos
• Songs
• Written words
• Spoken words

It is OK to make mistakes

AAC users need to see that we all make mistakes. Take this as an opportunity to share humour, and show them it is OK to make mistakes!

Show your working! The AAC user needs to see how you find things and problem-solve. You can say "I'm looking” or “I’m thinking" to keep their engagement. 

Use AAC all day and everywhere

If you are using symbols, a communication book or boards, or activity boards, where possible always keep AAC around the user so it is there for you to use it with them.

At home or school, keep the AAC with the user or in a consistent place so they know where it is when they want to use it.

Get everyone involved

As we grow up, we learn language from lots of different people.

Ask siblings, family members, school or setting staff, professionals, and friends to watch this video and then show them how to use the AAC.

The more normal and used the AAC is, the more likely the individual will be to use it. We all communicate in different ways, so it is important to show AAC users that we do this, and they can choose how they would like to communicate or use AAC.

Lastly, Have fun!

It is good to have fun with AAC! In fact, we should target this.

Expand from choice making around routines to thinking about what motivates the user.

Use the AAC system with them to support their understanding of your spoken language.

AAC users are more likely to use their system if communication is fun!

For more information on supporting children and young people’s speech and language needs, please visit our website. 

The resources section has lots of useful information for supporting speech, language and communication needs and the training section hosts a range of free to access to videos as well bookable workshops.

Our Facebook page contains lots of useful tips for supporting speech, language and communication.

Thank you

>> Laura: Hello, my name is Laura, and I am a Support Practitioner working with Bedfordshire Community Health Services NHS Speech and Language Therapy team.

You’ve probably come to this video because a speech and language therapist has recommended that you use objects of reference to support your child’s understanding. Objects of reference are objects used to represent people, places or activities. When used consistently over time children will begin to form an understanding of what the object represents. We use objects of reference to support a child to understand what’s happening in their environment or happening next in their day and transition between activities.

First you need to identify an activity that your child does regularly every day. For example, bathtime, bedtime, mealtime going to Nursery. We start with familiar activities so that the child can build up an association between the activity and object. Once we’ve got that in place we would then begin to use the approach for unfamiliar or new activities for your child. Then we need to identify a meaningful personal object to represent that activity, person or event to your child.

Here are some things to consider when choosing your objects of reference

Number 1: The object must be relevant to your child. They have to be able to form an association between the activity and the object. And the object might differ from child to child. For example, for one child it might be the smell of their shampoo that reminds them of bathtime while for another it may be their favourite bath toy.

Number 2: You can use the whole object for example a cup to represent a drink, or you can use part of the object for example part of the car seat belt for going out for a drive.

Number 3: Think multisensory, the child can build a better mental picture of an object if they can hold it, see it, smell it may be even hear it. For example, if you’re going to Grandma’s house it could be the smell of her perfume or if you’re going out in the car, it could be a fan or the feel of the wind passing through the window or the feel of the seat belt as mentioned before or the music they always listen to in the car. Just remember if your child has a visual impairment think about the other senses, that they can use to explore the object. Think about the texture sound and the smell to support their understanding. also if your child has a  dislike for certain sounds or smells or textures try and avoid these when choosing your objects.

Number 4: Avoid using the actual object that is used in the activity. For example, if its the object of reference for drink have a drink ready made in their usual cup. Show them the object of reference cup and then immediately give them the cup with the drink in it. This is because we always want the object of reference to be available to the child but if its just had a drink in it and its going in the dishwasher then it’s no longer available.

5 top tips for using your Objects of Reference

1. The object must be presented immediately before the activity happens.
2. The same object must be used every time you do that activity to give your child the best opportunity of building up that association.
3. The object must be presented in the same way every time.
4. Let your child handle the object to build up a better mental picture of the object
5. The object should be kept near your child throughout the duration of the activity.

We would suggest that you start with three objects of reference for your child. Once they are showing awareness and or understanding of the object, for example they look at the object or when the object is presented they go towards the area in which that activity is going to happen, then we would look at bringing in some more objects for them.  

Your child’s objects of reference should be kept in the same place that is accessible for them. This is to give them the opportunity to bring the items to you to request if they want to do a certain activity, once they’ve got that understanding of what the objects represent.

Photos can also be used in this way and this is known as photos of reference. The object will be replaced by a photo and in choosing and using your photos of reference you follow the same rules for objects of reference. If photos are appropriate for your child your Speech and Language Therapist will discuss this with you.

The reason we begin with objects is because objects are easier to understand and give that multi sensory approach.

If you need any further support with implementing objects of reference for your child please contact your speech and language therapy department. Thanks for watching.

Slide 1: Choice Boards. 

>> Male Narrator: Welcome to this video about choice boards. 

By watching this video, you will:

• know when to use choice boards
• will have explored how you can make one for a child or young person.

Choice boards are a great way of showing your child the power of communication – to make a choice about something that they really want.

A choice board is a way to visually present options to a child within an activity or a situation.

It is a visual represented by real objects, photos, symbols, or text.

We use choice boards to support spoken language for example, “shall we play with bricks or cars?”

A visual choice board can make the choices more concrete and help children understand more easily.

For children who have limited expressive language skills and/or are developing their spoken language skills, choice boards allow them to express their choice. They may do this by reaching for their preferred object or pointing to a photo or symbol.

So, where do you start?

First, identify what choices are meaningful to the child or young person, for example, preferred activities, favourite foods or drink or places. It is important to choose play activities closely linked to the child’s interests. That could be bubbles, a tea party, train track or even doing each other's makeup or hair. 

Think about how you can use choice boards in a range of contexts or situations. Try to avoid just having choice boards around one activity or routine for example mealtimes. This gives the child the opportunity to communicate in more situations.

Once you have decided on the meaningful activities then take photos of the item or activity.

Try to take these with a white or plain background so the item stands out.

You could also use logos from a favourite character such as Paw Patrol or Spiderman or cut logos from favourite food packaging such as crisps or cereal.

The next step is to print the photos.

You want the choice board to be accessible so aim for the photos to be about the size shown on screen 6-8 photos per A4 page is ideal.

Although not essential, it can be beneficial to laminate the pictures and the choice board so that they last longer. You can use Velcro or blue tack to help keep the photos in place – but again this is not essential.

Sometimes you might need to decrease the number of choices. For example if a child normally chooses from 8 options but they are distressed or dysregulated, it may be beneficial to present them with 2 to 4 choices during that time.

Present the symbol, object or photo choices whilst verbally labelling and pointing to them. When the child indicates their preference, the adult should verbally label the item again, and immediately give the object to the child. You could start by introducing symbols or photos alongside a single activity. It is important to show the pictures alongside the activity.

>> Female narrator: Let’s choose our snack. Biscuits, cheddars, biscuits, cheddars. Choose.

>> Male narrator: If the child does not respond to the photos, then offer them the objects as choices. If, or when they indicate their choice toward an object, then reinforce their choice by directing their attention to the photo representation and immediately give them the object.

When verbally labelling the item, we can build in pauses to provide an opportunity for the child to imitate to the word if they want to, however, we should not actively attempt to get them to copy our words.

As the child gets more comfortable or confident with the system you can add photos and build on the number of choices. 

>> Female narrator: Let’s choose what we’re going to play with. Tambourine. Cups. Bubbles

[Pause]

>> Male narrator: Always reinforce the choice.

>> Female narrator: Bubbles!

Here are some top tips for using a choice board

1. Create opportunities for communication. Think about times in the child’s day where there are opportunities for requesting, for example requesting more snack, requesting to be pushed on the swing, requesting a toy from the shelf.
2. Use the board consistently. The more you use the board to support communication, the more familiar the child will become with the strategy and the more their understanding of symbols and alternative forms of communication will develop.
3. The child needs to have lots of opportunities to learn how to use their choice board in a meaningful way. They may not understand straight away; this is all a part of learning.
4. Encourage use of the board through modelling it yourself. Do not ‘test’ the child using the board as this could deter them from using it. For example, do not ask your child to ‘find symbol X’ or to ‘point to symbol Y’.  
5. Equally we should never physically move the child’s hand or finger to point to the board. This could deter them from using the board and will not necessarily help their understanding of the symbols. Accept a total communication approach – for example, if the child doesn’t point with their finger but uses their eyes, this is totally fine.
6. Respond to every use of a symbol. If the child points to a photo or object by accident, you should still respond to them as if it was meaningful. For example, if they point to the ‘bubbles’, but you know that they want the ‘cups’, you should verbally label ‘bubbles’ and give it to them. This helps the child understand the meaning behind using their communication board.

For more information on supporting children and young people’s speech and language needs, please visit our website. 

The resources section has lots of useful information for supporting speech, language and communication needs and the training section hosts a range of free to access to videos as well bookable workshops.

Our Facebook page contains lots of useful tips for supporting speech, language and communication.

Thank you