I’ve talked before about how to know if your child is ready for an AAC device and I’ve dispelled some common myths about AAC, but we haven’t really gone into how to teach children to use AAC devices.  For those of you who don’t know, AAC stands for augmentative/alternative communication and AAC devices are devices that a child can use to communicate for them when their speech mechanism is not able to express all that they have to say.  This may be for a child who has motor planning or muscle problems, or for a child who is a late talker, who has autism, or some other disability that impairs his ability to speak.  This article is written for those who work with a child who already has a device (usually selected for them by an AAC evaluation team) and now they need to know how to teach it to the child.  The company that sells you the device should be able to provide training on how the device works, so this is more general information on how to teach children to communicate effectively with AAC devices.  Be prepared that this will take time and you will need to have patience and work hard!

How to Teach Children to Use AAC Devices Step One:

Decide How Your Child Will Activate the Device

This is something that the company that sells AAC devices will help you do.  There are many ways for children to activate AAC devices and they will know which one is right for your child.  Some children will activate the device by pushing a button with their finger.  This is the most common method.  However, there are children who have significant motor problems and this may not be a reliable way to use their device.  For these children, you will need an alternative means to activate the device, such as a switch that when pushed will stop a light that is scanning past the buttons.  When the light is stopped, it will speak whichever message it is on.  Other systems have the ability to track your child’s eye gaze and will speak whichever button the child looks at for a few seconds.  There are other ways to activate the device as well so speak with your representative about the best method for your child.

How to Teach Children to Use AAC Devices Step Two:

Give The Child Time to Explore

Like any new toy, your child will want to explore her new device when you give it to her.  This is completely OK and should be encouraged!  This is how your child will learn how it works.  As she explores it, show her how it works.  Show her how to push buttons and make it speak.  Many devices require the child to push the button she wants and then push the message window to make it speak.  Show her how to do this but also allow her to explore and find out what the buttons say and which buttons are in which folders.  While she’s exploring, respond to the buttons she pushes as though she had said it.  For example, if she pushes something that you have close by, pick it up and show it to her.  Repeat the word that the device said and show her what it is.  If it’s something that you don’t have nearby, you can say “Horse?  We don’t have a horse here.  A horse says “Nay!”.

How to Teach Children to Use AAC Devices Step Three:

Teach The Child One Button

Decide on the first button you want to teach your child.  Try to choose something that is highly motivating to your child (something he really likes) and something that isn’t too hard to find on his device.  Hold up whatever it is (for example, bubbles) and let your child see it.  If he reaches for it or makes some kind of indication that he wants it, take your child’s finger and push the buttons (or use the switch or other activation) to find the correct one.  Say the name of the button as you push it.  For example, if your child’s device has “bubbles” in the “things” folder, say “things” as you push it with his finger, then say “bubbles” as you push that button with his finger, then push the message window so it talks.  Then, give your child what he has requested, in this case “bubbles”.  After you help your child in this way several times, see if he can do any of it on his own.  If not, try giving verbal prompts like “push things” or point to the button instead of using his finger to push it.  If those prompts don’t work, go ahead and push it with his finger like you did before.  Keep doing this every time your child wants that thing until he is able to find the button on his own.  Then, pick a new button and teach it to him in the same manner.  You can also teach her to request actions like hug and tickle or use social language like saying “hi” or “my turn”.

How to Teach Children to Use AAC Devices Step Four:

Have Your Child Choose Between Multiple Items

Once your child is able to request one object when you hold it up, try having a few different choices in front of her.  Show her all of the things you have but don’t let her have any until she uses her device.  If she reaches for the object instead of using her device, try to use prompts like “use your talker” and point to the device.  If she still doesn’t use it, you can help her like you did in the previous step.  Keep working on having your child request things using her device any time she shows a desire to have something.  If she points at something or takes you by the hand to get something for her, take her to her device and say “Show me on your talker.  What do you want?”  Then help her find it.  The more you do this with children, the faster they learn AAC devices.

How to Teach Children to Use AAC Devices Step Five: Combine Words

Just as a child starts speaking by using one word at a time and then combines two together, you will eventually want your child to start using multiple button pushes to create simple sentences.  You won’t want to work on this until your child can use his device to functionally communicate a lot of one-word utterances.  When you’re ready to help him start combining words, model this for him by creating two-word combinations when you speak to him.  You can also expand on what he pushes by creating a two-word combination using the button he pushed.  For example, you could ask your child “want cookie?” and push the buttons “want” and “cookie” while you do it.  Then, when your child pushes “cookie”, show him how to push both “want” and “cookie” to create the combination.  After showing your child how to do this several times, you can help him do it by using the method described in step three.  You can continue using your child’s device in this manner to teach him how to create other combinations all the way up through complete sentences.  Keep in mind that it may take years before your child is able to produce full sentences with his device, but it’s something to keep in mind as the future of what you will be able to use it for.

Input From a Reader: Don’t Forget Modeling!

I just received this comment from a reader.  Her message highlights a very important aspect of teaching AAC that I have missed in this article: keeping it natural.  She talks about the importance of modeling and integrating the AAC device into a more natural setting.  The steps I have listed above work great in a therapy setting to increase a child’s knowledge of how to use the device, but I LOVE what she has to say about keeping it natural as well.  The approach she describes will be great for helping a child actually use it functionally and helping a family learn to make it a part of the natural routine.  Amazing stuff here, take a look:

“I like step one and I like that step two emphasises the importance of child led exploration of the device and being there to respond naturally to the varied things they might say whilst exploring – this for me would be part of the Opportunities, Observing and Responding parts of the Opportunities for MORSE acronym for aided language stimulation.

For me though something critically important in successful teaching and learning of AAC devices is missing from these steps, the most important thing in my opinion. I do think that modelling must be highlighted as so, so, so very important, perhaps the most important thing any family can do. Model, model, model the child’s device every day, as many times as possible, in natural, real situations, to say real things to real people. Aided Language Input, Aided Language Stimulation, modelling – we can’t underestimate just how important it is for AAC users to see their device used by the people they love and spend time with to communicate for real reasons. It’s just so so important and to neglect it jeopardises the child’s success at ever learning how to use their communication device. The stats regarding how many hours of modelling a typically developing child gets with spoken language before they begin to speak at around 18 months (4,370 waking hours!) means that if a child learning to use AAc only gets input on how to do this two times a week for 20-30 minutes at a time it will take them 84 years to have the same amount of experience with their device as an 18 month old child has with spoken language (Korsten, 2011, QIAT) so as much modelling in as a natural a situation as possible is crucial. The easier and more natural it is to model, the more likely modelling will happen so it’s good to help families do this rather than worry so much about which word they must focus on first and which one next, I believe.

I think it’s also really important to talk about multimodal communication and the need to respect ALL communication modes. I don’t think it’s wise to tell people new to supporting beginner AAC users to say things like “use your talker” or “show me on your talker” if the child / adult has already successfully communicated what they want by holding your hand, taking you to it and pointing. Such comments may cause frustration, breakdown the flow of communication and could damage the communication strategies they already have. Causing frustration for the child can lead to frustration for the families and could quickly lead to device abandonment. We all use multiple modes of communication across our daily lives. It would be more respectful in my opinion if all the child’s communication attempts were recognised and validated and that the flow of communication was not disrupted by making the child communicate in another way. I think it would be better if instead of disregarding the child’s communicative intent and disrupting the flow and pleasure of successful communication the adult responded to the child’s communication efforts by modelling how the child could have used their device to make their point more efficiently, clearly etc. The adult could activate the symbol for the item the child has indicated seek clarification using the device by adding another word because maybe the child didn’t actually want that item they brought the adult too, perhaps they just wanted to show it, or give it back, or indicate yes, I’ve got one too having overheard a conversation or shared a book… We can’t always assume it’s about indicating wants. And the more we model the different reasons for communicating over just wants the better!

I am also uncomfortable with steps four and five being so focused on requesting and no mention of other reasons for communicating as well as being very test oriented, setting up choice making situations and making the child ‘perform’ before introducing a wider variety of choice or introducing combining of words. I think the more naturally we can encourage and support communication learning the better. We naturally expand the utterances of young babies and toddlers before they are clearly using many single words and in my experience the more we can make teaching a child learn to use their AAC system seem a natural extension of this, the more confident families will be to just start exploring rather than feeling they need to set up teaching times, the more positively and easily they will view their role in teaching their child to learn AAC.

I do think it is helpful to have go to lists like these, I just think we need to be careful not to overload families with the guilt of having to fit in more things when actually, the more natural the better most of the time. Just my thoughts however!”

I am so grateful for this other perspective on AAC.  Thank you for sharing!!