It has been a LONG time since I’ve used an AAC device in my speech therapy sessions. The last time was probably over 15 years ago when I worked with multiply handicapped children, and the AAC devices were LOW tech. If I were a betting person, I would have put money on never encountering an AAC device again in my career. But never say never!
In September, Eddie (name is changed to protect his identity) was new to my school, a private placement for students with learning and behavioral difficulties. He presented with the most severe case of apraxia I have ever encountered, with largely unintelligible speech. Eddie is an intelligent child who works hard during our sessions. Once I was able to get a handle on his sound inventory, it was also apparent that there were language-based ESL issues. So even somewhat intelligible utterances were impacted by poor syntax. At nearly 13 years old, I recognized that the window of opportunity for significant improvement in speech intelligibility was quickly closing and the need for compensatory measures was desperately needed.
My first question was why didn’t this child have a device to help him communicate? The answer was obtained in a parent meeting. Eddie’s parents were loving people who did not understand the severity or nature of his disability. They argued that he was “not autistic”, that a device would stigmatize him with peers (how could it be any worse?), and that all I needed to do was “fix this” (pointing to their mouths). I gently pushed back, providing evidence from research in the field such as this recent article by Millar, et. at (2016). The end result was an agreement to “give it a try, but it’s probably a waste of time”.
The long road to obtaining a device for Eddie ended with the purchase of the “TouchChat with Word Power” app. Although he quickly took to the device, the work of customizing the app to make it functional for Eddie has been an undertaking I had not anticipated. I am by no means an expert, but I wanted to share some tips for AAC success with adolescents:
1. Involve your student in the AAC process
Prior to obtaining his AAC device, I explained to Eddie why I thought it would be helpful. This discussion provided the opportunity to talk about apraxia, remediation and compensation. You can use whatever level of language is appropriate for your student, but demystifying his disability and the therapy process proved to be a powerful motivator for Eddie.
Eddie is also involved in the programming process. It’s always amazing to me how intuitively and quickly kids pick up on computer language! Making children active participants in the therapy process is always exciting and is one of the qualities I love about adolescents! Eddie is super motivated to be part of “program” development, as we create a customized device for his needs.
2. Educate parents on the AAC
Eddie’s parents are immigrants who speak broken English and have limited formal education. They do not understand his disability and are suspicious of the AAC device. During meetings, they are outspoken about their concerns, do not support the use of the device, and will not allow Eddie to use the device at home.
In working with parents, I have come to learn that no matter how adversarial, parents should always be regarded as part of the therapy team. Most protests stem from fear and confusion, and as an SLP it is my responsibility to provide parent’s with research, progress and information about clinical recommendations and treatment. The journey with Eddie’s parents will be slow, but I am confident that taking the steps to educate his parents about his disability and involving them in the therapy process will have a positive outcome for everyone!
3. Make the AAC academically relevant
The first order of business was to add information that would help Eddie function in the classroom. First we added a page that listed all of Eddie’s classes and teachers.
I quickly turned to classroom teachers in search of academic content that could be programmed into Eddie’s TouchChat. This was a great opportunity to not only involve teachers and assistants, but to explain the function of the AAC device. Many wrongly assumed the device was to replace speech. They were also relieved to learn they did not need to learn how to use the device, as Eddie is an independent user. Not adding to the workload of teachers and classroom assistants and keeping things as simple as possible has been helpful in gaining staff support.
From each subject area, Eddie & I created a page that includes important concepts and vocabulary. For example, in social studies his class was learning about Alaska and dog sled races. Adding academic vocabulary to his device gave us the opportunity to work on vocabulary concepts and sentence structure, skills that will support Eddie during class.
4. Provide AAC opportunities for peer interaction
Eddie is currently the only student in our school who uses an AAC device, and he is concerned about being teased by peers. He was already socially isolated, and had been the subject of taunting due to his disability. My challenge was to provide Eddie with tools to use his device to create social interactions with peers rather than adding to his social “differences”.
Together we created a page for games and gaming characters. Eddie is learning to use his device to play Uno, Guess Who and talk about his favorite Yo Kai Watch characters! His peers are intrigued as Eddie demonstrates the device, and Eddie loves the peer attention!
Do you have any tips to share about using AAC devices with your adolescent students? Please share below!