Interview between Speaker 1 (Meg) and Speaker 2 (Kate McLaughlin)
Episode 52 – AAC Listener Q&A with Kate McLaughlin
[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in our professional therapy practices. I’m Meg Proctor from learnplaythrive.com.
Meg:
Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say ‘autistic person’ rather than ‘person with autism’. What we’re hearing from the majority of autistic adults is that autism is a part of their identity that they don’t need to be separated from. Autism is not a disease, it’s a different way of thinking and learning. Join me in embracing the word ‘autistic’ to help reduce the stigma.
Welcome to our Listener Question & Answer episode with Kate McLaughlin. Kate is a speech language pathologist who specializes in augmentative and alternative communication for individuals with complex communication needs. She believes that autonomous communication, inclusion, and self-determination are fundamental human rights, and we absolutely agree. I love talking to Kate about AAC because she always brings us back to the question about whether we are truly encouraging autonomous, authentic communication for our emergent communicators.
I’ll tell you a little bit about Kate. Her private practice is called AAC Services of Connecticut where she partners with learners and their families to support their AAC journey through direct or consultative services. A lot of y’all know Kate from her social media presence as The AAC Coach. She’s also the course instructor for the Learn, Play, Thrive course called ‘Authentic AAC’, which is registered for AOTA and ASHA CEU’s. If you check out the page for that course, it’s learnplay thrive.com/aac and fill out the form, she also has a one-hour free training that you can watch on teaching for autonomous communication. Kate’s going to be speaking at our upcoming summits. We have a SLP neurodiversity continuing education summit in October, and one for OT’s in January of 2023. You can find both of those at learnpplaythrive.com/summit.
Clearly, I love learning from Kate and sharing that with all of y’all. In this conversation today, Kate answers listener questions about how to teach AAC to emergent communicators, really getting into the ins and outs of that. She answers technical questions about how to choose a device and things like grid size, and she goes into addressing access barriers. So, Kate is just such a wealth of knowledge and even though I’ve taken her course, I still learned so many new things in this conversation fielding your questions to her. Here’s the interview.
Hey, Kate! Welcome to the podcast.
Kate:
Hi, Meg. Thanks for having me back.
Meg:
It’s always so nice to sit down and talk to you about AAC. So, I asked folks for questions for you by e-mail and on social media, and I got a lot of responses. Can we just dive in?
Kate:
Yeah, absolutely. I’m excited.
Meg:
Me too. I’ve grouped them into three categories. The first is teaching strategies, and then questions about technical recommendations for devices, and then addressing access barriers. So, we’ll start with teaching strategies. I had a couple of ‘Advice for Beginners‘ questions. One was an OT who doesn’t really know much about AAC but is excited to get started, and another is a parent whose child just got a device. What advice would you give to these folks for where they can start?
Kate:
Yeah, so I think that whenever we’re starting on an AAC journey, it’s really, really important to frame our conversations and our decision making around what is our long-term goal, or what are the outcomes that we’re really hoping for, for this child or for this individual who’s learning to use AAC? And for me, that comes down to communication autonomy. And that, the definition for communication autonomy comes from Gayle Porter, and she says, basically, that means being able to say whatever you want to say, whenever you want to say it, to whomever you want to say it, and however you want to say it. And if we really sit with that definition of communication autonomy and let it guide us through our decision making, we’re really laying a very strong foundation for how to proceed and how to make sure that the decisions or the choices we make around via technology or teaching strategies, if we’re really centering communication autonomy, we’re really starting off this journey on a good foot, if that makes sense.
And so, if you’re a parent who’s just beginning AAC and your child just received a device — assuming that the device or the system is really well-selected and is a robust communication system, meaning it offers lots and lots, thousands of words and grammar and all the sorts of things that your child is going to need way down the line — assuming it’s been well-selected in that way, really, what we start to do is lay the foundation with some firm habits. So, making sure that that AAC system is always available. And, you know, I say to parents, it’s okay if the initial stages of your AAC journey is literally just working on making sure that that AAC system is available, meaning it’s within arm’s length and your child can use it at all times of the day, regardless of where you are, who they’re with, what position they’re in. And that doesn’t necessarily even mean in those beginning steps that you need to be using it or your child needs to be using it. But it’s really just laying the foundation of making sure that that AAC system is available.
And then, once that really feels second nature, like you feel funny if the AAC system is not there, that’s a good sign. And you can start to use that system to talk to your child or around your child, to other people in the environment, just naturally; as naturally as you can. Be kind to yourself because using AAC does not necessarily feel natural. So, it does take a little trial and error to figure out what works for you. But begin to use that system just to talk to your child about the things that matter to them, about the things that are happening just naturally in the day. And that’s a really good place to start.
Meg:
I love that answer. So, starting with our long-term goal of autonomous communication — saying what you want, when you want to say it — and then doing the work of getting in the habit of having the device around, and then starting to model using it. That’s a great place to start. I have a couple of questions for you about prompting. Let’s start here. Christina wants to know, “How do you increase initiation for use of AAC as opposed to needing to prompt?”
Kate:
It’s a really, really good question. And really, we don’t want to be using — when we think about that definition of communication autonomy, saying what you want to say, when you want to say it, however you want to say it, to whomever you want to say it — prompting is really in opposition to that. So, it’s one thing to maybe suggest like, “Your AAC might help us,” but getting in there and prompting somebody to say something that they might not want to say, when they might not want to say it. That very much works against what we’re trying to achieve with communication autonomy. So instead, what we need to be doing is showing the AAC user how to use their system by modelling it ourselves. And when I say modelling, I’m not talking about modelling as a modelling prompt. I’m literally meaning just using the system to talk to the child or to whoever else is in the environment. And doing that naturally. Beyond that, what we can start to do is be really explicit in talking about initiation with the AAC user. And that’s something that I cover quite a bit in the Authentic AAC course.
But basically, being really explicit about, “Oh, I have something to say and I’m going to use the book,” or, “I’m going to use the talker, the device, because I have something I want to say to you,” and if the AAC user might need to be more explicit about when they have something to say, that might mean teaching them to raise a hand, or tap a book, or tap at their device, or move over to their device. But I’m really explicit with them when I’m using the system to be modelling what I think they need to do, so that they can see how to do it.
And I think the other piece of this conversation, Meg, is people often expect kids to use their AAC system far sooner than what is reasonable to be expected. So, we have people who start AAC, who it takes them many months before they start to use it themselves. Some even longer, up to a year. And when we think about language development for speaking kids, we do — we talk to them for at least a year before we expect anything of them. So, it’s really important to also check ourselves and say, you know, have I been modelling this really well in a really engaging way? Have I been showing them what they need to do for a really long time before I expect anything from them? That’s kind of where we need to put our attention before we worry about trying to get them to say anything.
Meg:
You know, so often as therapists, we think our job is to make a kid meet a goal because we wrote the goal. And I love that reframe that that’s really not our job. Our job is to provide the opportunity, and to do a lot of modelling, and to give the opportunity for that authentic, autonomous communication that you’re always talking about. That’s a really big shift.
Kate:
It is the big shift. And I think the other piece of that is, if you really are honest with yourself, and we’ve been doing this a long time, I’ve been talking about all this stuff this kid really cares about and doing it in a really a way that feels safe to them, then it’s really about stepping back and trying to problem solve what might not be working for this particular kid. Is there an unrecognized sensory or motor need or vision, right? Really getting curious about what might be the issue, rather than jumping in and prompting them to say something.
Meg:
Yeah, I want to make the observation that you’re not only saying, don’t jump to prompting, but you’re not saying, well, if they don’t use it, then we’re going to tack on behavioral strategies, we’re going to use hand over hand, we’re going to withhold something until they ask for it, right. There’s no moment at which you’re going to recommend that, that there’s always more listening, more learning we can do with our autistic clients to figure out what would support them in communicating in a way that is authentic to them.
Kate:
Yeah, and I think that, as you say, authentic to them, right. Part of this communication autonomy is choosing how you’re going to communicate. Now there are some reasons that symbol-based, or word-based AAC, or a letter-based AAC is helpful, right. You can be super specific, and you can talk about things that aren’t currently right in front of you or in the environment. But these kids, or all kids, are communicating all of the time. And so, some of that problem solving around initiation likely needs to be, how are they communicating to us now? And how do we get in there in those moments and use the AAC to talk about the things that matter to them in that moment, so that were really reflecting language that is likely important to them? Because they’ve initiated in some way, even if they haven’t initiated use of the AAC. And when I talk about ‘Am I modelling well for a long period of time’, part of that is being really responsive to their multi-modal communication.
Meg:
I could talk about every single one of these questions for the full interview with you. I want to ask you a follow up question on prompting from Renée. She wants to know if we should be prompting for things like using the spacebar and clearing the screen?
Kate:
It’s a good question. And these are operational skills that are really valuable, especially as AAC users get more and more competent with their system. And there are a lot of reasons for that. If I don’t clear my message bar, but I’m playing it, people hear all the old words, and they’re not sure what’s important. Or if I don’t, you know, if I’m typing and I don’t use a space, then things will run together. And so, what’s important as AAC users move along in their AAC journey is that we’re having really clear conversations with them about that, like, “Hey, you didn’t clear your message bar, so I am not sure what I’m supposed to be listening to right now,” right, or, “You didn’t speak your message, so no one heard you.”
So, if you, you know, if you put that up there, “Because it was important for people to hear, you have to remember to clear it,” I think that we can be having really direct conversations in helping them understand their power in the situation. “If you do these things, then people will understand you a little bit better or more efficiently,” or whatever that is, and then we’re also embedding those things into our modelling. So, when I’m working, and working on clearing messages is something that comes up frequently. But when I’m working with an AAC user on that, I’m talking about it as I’m modelling. So, “I played my message so everybody can hear and I’m gonna take out the, you know, clear out the old words, we don’t need those anymore; I can let them go.” And so, talking to them directly about the choices that they’re making, and if they’re supporting what they’re trying to achieve, and also talking about it as I’m using the system, just to highlight it for them in a balanced way. So, it’s not really all about what you need to do. It’s about these other things that help anybody be more successful using their AAC system.
Meg:
Yeah, so modelling, directly addressing it. Are you making a distinction between prompting and giving feedback?
Kate:
I think, yeah, I think that’s an important piece of that. Feedback — you can take or leave feedback.
Meg:
Yeah, it’s true.
Kate:
I’ve had AAC users who have very much not wanted to take my feedback for long periods of time, particularly around clearing. And only they know their reasoning, right? It may feel like too much for them. It may just be too much of a load at any point in their development with AAC, and that’s okay. But I keep giving them that feedback so that they can take it on when it feels workable for them. Whereas if I’m in there prompting and not letting the conversation continue until they do what I say, I’m really changing the dynamic of the interaction between the two of us. And it’s not in a positive way. I’m really kind of becoming an authority and not — it takes me out of connection with them, authentic connection with them. So, feedback is a way to kind of do that learning and teaching, but without making them do, or moving towards compliance.
Meg:
I’ve never really sat with this distinction before. I’m thinking about people who I share power with equally — not children, not clients, like let’s say, my partner — I wouldn’t prompt them to do something, and I would give feedback.
Kate:
Yeah, yeah. I really appreciate that distinction.
Meg:
Liesie is looking for guidance on working with older students. She says, “I’d love more guidance on how to support older students who are new AAC learners. I work at a middle school and have several students trialing and learning AAC, but most of the ideas and content I come across are too young for them.” Kate, is working with older students something that you model and cover in your course?
Kate:
Yeah, so the course is really designed for emerging AAC users regardless of age. So, the principles of starting AAC are the same. But you do need to adjust how you’re interacting with the AAC user, making sure that you’re really being respectful of their interests and what matters to them. And if you’re coming across activities that seem young, then they are not appropriate for older students. What I will say is that, in general, you don’t need a lot of fancy activities to do AAC, it’s really about just getting to know the person in front of you and using the AAC system as part of that interaction. So, the other thing that I would suggest when thinking about older students is a lot of these students have been underestimated for a very long time. And so, they have a greater tendency to check out because they have had a lot of people not recognize them for the able person that they are. And they also may have a lot of experience with people bringing AAC to the mix, and then prompting them and it may feel like, “This is not something that really helps me as an individual.” So, it can take older emergent AAC users longer to realize that you’re going to respect them, and respect what they have to say, and you’re going to use that AAC system to authentically connect with them. All of that is still really, really important.
Meg:
Kate, I had a couple of questions about parent buy in. Fiona wants to know how to encourage buy in for parents who may not be very tech savvy, or who may feel like AAC quote ‘gets in the way of their naturalistic way of communicating’. Christina had a really similar question — I’m gonna lump it together here for you — about getting parent buy in when the parents’ goal is spoken language. What advice do you have for Fiona and Christina?
Kate:
Right. So, I think, a couple of things. In terms of the tech savvy piece, remember, AAC doesn’t always have to be high-tech. It does need to be robust. And there aren’t as many options for you if you’re looking for a non-electronic robust system, but they are out there. And it is really important to acknowledge that parents likely have developed real, effective means of communicating, particularly for things in the here and now, things that are in the environment. Gestures, vocalizations, facial expressions, they’ve probably been, you know, watching the nuances of those expressions for very, very long and they’re likely pretty successful to some degree. That said, you can’t be super, super specific about your meaning without language. So, what I think can be a helpful for parents is to talk about that long-term view of communication autonomy and help them see that there are certain communication modalities like gestures, and vocalizations, and facial expressions that are going to be super-efficient and really effective. And we want to be respecting those and using them, right. But there’s probably more that their AAC user has to say than they’re able to express about that, because they can’t really necessarily talk unless they’re using, you know, a language like sign language, and able to put words together using sign language. They’re limited in what they’re able to talk about. And that, as a parent myself, that can be really hard for a parent to understand.
You know, and when we think about our kid’s development, they help us see them differently. They do something new; we think about them like, “I didn’t know that was important to you. I didn’t know you were thinking about that.” And for learners who are non-speaking and are primarily using gestural communication or facial expressions, non-symbolic means of communication, it’s really hard for them to show their parents that they’re thinking about all sorts of different things, particularly. And that’s even more so the more complex their body. So, helping parents understand that there’s likely more that they want to say and that this tool is going to help them do that. And know that that’s going to be a slow realizing for some parents who, you know, who have really established patterns of communication with their kid. But understanding that we’re not trying to get rid of the way you’re communicating, we’re trying to kind of add to the toolbox and enhance what you’re able to learn about your kid and really get to know your kid even more.
And in terms of the spoken language, I think that, again, going back to that communication, autonomy, you know, a lot depends on to what degree speech supports the child’s ability to communicate what they want to say, when they want to say it. And we can talk about the different communication modalities, and who they work with, and what they work best for. And again, talk about it as increasing the toolbox. Because I think that we’re not talking about speech or AAC. We’re really talking about a full toolbox of ways to communicate so that the child can choose what works for them in the moment. And I think that that can kind of help reframe it — yeah, we can keep working on speech. And, you know, we can also be offering lots of other ways, and we can just follow them and see what works for them, you know, they’ll show us what works best for them, because they’re the only ones in their body knowing that in the moment.
So, you know, it can be hard for parents to not see speech as the, you know, the most important thing. But I think that part of this, as therapists, is us helping them to understand what works best for their child. And when they start to have success with AAC, then they can start to see like, “Oh, there is more here that we can use to communicate,” and, “Wow, it does help me get to know them so much better,” and, “Oh, speech is not as important as I thought it was. What’s really important is connecting with my kid, understanding them, having them understand me.”
Meg:
That’s so helpful. I love how you tie it into the parents’ long-term, deep goals for their child. I get a lot of questions about kids who repeatedly push the same button on a device. Here’s one I’ll just read to you word for word: “I’m looking for strategies for students that use their communication device to self-simulate by touching the same button over and over or repeatedly activate buttons or pages that are off topic.” Okay. And I have another really similar question from an OT who’s a school Assistive Technology Coordinator. She wrote, quote: “We often get questions about stimming on AAC devices, we’re constantly communicating about not taking devices away and trying to find the reason behind the stimming. We have continued to research this topic and have learned a lot. But I would want another perspective about how to respond when an AAC user is stimming, if there are strategies that have helped with redirecting it during academic teaching times and teaching appropriate times for stimming on the device. I hope this makes sense hard to write through e-mail without sounding like we’re trying to muffle the child’s voice. Not the case, but just want any advice you have.” How would you respond to these questions, Kate?
Kate:
There’s a whole lot in there, Meg, and I think that first, think about the stimming. I think they said, you know, we’re really trying to understand the why or what’s the reason behind stimming? And that’s a really important question, because it could truly be stimming; it could be babbling on the AAC system and just kind of exploring and seeing what words are available, and when you say those words, what do people say back, right. it can also be that there’s a message that’s gone un-understood. So, you know, really kind of digging into that with the AAC user and talking about the things that they are talking about and showing them language that goes with those words, because that might help them figure out how to adjust their message so that people will understand. And then, the other thing is really making sure that people are consistently responding. Often, if people haven’t been consistently responding then they may be not necessarily thinking that they’re doing it for somebody else’s response, right. They may be exploring the words on their own or thinking about — remember, for some AAC users, too, that can be their internal voice. So, I have AAC users who will put lots of things in their message bar, and then delete it because it was just an internal thought that they didn’t want to share with somebody. So, there’s just so many reasons why kids do what they do with their AAC system.
But one of the things that I heard in the two questions there were activating buttons or pages that are off topic, and also trying to, how do we redirect during academic teaching or teaching times? And I think if, you know, speaking, kids are always allowed to say whatever they want, they may get responses they don’t want, but no one says they’re not allowed to talk at that moment. And I think that for our — particularly, our emergent AAC users, they really need people to be listening and talking to what they want to say. And so, developmentally, for anyone, they speak on their own topic and agenda before they are developmentally able to follow somebody else’s. So, when you think about speaking kids, they go through many, many years of sorting out all of that communication stuff before we put them in this academic context.
And that is to be very clear not to say that our AAC users should not be fully included in their academic curriculum, because it’s absolutely critical that they are, but that we need to be more flexible, we need to be willing to follow what they have to say and try and make connections with what they’re saying either around topics that are meaningful that emerge, or how do we make connections to the academic content around what they say? Because what they say may be connected for them internally, and we just haven’t made that connection yet. So, you know, I think that, again, thinking about that really long-term picture, not getting too caught up in ‘is this stimming’, is this, you know, quote-unquote ‘intentional’, or is it not — all of those things very quickly take us off that path to towards autonomous communication.
So instead, noticing, getting curious about why it’s happening, trying different things to help them work through this moment in their AAC journey, but still going back to what are our really important practices of modelling and connecting and teaching them all of these interesting academic contexts that they can benefit from, that opens up their world to learn more, and to engage more with people. So, it’s not something that I recommend people spend a ton of time worrying about, if that’s the short conclusion there.
Meg:
Yeah, that’s a really interesting answer, and really asks us to question some of our assumptions and biases, because I hear you saying that both of the questions had an assumption that it was stimming, which we don’t know. And we know from autistic people that stemming is self-regulatory. And so, they’re asking us, please don’t try to take stimming away from autistic people, because we’re trying to get the input we need to regulate. So, there’s that possibility. But there’s also, like you said, the natural progression of language learning, that when people are learning this by speaking, we don’t try to control and inhibit so much babbling — or speaking, I think you said — on their own agenda before they speak on someone else’s. So, if our goal is for this child to be able to use their device and communicate, if there’s a chance that that’s what they’re learning to do right now, we don’t really want to be so controlling and compliance-based that we inhibit that.
Kate:
That’s right. And that’s really what happens, is people get so concerned with it that all their good stuff stops, and they try to start to redirect or to inhibit it. And really, what some of what we need is just keep going.
Meg:
Yeah.
Kate:
You know, keep focusing on the good stuff of modelling and connecting.
Meg:
Okay, there’s another person who wrote who every time they give the device to the child in the schools, the child goes into game settings. And it’s really feeling like a struggle for this therapist. Do you have any advice?
Kate:
Yeah. So, I think that, you know, for the last however long it’s been since Guided Access came out on iPads, the advice has been to lock people in to their communication app. And my opinion on that has shifted pretty significantly. And I think, especially when working with non-speaking autistic kids, I think we need to look at everything as communication, one. So, if somebody is consistently going into the game settings, are they telling us that whatever is happening right now is not engaging for them, or doesn’t feel meaningful? Are they trying to tell us something?
I have one AAC user who I work with on a regular basis, and she frequently goes into her settings to highlight for me that something’s not working right, or she wants me to program something. So, there could be a meaning around why they’re going there. And then, if it is that they’d rather be playing games — oh, the other piece that I should say is gestalt language processing. Like, is there something in those games that they’re using communicatively that we haven’t thought about? So, that’s another piece to think about.
But beyond that, if you’ve kind of thought about all those things, and they still want to go into the game settings, well, is there either another AAC system that you can be modelling on and looking at those games together so that that becomes the connecting activity? Or, you know, and that doesn’t have to be a whole ‘nother device. My recommendation is always that all AAC users have both an electronic and a non-electronic version. So, is there a paper-based version of their AAC system that you can be modelling on while you take a look at those game settings together? I think that if that kid keeps going there, there’s something really meaningful about that for them and we want to — we don’t want to get engaged in a power struggle around it, we’d rather want to connect with them. And that can be an opportunity to connect with them.
Meg:
That’s such a good reminder. We hear this a lot on the podcast, to not take people’s interest from them, to not try and restrict it because we do not know what they are actually learning. And our perspective taking is so very limited for our autistic clients. That, like you said, there’s no telling what they’re trying to learn or what they’re trying to communicate with that. And we have to recognize that our understanding of it is pretty limited. And I love how you keep saying ‘Get curious’.
Kate:
Right. And I think, especially when we’re in the therapist or teacher mode, it can be really easy for us to think that our agenda, again, is more important than theirs. And yeah, taking a step back and saying, “Well, what’s happening here? And how am I going to connect with this kid around what’s happening in this moment?” rather than you know, putting on that therapist/teacher hat.
Meg:
Kate, you mentioned gestalt language processors. I got a lot of questions about gestalt language processing and AAC. Let’s start with the basics. Can you briefly explain what gestalt language processing is? We have a whole podcast episode on this for people who want to go back and really dive deep and learn more, but just the quick overview of what it is and how it relates to AAC.
Kate:
Right. So, just broad brushes, and I think that your interview with Alex is really excellent for people who want to dig into it. But there are two typical avenues for language development. One is analytic language processing. Analytic language processing, kids learn individual words, and then learn how to put them together. Gestalt language processing, which is far more common for our autistic learners, they learn chunks of language — think of scripts, echolalia — and overtime, learn how to break down those chunks of language into their individual word parts, and then combine those individual word parts. So, they have a couple stages of language development, before they’re working at the individual word level. And it’s really a powerful thing to understand when you’re working with autistic students, because it allows you to really connect with their language in a different way and think about how they’re using language differently. For our AAC users, it can be a little bit more challenging, particularly in the early stages of natural language acquisition, because all of our AAC systems are designed with analytic language processing in mind. So, thinking about individual words, for the most part.
And so, it’s something that as a field we’re doing a lot of talking about right now, which is really exciting. But what’s important to think about is how do we embed some of their scripts into — or the echolalia — into the AAC system so that they can access the language that’s meaningful for them? For kids that are primarily non-speaking, this can be challenging. And so, we want to look at what kind of media are they engaging in? Are they watching certain videos over and over again? That’s part of the reason for those games, right. If they’re going into something over and over and over again, can we get curious about well, what is that communicating? And if there’s a chunk of language that seems particularly meaningful, making sure that we put that into the device.
And also, help them in that system mitigate that meaning. How do we help them break it down? And then, once we’ve worked on breaking it down, how do we map that to the full language system? That is the robust AAC system. So, I think that Kate Flaxman, who is a SLP that I’ve done some work with, she talks about good AAC is still good AAC when you think about gestalt language processing, and that’s absolutely true. Everybody still needs that robust language system, because everybody’s going there, right? Regardless of if your analytic or if you’re a gestalt language processor, you’re moving towards individual words and combining them in novel ways. But it does, for those early stages, require that we’re really thoughtful and, again, curious about how they’re interacting with language.
Meg:
I want to move on to some of these more technical questions about devices and grid sizes. Someone wrote in with a four-year-old AAC user and they’re just wondering what your favorite AAC apps are. Do you have any go-tos?
Kate:
So, I do. I think that, again, for me, it comes back to do they meet the criteria of robust AAC? And there are lots on the market that meet that criteria. The system that I use most frequently is PODD, Pragmatic Organization Dynamic Display, which lives on a lot of different platforms, both high-tech and paper-based. I have also used Proloquo2Go, The Crescendo; I’ve used WordPower, I use Unity. And I’m trying to think of others off the top of my head. Those are the ones that I probably use the most. And really, what’s important though, is that you’re finding one that your family, you know, if you’re a parent, you’re finding one that your family can use and use naturally, and use conversationally. And that’s really the most important thing.
Meg:
Okay, here’s a question from someone who just started your Authentic AAC course. She acknowledges that this question may be answered along the way, but she didn’t want to miss the chance to ask you. So, she says, I’m going to read her question: “I’m curious about the grid size for young learners ages two to four. Parents are asking me if the grid I’m modelling has too much on it. Should we minimize and hide buttons? Or should we use larger buttons with fewer to access on a grid? I’m supporting the families to model authentically and to use the more robust button grids at this time. But I’m wondering if I’m doing the right thing.”
Kate:
Right. So, it sounds like yes, you’re doing the right thing. I think that there’s no such thing as beginner AAC. So, anything that is marketing itself as beginner AAC doesn’t really understand that long-term vision of AAC. You do need lots and lots of words. That said, we have to make sure that they’re well — that whatever AAC, robust AAC system, we’re using is well matched to the person who’s going to be using it. So, thinking about their motor skills, thinking about their vision skills, thinking about their sensory processing, what is enough but it’s not overwhelming, you know. It’s about kind of finding that sweet spot. And I think that that can change as kids get older, which is why picking a system that has that long-term goal in mind can allow you to — and I should say this varies very, very much based on the system that you’re using. Some systems offer smaller grid arrays, and then larger ones as the learner develops more language. And others are really large arrays from the get go. And that will really depend on the individual and trialing about that with the individual and seeing what works for them.
The one thing that they asked is should we be minimizing or hiding buttons. And I know that something that’s out there as a recommendation for AAC and I — it’s something that I’ve done in the past that I do not do anymore. And the reason for that is that hiding of buttons really is in line with prompting. Often, it’s because we’re targeting a specific word, or a specific phrase, or a handful of words. Again, we don’t know what that individual is going to find to be really important for them. And often, when you give a kid a full robust system with everything available, the things that they pick to talk about are not the things that you are going to pick for them. And so, by hiding, we’re really actually limiting their ability to show us what they’re interested in. So, it’s messy in the beginning. And that’s okay.
The question about is it too much, I think that’s a really common question for parents and professionals. Because we see this full grid, particularly those of us who are literate, and we’re trying to process all of it at one time. For most emergent AAC users, particularly very young AAC users, that’s not necessarily their experience with the array, right. They’re finding the things that are important to them. And it’s kind of seeing the important things. I kind of think about it as signal-to-noise, the things that are important to me, and the things that don’t aren’t important to me. You know, I’m focusing on what’s important to me versus taking everything in. But for those of us who are literate, who are kind of looking at the full array and trying to make sense of it, we’re using it or thinking about it in a different way. And so, yes. Is it overwhelming to us? Absolutely, especially in the beginning. But is it as overwhelming to them? Probably not.
Meg:
Oh, that’s really interesting. Yeah, I appreciate you bringing us back to autonomous communication as our goal. I think we need to be brought back there over and over and over. Because when we’re teaching language to young children through modelling, we don’t just model a few words in order to not overwhelm them with the possibilities. We talk all the time.
Kate:
That’s right. And you think about for kids who are speaking, they are just immersed in this, and they get to pick whatever words that they want to say. And we want to mirror that experience for AAC users who are just beginning to learn language. We want to let them pick whatever is important to them.
Meg:
Yeah, okay, so we’re not hiding and minimizing buttons. But Lauren, who’s an SLP, wants to know if there’s a template or a way that you use to categorize words and get them organized on the device. Do you have a tried-and-true organizational system?
Kate:
So, this really comes back to picking a robust system, a really well designed, robust system. So, I look for robust language systems that have been around for a long time, that have been data tested over and over, and given feedback over many, many years. And if you’re selecting a system like that, then they’ve already — they have a system of organizing the words and categorizing them depending on how the system is designed. So, you don’t have to do that. In fact, if you’re spending a lot of time doing that, that suggests that maybe the system you’ve selected is not as robust or as well designed as you might think. So, there’s a lot of value in personalizing our system to make sure that the words that somebody needs are there for them and that, you know, the gestalts, whatever, but we still want to be maintaining a language organization system so that there’s organization. When we try and do it from the ground up, it tends not to be anywhere near as well-designed as what’s out there. So, pick a robust system and then add to it in a way that works for your AAC user. Don’t try and create on your own.
Meg:
So, we’re talking a lot about robust systems. I got this question from Lyrica, who wants to know if it’s okay to use simple, less robust communication boards with photograph sometimes. Lyrica says, “I know a lot of people recommend only robust systems with symbolic pictures, but I’m having a hard time getting parents and coworkers to buy into that.”
Kate:
Yeah, I hear that a lot. Is there a time when it’s okay to use simple, less robust systems with photographs? Yes, but only if you’re also offering, you know, have that robust language system available to them all the time? You know, I think that there are often conversations where parents or other professionals don’t get it yet. And so, sometimes, you are just looking to how do we get this conversation going. And I had this issue recently with a client. And I think that we want to be using a robust system and then helping other people come on board. So, that might mean using a robust AAC system and also having topic or activity-based displays that are available. They’re not great, right. Activity displays or communication boards that might have things related to that activity, it still needs to have a lot of core vocabulary, pronouns, verbs, that sort of thing. But it may be specific to mealtime, or specific to Play-Doh, or whatever.
We want to make sure that all that language is still in the AAC system, the robust AAC system that the learner has, and that it’s organized in a way that makes sense. That, you know, you’re not giving them lots of things that don’t work well together. But that sometimes can be a way for people to see like, “Oh, they can use this a little bit.” But they have significant drawbacks. That, you know, if you’re using a activity specific display, it lives wherever that activity happens. And that doesn’t mean that the AAC user’s only thinking about those things when they’re in that spot. So, if you’re only doing something like that, you’re really doing a disservice to the AAC user.
Meg:
I think that ties back and really nicely with our conversation about parent buy in, because the person who asked this question isn’t saying, “I don’t think a robust system is right for this child.” They’re saying, “I’m having a hard time getting buy in on it.” So, it sounds like it really is an opportunity for us to advocate for our clients.
Kate:
Right.
Meg:
I want to shift to access barriers. There are a lot of questions about logistics and access. Here’s one from Deborah, who’s an OT. She’s working with zero to three-year-olds, and she hasn’t found any speech therapists in her area who introduced AAC to this age group. So, she took your course, Authentic AAC, she says, “I found it so interesting and helpful. But I still feel at a loss to know what might be the starting step to introduce AAC to a family. It seems so huge and complex in terms of the training that the parents would need. Where do I start without overreaching my professional boundaries? I don’t want to step into that SLP role. Seems the robust systems that I could find online are expensive.” She’s really overwhelmed, right, by trying to introduce AAC as an OT to families for the first time. And there were some other similar questions from therapists wondering, how do we even get a device for kids under three in the U.S.? Can you talk a little bit about the logistics?
Kate:
Sure, it’s a big question. I think, first and foremost, if you’re somebody who’s informed about AAC, having those conversations, having them with the professionals that you’re working with, having them with the family, putting families in contact with people or sources of information that talk about the value of AAC and what is important for having, you know, successful AAC use and why it’s so important. And there’s a lot of autistic people talking about that online that’s available for free and parents can connect with. So, I think having that, even if you’re not the person leading the AAC conversation, bringing those conversations up and wondering about it with other professionals, “Hmm, I might wonder, you know, how we’re —” and I think, with professionals in any way, I find it really helpful to just ask questions like, “Hi, you know, I noticed that you’re, you know, we’re working on speech, but I’m wondering, speech seems hard. How else could —?” you know, asking questions, or, “You know, I noticed we have picture cards, but gee, I don’t know if that’s all they have to say. I wonder how would they tell about something that happened over the weekend,” right. So, asking questions, just to get people’s minds going and thinking about maybe things that haven’t been considered yet.
In terms of the therapists gaining access, it’s a little trickier for OT’s, because I’m not, I’m not in that role. And so, I am not sure. I do know that many SLP’s can contact companies and get therapists licenses for AAC systems. So, if it’s often what I would do, particularly, when I wasn’t working with all AAC users, is I would just bring a system with me and use it to talk about myself and talk about it as a visual for language comprehension and language learning. So, if you are an SLP, I think if you’re an OT who’s really passionate about AAC, I would encourage you to reach out to those companies and let them know that that’s of value to you, too. And you know, many of the device companies look for ASHA certification as a way of kind of vetting that that’s worth sharing. But I think it’s worth OT’s, being loud about that, too, because communication is, you know, essential to all these therapeutic relationships.
In terms of getting access to AAC funding, particularly for kids under the age of three, it will vary a lot depending on what country you’re in, what state you’re in, what medical insurance that somebody has. The two major funding sources I would look toward is the Early Intervention Program, and then medical insurance. And I think that it’s important that as therapists we’re advocating for those AAC systems for the kids that need them. And that that isn’t always popular with funding sources, but it’s a really important piece of advocacy. Then the other piece of it in terms of medical insurances is as you gain knowledge and AAC and experience with writing very detailed funding requests for medical insurance, it certainly is possible to fund AAC systems for younger AAC users. But it does come down to being really skillful in your documentation of their use, and how you report that to the insurance company so that they know that they’re spending their money in a responsible, ethical way.
Meg:
I appreciate you looping in OT’s here. I know often in the school system, OT’s are on the Assistive Technology Team. And we have a real opportunity if we’re here, we’re listening, we care to build our expertise in this approach to AAC that you’re teaching that is focused on autonomy and robust communication systems, rather than the more traditional approach to AAC. So, there’s a clear opportunity in the schools. I would say three or four of the questions I got were, “Wait, what’s the role for OT’s?” Well, functional communication embedded in daily occupations is in our practice framework. And frankly, emergent communicators need as many people advocating for them as they can find. And I think a lot of OT’s are, like, “I’m sick of just waiting for this neurodiversity-affirming, AAC-trained SLP to appear in rural Kentucky,” or wherever you are, right. So, there’s an opportunity for them to step into that role, acknowledging that logistics and insurance in that can be tricky. But in terms of our practice framework and our skill set, like yeah, we can step in too.
Kate:
Absolutely.
Meg:
I know you and I had this conversation a lot when you were developing your course was like, “Is it appropriate to register this for AOTA, the OT organization in the US, for CEU’s?” And we said, “Absolutely.” And you know, what AOTA also said, “Absolutely,” right. They registered the course. So, they’re saying like, yes, this is in our scope of practice, too.
Kate:
Yeah, absolutely.
Meg:
Definitely, it’s more in yours. We need everybody though.
Kate:
We do. We do need everybody advocating. And I think that OT’s are critical for making sure that an AAC system is well-selected, and that it’s accessible for kids, and that they’re able to use it, as you say, in their activities of daily life and to connect with other people. And I think that that is a place for advocacy to start. And so, if it’s not in place, again, asking those questions and asking, “Well, if we don’t get something in place, how is this going to ever happen for this kid,” or if we don’t get this in place, we think about speaking kids who have access to their language system from day one. And so, how — what are we waiting for? And so, I think sometimes, really good questions are very powerful advocacy.
Meg:
I love that. And the other scenario that comes up for OT’s and educators and all these other professionals who aren’t SLP’s, is a kid shows up to your session or to your class with their device that they’re still learning how to use that’s tucked in their backpack, that somebody may or may not have ever taught the parent or the teacher how to model or what in the world to do. And we have such an opportunity then to incorporate the device using all the strategies that you’ve talked about.
Kate:
That’s right, or the occasion for they don’t show up with their device. If they know that that kid has a device, and they show up without it, asking the questions of well, how are they going to communicate with me if their device is not here, right. And that in and of itself is advocacy for whoever they’re with that moment in time to stop and think. And as you’re using, if there is something in place, but you’re noticing it’s not robust, then that, you know, using it in your sessions, you can highlight the barriers or the problems with that. So, you know, some of it is being on top of what’s happening, and responsive, and providing feedback.
Meg:
Yeah. Kate, we’ve talked about so much today. If there’s one big takeaway that therapists listening get from our conversation, what do you hope that is?
Kate:
Well, you know, I’m not particularly good with one short takeaway, but I think that autonomous communication, that that’s really the long-term goal. Being able to say what I want, when I want, to whomever I want, however I want. And making sure that that happens for the AAC users that you’re working with or who are in your family, that that’s the piece that we want to be focusing on.
Meg:
Okay. So, you have available a free masterclass on teaching AAC, you have a continuing education training on AAC at learnplaythrive.com/aac. They can find the free masterclass and your course there. You’re speaking in the upcoming OT and SLP neurodiversity Summits at learnplaythrive.com/summit. What else do you have going on, Kate? What are you working on, and where can we find you online?
Kate:
Well, you can find me on Facebook and Instagram at @TheAACCoach. I’ve done recently, which might be of interest to listeners, a presentation on AAC and gestalt language processing that’s available for free online through AAC in the Cloud with Kate Flaxman and Laura Hayes. So, that’s worth checking out if you’re supporting AAC learners who are gestalt language processors. But I’m always working on something else and the best place to find that is really Facebook and Instagram.
Meg:
I will link to all that in the show notes. Thank you so much, Kate.
Kate:
Thanks, Meg.
[Ending music]
Thanks for listening to the Two Sides of the Spectrum podcast. Visit learnplaythrive.com/podcast for show notes, a transcript of the episode, and more. And if you learned something today, please share the episode with a friend or post it on your social media pages. Join me next time, where we will keep diving deep into autism.
