Your quick Monday reminder that language therapy (AND AAC therapy) shouldn't *ONLY* focus on requesting.
While many late-talkers or AAC users are motivated by asking for something, we need to ensure we are modelling and teaching all the reasons we communicate! If we don't, we may be limiting our children's scope of communication and the connections they can build with others. Just think about how boring it would be if you could only ask for something, and not comment, tease, protest, narrate, or exclaim! Let's make sure we're doing the same for our clients today. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
Kicking off AAC Awareness month with some differences between high tech and low tech AAC!
While it is always a good idea to have low tech available as a backup, remember there is NO prerequisite for high tech (and robust!) AAC systems, meaning kids shouldn't start with PECs (which only focuses on requesting) or have to 'prove' that they are ready for a more complex communication system. âJust like speaking children hear and learn from a complex adult language system, we need to provide the same models and access to children who are non- or minimally- speaking through THEIR modality. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
I think this clip demonstrates a few things we really strive for at HAEPI SLP: following the child's lead, embracing all play, and modelling without expectation both on AAC and verbal phrases for gestalt language processors.
The @gestaltgoodness cards shown were also a great addition - my kiddo loved listening to the child model via the QR code. Usually I stay completely away from flash cards with GLPs, but these ones are designed for the communication partners (not necessarily the child), so WE can remember to model naturally in play, and use easily mitigable phrases across contexts. I also loved introducing the cards to school staff to further explain how we can model (!!!), because it takes a while to become natural for anyone new to GLP! *I received these First Phrases cards as a gift, with no expectation to review. Just love them that much!* by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
Qualification criteria is ableist, not evidence-based, and restricts access to the human right of communication for kids who need it the most.
Could you imagine what it would be like to tell a kindergarten-aged child, "looks like you can't hold a pencil, so that means you'll never be able to write. We may as well never let you have a pencil since you clearly can't use it." Do we all agree that's ridiculous? Yet, that's essentially what we are doing when we deny a child access to AAC systems because they aren't matching a picture or selecting an icon independently during the time of the AAC assessment. My hope for the future is that we can eliminate qualification criteria for funded AAC systems, so that we can get AAC into the hands of all children who need it. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
To all Speech-Language Professionals: if you've ever wondered how you were going to model AAC to a child with a device during a virtual session, I hear you!
We know AAC is best modelled in natural environments and during play, and while most SLPs have figured out ways to do something resembling play-based therapy over Zoom, AAC can feel like a whole other ballgame. So, I wanted to show you one of my favourite resources to use: music videos and songs! This is completely free using YouTube. I'll sometimes do a Boom Deck first or something that teaches the target words (e.g., we learned "go" and "stop" in a Boom Deck game) and then follow that up with "singing" along to a song. I have an iPad Pro that I like to use for modelling as it's quite a bit bigger and therefore easier to see on Zoom while the video is playing. I also like to use this with "Head, Shoulders, Knees, and Toes" and "5 Little Ducks." Just because our kids may live in hard to reach places (like in remote Northern communities), this doesn't mean we can't still do play-based AAC virtually... we just need to be creative! by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
"I want" is a necessary phrase to know, but it's often drilled into our AAC users in a way that results in them learning that AAC is only for requesting and not for anything else, like negating or protesting.
In this post, I wanted to show how we can and should work on requesting while including protesting. I also wanted to illustrate that this can be worked on naturally, even with an AAC user virtually over Zoom! We played a Boom Cards game where we opened presents and decided if he wanted what was inside, or didn't want it. I also modelled other words throughout the game. I use an iPad Pro whenever I am modelling over Zoom because of its larger size (remember, his screen would be split to show me and the iPad on one half, and the game on the other). The takeaway: "I want" is still a useful and functional phrase, but it shouldn't be your sole focus. It should be introduced alongside a way to protest, too!
Check out a glimpse of Kaelyn's Music-Directed Speech Therapy session with a Stage 1 GLP and new AAC user!
Music is highly motivating for many gestalt language processors due to musical features like intonation and pitch. You'll notice how this child actually requested help when he gestured for Kaelyn to touch his device, which demonstrates how quickly he has learned the purpose of an AAC device for communication. Furthermore, watch how Kaelyn honours every mode of communication, whether it be speech, gestures, or AAC. This child also receives GLP-focused intervention with an SLP to expand his repertoire of Stage 1 gestalts. Lastly, we have the school to thank for letting us work in the sensory room, where this child can receive external sensory input to aid in regulation. We love a full team approach! by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
We are thrilled to have been selected as 1 of 13 recipients (out of 274 amazing applicants) of the 2023 Dow Indigenous Economy Fund. With this grant, we received $5000 and membership as a Certified Canadian Aboriginal Business.
We have used these funds to purchase 5 new iPads for our growing staff (of course they are pink!), which will be used in therapy sessions with our AAC users. We are so honoured to be able to service our AAC users in Northwestern Ontario better because of this grant.
I wouldn't be a true Canadian SLP without a session at Tim's, eh?
Community-based sessions (at a park, a coffee shop, the pool, mini putt, etc.) are SO valuable because they allow us to work on goals in real-life settings. The truth is that working on these goals wouldn't be nearly as effective in a clinic or in-home setting. That's why at HAEPI SLP, we love our model of home-, school-, or community-based sessions! For this AAC session, we had a number of goals:
If you could choose anywhere, where would you like to have an SLP session? (We may even be able to accommodate!) by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
It can be hard to get your child's team on board to using high tech AAC if there are concerns about the child's "accuracy" or ability to isolate individual buttons.
As SLPs, we know that mis-hits are completely normal and are part of the process of learning the AAC device. However, I understand that sometimes it can impede on getting that much needed buy-in from others to use the device. Rather than limiting the number of buttons on the screen, try a keyguard instead! A keyguard is a piece of plastic that is custom-made to fit your device and program. It sits nicely on top of the screen and under the case, and allows separation between each of the buttons. Most people would benefit from a keyguard -- adult AAC users have spoken out about how they are helpful for using the device without looking. In Ontario, your speech-language pathologist can recommend a keyguard as part of your required AAC equipment! Have you tried a keyguard yet? by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
Motor planning is the "muscle memory" that we all have when doing tasks, such as typing, driving, or even knowing where to reach your phone in the middle of the night.
For children who use AAC programs (such as LAMP Words for Life that you see pictured here), it is so important (I can't stress this enough!) to keep that motor plan consistent from the start. This means not limiting the screen to only a few buttons in the grid. The child's vocabulary will inevitably grow, and it is going to be so frustrating for them to have to relearn the motor plan for each word again and again. Usually, we recommend starting with the max number of words available (or at the very least, the maximum grid size) and hide buttons that aren't needed right away. You'll also notice that I try not to complete a partial motor plan. I may guide with a point or help him figure out where to go, but if I immediately opened to the "vegetables" page for him, he would not learn the plan to get there. Similarly, when I model words, I try to model the entire plan for him. A lot of my clients use LAMP Words for Life due the motor planning aspect, and that's why I am proficient at using it upside down (since I have now learned that plan too!). We add gestalts on an individual basis, but I do see the huge advantage of this system for educating teachers, paras, support staff, etc. as the system is standardized while still allowing for customization! by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
A common misconception is that AAC is not needed or useful for children who can access verbal speech.
While this may be true for some kids, AAC in verbal children can be used to support verbal speech, especially during times of dysregulation, illness, or stress. I had a client like this I saw for consult recently -- she used to use an AAC device, but it fell by the wayside once she gained more verbal speech. However, in moments of dysregulation, she began to experience self-injurious behaviour, notably head-banging. She was frustrated because she had no way of communicating in moments like these. Once we introduced AAC again (even though it was years later), she was immediately interested. We were able to program some of her new visual supports from her behaviour team into the program (i.e., "I need a pillow," "it's too loud," etc.) and this helped those behaviours immensely. Just because our children may seem like they no longer need AAC (or funding services don't want to cover it because they use verbal speech), we need to advocate for our children to have a reliable method of communication available to them at all times. Do you struggle getting AAC support when a child also uses verbal speech? by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
Having a robust AAC system can feel overwhelming at first, and as SLPs we completely understand that there will be a learning curve! However, the pros of having a robust AAC system (which may seem complicated at first) far outweigh the cons.
But first... what is a robust AAC system? A robust AAC system will allow an AAC learner to be able to completely express themselves with their system to the same extent as a verbal communicator. While it may be difficult to imagine our 2-3 year old using sentences, we need to start with the end in mind. If we put our kids in a box from the beginning, it will be a lot harder for them to have the opportunities to become independent communicators. So what are the components of a robust AAC system?
One of the best ways to ensure that a system will grow with a child is to start with the largest grid size possible, so motor planning stays consistent as the child learns more vocabulary. Encourage exploration of the device -- that is one of the ways the child will learn it! Many of our Autistic kids are amazing with navigating televisions, iPhones, and YouTube... and this is another great indication that yes, they can "handle" a robust language system! by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
One of the biggest reasons we don't see progress with AAC is because the device isn't being used enough across all environments. A communication device (often an iPad) isn't just something that should be pulled out during speech sessions and then tucked away, it is the child's *voice* and needs to be accessible across all situations.
Wouldn't it be silly if we only gave a child who needed glasses their glasses when they were at the optometrist? The same thing goes for AAC! Some kids might use a combination of verbal speech and a speech-generating AAC system, but it is up to THEM to decide when they need which system... not us. Kids also learn AAC the same way verbal language is acquired -- by having consistent input by different users across all environments. We need to model the use of the device, and immerse the child in its language, for them to use it independently. So please, take it out at recess, bring it to gym, explore with it at lunch! These are often moments in the day that are meaningful to our children, and we can model so much valuable language input during these activities. Plus, there are many great iPad cases out there can protect the device across all environments. I personally think the trade off is more than worth it! I'll end with a quote that always resonates with me on this topic: "The average 18 month old child has been exposed to 4380 hours of oral language at a rate of 8 hours/day from birth. A child who uses a communication system and receives speech/language therapy 2 times a week of 20-30 minute sessions will reach the same amount of language exposure after 84 years." --Jane Korsten So let's ask ourselves... is it really the kids who aren't progressing, or are WE responsible for not providing the input and therefore limiting their success? by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
As SLPs, caregivers and providers, we want children to feel comfortable in their environment and be fully able to express themselves across many different communicative functions -- including *bodily awareness and integrity*. This means that they first need to learn how to identify and refer to their own body parts, and this of course includes AAC users!
Many kids who are minimally verbal have a hard time identifying when (or where) they experience pain. By teaching them to find the words for body parts using AAC, it can help them express themselves during crucial moments when they are hurt, sick, uncomfortable, etc. All children deserve to have the ability to advocate for themselves and to express bodily autonomy. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP Let me preface this post by saying that *high-tech AAC is worth any and all technical difficulties that may come with it*… but as with all kinds of technology, stuff happens and we should always be prepared. So, here are my top tips for getting started with AAC: - Invest in a good screen protector and case. The AAC device is going to go along with the child in most (if not all) of their environments, so it's a good idea to plan for durability and provide additional support based on however the child is going to carry it. - Enable guided access. This 'locks' the child into the AAC app and teaches them that the device is meant to *only be used for communication.* Games and videos can still be accessible to them, just on a separate device! - Back up your vocabulary! All AAC programs will have methods for backing up your data (e.g., Dropbox, email, airdrop) and it's important to do that regularly! *When* (not if!) you run into tech troubles, you don’t want to lose all customizations you've made within the program! by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP PSA: we can customize and modify language systems (such as high-tech AAC, as shown above) to support bilingual language learners. This child has an interest in learning animal names in Ojibway, and we can use AAC to support his expressive vocabulary in this language. While there are currently no AAC systems that have Indigenous languages programmed into them, programs like LAMP (Language Acquisition by Motor Planning) are easily customizable and allow for this addition. This child's motor plan is still kept consistent while navigating between the two languages. It’s an honour to support this child’s journey with his language! by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
This will likely be a *controversial* post, but I am not trained in (and will not be trained in) using PECS (the Picture Exchange Communication System) for my AAC users for a number of reasons.
PECS focuses heavily (!!!) on requesting, and this can often result in communication only being used as a source of extrinsic motivation (i.e., to get something). It doesnât take into account all the other reasons to communicate (such as greet, negate, argue, comment, suggest, direct, etc) in order to build intrinsic motivation to communicate. Communication and connecting should be the reward! Teaching PECS often involves hand-over-hand prompting of the child, violating their bodily autonomy. This is not a necessary part of learning picture communication. Modelling for the student on their device with no expectation for the child to copy is an evidence-based way to teach picture/symbol communication, which allows for the child to regain this autonomy and express what they WANT to express. Furthermore, PECS doesn't allow a motor plan to develop as the symbols are always moving, which is an important part of communicating with a symbol-based system. Since PECS focuses on single words to start, it also is not the most appropriate for our gestalt language processors (and up to 85% of Autistic children are GLP!). We don't want our AAC to further contribute to our children being 'stuck' in their single-word or multi-word scripts. And lastly, PECS is not a robust language system that can grow with the child. Our children can learn much more competently if their communication systems are robust from the start, and not being 'upgraded' every few years. We need to presume competence right from the start. NOTE: This is in reference to the Picture Exchange Communication System and not all picture-based communication, such as low tech AAC and core boards. âWhile PECS may have a been a gold standard in the past, and many well-meaning therapists have endorsed its use, it's important to listen to our Autistic community who have talked about the negative aspects of the system. Once we know better, we can do better. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
PSA: There's no right or wrong or better or worse way to communicate.
As an SLP, one of my commitments is to honour *total communication* from the child I'm working with, no matter what that may look or sound like. Just as speaking individuals are not limited to just spoken word, 'total communication' includes things like gestures, facial expressions, body language, texting, writing, vocalizations, etc., and we should be taking it all into account. In other words, honouring total communications just means that however the child communicates is valid, and we roll with it! In this reel, I honour whatever way the child prefers to communicate with AAC, whether it's using symbols or the keyboard. Any method with which they can convey their ideas, opinions, requests, statements and desires is encouraged. Communication is communication. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
In my experience, the BIGGEST predictor of AAC success is if the child experiences JOY from communicating with the device.
Too often, AAC is treated like "work" for the learner, and they are expected to use it in a certain way (e.g., they have to say how they feel or what their name is). We know that is approach of adding expectations doesn't work for late-talkers (and why it is common practice in the SLP world to discourage parents from insisting that their child "say X" and "say Y"). The exact same approach is needed with our AAC learners. We need to create situations that are intrinsically motivating for our learners, and show them that communication does lead to shared joy! For a learner like this, I have modelled bubbles many times, and if she is struggling to find it, I would not insist that she needs to. I'd show her where it is again, and continue to model other words. However, she is showing us all her intent and ability to communicate about something that brings her so much joy. Video shared with consent. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
Requesting is a very common strategy and goal used in speech therapy, but there's a lot more to language than just that!
I believe that kids of all abilities should be exposed to and taught how to use all sorts of different functions of communication, from telling stories and answering questions to saying no and arguing! This of course includes AAC users. Having access to colourful language simply means that a variety of kinds of language should be modelled for them throughout the day. Requests are often focused on because they result in a reward, however, communication is its own reward, and it's our job to show them that. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
All AAC learners (regardless of skill level) need to see what it looks like to communicate using their AAC system in real conversations. Just as we don't expect any child to learn to talk without seeing or hearing the adults around them talking and communicating, *modelling* the use of the AAC device is just as crucial.
Modelling is a fancy term used by SLPs that simply means showing the child how to use the device without expecting or forcing them to copy. The best way to start doing this is by finding a word or two on their AAC system or device for each sentence you want to say, and pressing the symbols as you say the word. Here are some strategies for effective modelling:
While it's important to include fringe words (words with very specific meanings) so children can better describe their world, the best approach when starting AAC is to keep the focus on core words. Then, incorporate personal fringe words as needed to help kids talk about what's important to them. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP
If you couldn't already tell, I love what I do.
Children learn best through play, so the more fun we get to have during our sessions, the more motivated they are to participate and learn. I strive for communication itself to be intrinsically motivating for my clients! SLP is more than just diagnosing and correcting difficulties with speech. By bridging the gap between verbal and (seemingly) non-verbal, SLP sessions can provide children with a safe and comfortable environment to fully express themselves and to grow as little communicative humans. We as SLPs can then inspire and motivate ALL children to succeed -- neurodivergent and neurotypical alike. That is why I'm an SLP. by Halle Demchuk, SLPPaediatric SLP | GLP-Trained Clinician | Owner of HAEPI SLP To me, individuals having access to and appropriate training with AAC (when needed) is a matter of equality and human rights. This quote has always stuck with me. 84 years versus just 1.5. If we don’t encourage the use of, give access to, and teach AAC to children so that it can be used outside of their SLP sessions, then it will take YEARS (84, to be exact!) for them to gain equivalent exposure to language (in their learning style) as children who are verbal do by age 1.5. If you ask me, that is a massive discrepancy. AAC can only be as effective as we make it—which is why continual and immersive modelling is so important. Modelling is a term used by SLPs that simply means showing the child how to use the device without expecting or forcing them to copy. The best way to do this is by finding a word or two on their AAC system or device for each sentence you want to say and pressing the symbols as you say the word. In order for AAC to truly assist children in communicating to their full potential, then, they must see their AAC system being used—in real situations, for real reasons, by the people around them. In other words, we must model, interact with, and use AAC as often as we can *outside* of SLP sessions, as well. This is how we bridge the gap between 84, and 1.5. — Halle Demchuk, SLPPaediatric SLP | GLP Trained Clinician | Owner of HAEPI SLP |
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