When making decisions related to AAC intervention, we must consider the AAC user’s abilities related to the stages of early communication development. These four stages are based on the stages of typical, verbal language development.
The four stages include (Beukelman & Light, 2020):
Beginning communicators who are preintentional
Those who are intentional but presymbolic
Those who are at the early stages of symbolic development using single words
Those who have many symbols and are beginning to combine them
Beginning communicators who are preintentional:
According to Beukelman & Light (2020), at this stage goals for intervention include teaching an AAC user how to develop intentional communication and identifying how the user is communicating acceptance and rejection.
How do we teach an AAC user intentionality? There's many different ways we can do that! Establishing routines that incorporate motivating activities, use the pause and wait strategy, being careful to watch for any intentional communication, and responding immediately to that communication signal (Beukelman & Light, 2020).
Establishing a routine can be as simple as pat-a-cake or peek-a-boo or you can choose an activity of daily living such as getting dressed in the morning or eating a meal. Identify a motivating activity and one that happens naturally in the individual's every day routine.
From there, we can use the pause and wait strategy. How do we do that? We provide the individual with the opportunity to use a signal to communicate by giving them plenty of time to respond.
This is when we are looking to identity any intentional communication signal from the communicator. That may be with a gaze towards an object, a gesture, or a vocalization.
Finally, we want to respond immediately to any communication signal we observe. That provides the individual with the acknowledgment that their communication signal was recognized and responded to. This positively reinforces communication!
Those who are intentional but presymbolic:
Beukelman & Light (2020) recommend goals for this stage to target teaching an individual to use consistent signals to express acceptance/rejection, teach them to communicate choices, and teach them to take turns in social interactions.
In this stage, we are focused on teaching the communicator how to communicate choices. How do we do that? We first must identify which moments are motivating for the individual to communicate choices, then determine how to represent those choices, identify how to present the choices, and then respond with natural consequences (Beukelman & Light, 2020).
When we are deciding which opportunities for the communicator to make choices, it's important to make sure we are identifying motivating moments. This may be food, drink, music, games, or people.
From here, we need to determine how to represent these choices. Most individuals in this stage are not yet able to use symbols, thus the need concrete, tangible objects that represent their choices. What is an example of this? Presenting a yogurt cup and a chocolate pudding cup as food choices.
Next, we have to consider how we are presenting the choices in terms of the amount of choices. Presenting two items to start, then moving to a larger array is recommended (Beukelman & Light, 2020).
Finally, once the individual has communicated their choice (rather that be by gesture, pointing, eye gaze, etc.), the communication partner should respond by labeling the choice and providing the selected item.
Remember, this stage doesn't just happen in one or two opportunities! This stage requires repeated opportunities across environments and with many different communication partners for individual to understand the association between what they chose and the outcome of their choice.
Those who are at the early stages of symbolic development using single words:
For individuals in this stage, goals should focus on developing a robust vocabulary for a variety of communicative functions, teaching initiation of requests for objects and activities, and teaching how to ask/answer simple questions (Beukelman & Light, 2020).
Developing a robust vocabulary may be different from one AAC user to another. It's important to consider both core and fringe vocabulary for the user. It's important to not eliminate vocabulary based on the categorization of words as "core" or "fringe", but to obtain a balance between the two that aligns with natural vocabulary and language development (Cargill & Street, 2016).
Those who have many symbols and are beginning to combine them:
In this final stage, Beukelman & Light (2020) recommend that therapy continues to target expanding the AAC user's vocabulary across a wide range of semantic categories for many different communicative functions as well as targeting the AAC user's ability to combine symbols to communicate.
This may include combining symbols for commenting about an activity or task, making specific requests, answering more complex questions, and providing detailed responses to questions.
Want to learn more about how clinical decisions are made related to stages of language development? Check out this case study: Personalized Early AAC Intervention to Build Language and Literacy Skills: A Case Study of a 3-Year-Old with Complex Communication Needs.
References:
Beukelman, D. R., & Light, J. C. (2020). Augmentative and alternative communication: Supporting children and adults with complex communication needs. Brookes.
Cargill, L. P., & Street, M. (2016). Immediate and long-term AAC intervention planning. Talk presented at the Communication Matters conference, Leeds, United Kingdom.
Light, J., Barwise, A., Gardner, A. M., & Flynn, M. (2021). Personalized early AAC intervention to build language and literacy skills: A case study of a 3-year-old with complex communication needs. Topics in Language Disorders, 41(3), 209-231. http://doi.org/10.1097/TLD.0000000000000254
Katie Threlkeld, M.S., CCC-SLP is a licensed, ASHA-certified speech-language pathologist and the Educational Program Developer at Forbes AAC. She has over eight years of experience in AT and AAC assessment and treatment with both the pediatric and adult populations. Katie has presented at the state and national level on AAC topics and she has University teaching experience at the undergraduate and graduate level.
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