Communication is a two-way street. This is no different for people who communicate using AAC than for anyone else. We can’t simply hand a user a communication system with a robust vocabulary and expect them to use it out of the box. If we want someone to become a successful communicator, both they and their communication partners must put in time and effort developing communication skills.
For family members, therapists, and teachers supporting early AAC users in learning communication, good teaching skills are a must have. In this post, we’ll take another look at the results of last year’s International AAC Awareness Month Survey to see what it tells us about the teaching strategies that family members and professionals use to support people who use AAC.
We asked the respondents to report how often (rarely/never, sometimes, or frequently) they use eight different strategies when interacting with their family member or working with clients:
- Modeling: demonstrating use of the AAC system for communication
- Specific receptive drill: asking the user where to find something on their system (e.g. "Find ‘cookie.’”)
- Direct instruction: specific and explicit teaching of individual words
- Timing-based strategies such as giving more time for the user to respond and expectant pauses
- Prompting (visual, verbal, or physical)
- Sabotage: setting up situations that require the user to communicate in order to participate in an activity or receive an item (e.g. placing items out of reach)
- Making comments rather than always asking the user to answer questions
- Providing regular and reliable communication opportunities within functional day-to-day activities
Ideally, we would hope to see high use of strategies that model and promote use of the AAC system in the context of everyday activities and take advantage of natural communication opportunities. If we want the user to become a skilled communicator, we need to make sure they have plenty of opportunities to see and practice communicating the things that we hope they will one day be able to say more independently. In contrast, we would hope to see lower use of strategies that put the user in a more passive role, where the teacher instructs him or her on what to say. In terms of the specific strategies, this means higher use of modeling, timing-based strategies, and the last two communication partner strategies and lower use of specific receptive drill and prompting.
Looking at the results, the good news is that at least 90% of family members and professionals report using modeling and timing-based strategies, commenting rather than always asking questions, and providing regular and reliable communication opportunities in the context of daily activities. Specific receptive drill, in contrast, is the only strategy that less than 50% of both groups reported using. Of those who did report using this method, most reported they did so “sometimes” rather than “frequently.” Direct instruction was the second least-commonly used strategy, with around three-quarters of both groups reporting using it. A majority of both groups reported using prompting. This likely reflects an area where improvement is needed, but interpretation is also limited by the wide range of specific actions that the term “prompting” can refer to.
For each strategy, the proportion of families reporting using it was slightly lower than for professionals. Families were also more likely to report using a strategy “sometimes,” rather than “frequently.” This could be because most professionals have spent more time practicing these strategies, and have more confidence with using them. Another possibility is that professionals spend a limited amount of time with clients, and spend almost all of this time doing teaching or therapy. Of course, family members who spend most of the day with the person who uses AAC aren’t spending all of their time practicing AAC intervention.
Results by diagnosis
We also analyzed the results of the Families survey after splitting them into subgroups based on the user’s primary diagnosis. Here, the three groups that were large enough to analyze were Angelman Syndrome (n = 48), autism spectrum disorder (n = 54), and cerebral palsy (n = 38). To simplify the analysis, users with diagnoses of both autism and Angelman Syndrome were assigned to the Angelman Syndrome category. Users who had both an autism diagnosis and a diagnosis of cerebral palsy, Down syndrome, Rett syndrome, or another specific syndrome were excluded, as were users diagnosed with both cerebral palsy and another specific syndrome.
We found that compared to family members of AAC users with a primary diagnosis of autism or cerebral palsy, the Angelman families were less likely to report using specific receptive drills, prompting and direct instruction and more likely to report frequently making comments rather than always asking the user questions. Family of AAC users with an Angelman or cerebral palsy diagnosis were both more likely than families of AAC users with a primary autism diagnosis to report using timing-based strategies. Another interesting result is that families where the AAC user had a cerebral palsy diagnosis were more likely to report either “never” or “frequently” and much less likely to report “sometimes” using prompting.
The Angelman Syndrome Foundation's excellent Communication Training Series likely deserves much of the credit for these results. This webinar series provides practical tips for implementing a robust AAC system and teaching specific core words in the context of everyday life. Two special episodes of the webinar focus on the advantages of non-directive approaches. While families of AAC users with any diagnosis would benefit from the suggestions in this webinar, parents of children and adults with Angelman syndrome most likely make up the majority of its audience. Our new AssistiveWare Core Word Classroom is another resource designed to meet this need for specific ideas for teaching and modeling core words in everyday activities.
One other possible contributing factor is that the AAC users with a primary autism diagnosis may receive AAC instruction based on ABA principles. This would be expected to increase the frequency of specific receptive drills, direct teaching and prompting for this group. However, this would not explain why the cerebral palsy and autism groups have generally similar results.
Of course, we do know that what people say they do on a survey doesn't always exactly match what they do in real life. People may say they do something more frequently than they actually do, because they know that they should be doing it. A parent or teacher may know they should model the AAC system, but struggle to effectively do so when interacting with their child or client. This may also explain some of the difference in how often family members and professionals report “frequently” using specific strategies. While the same effect would apply to both surveys, it would likely be stronger for professionals, since use of effective teaching strategies directly reflects on job performance. Without being able to observe any of the respondents, we cannot be completely certain how often they are using any particular strategy. We also know that our sample is biased toward families and professionals who actively seek out online resources related to AAC.
Fortunately, the results do indicate that at the very least, most respondents have a relatively strong understanding of which strategies they should be using more often. In general, respondents also understand which strategies they should be using less often. The promising results from the Angelman families suggest that one way to bridge the likely gap between theoretical knowledge and actual practice is to develop materials that provide specific examples of ways to implement effective teaching strategies with targeted words.