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SEP 17 2018
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Tip of the Month - September 2018: Supporting Adult AAC Users

Posted by: Shauna McCabe in Tip of the Month

Posted in Tip of the Month

Why are Support Workers Critical in an AAC User’s Journey?

People using AAC should have the opportunity to say whatever they need to say, to whomever they want to say it to, whenever they want. However they may need support to get there, and this support comes from the people that interact with them the most. Often support workers are key communication partners and key facilitators, for individuals to learn and to use their AAC tools and strategies. Support workers therefore play a very important part in an AAC user’s journey in becoming a successful communicator.

This tip of the month focuses on these communication partners and things that they might experience working with an individual who has difficulties communicating. It also covers tips and strategies that may be useful in supporting someone who uses AAC.

Communication Break Downs

What is a Communication Breakdown?

A communication breakdown occurs when there is a misunderstanding between two conversational partners. This can happen for two reasons; a lack of understanding by the communication partner, or an inability for a person to communicate clearly what they want to say. This can be frustrating for both people involved.

What do communication breakdowns look like? :

Communication breakdowns can look different depending on why the communication breakdown has happened. For some individuals who are not able to effectively communicate through speech alone, communication breakdowns may happen for one or more of the following reasons:

- when the person is communicating about something out of context

- communicating with a less familiar person 

- having a limited way of communicating (e.g. through pointing and gestures, speech that is hard to understand) 

- their method of communication is not always consistent (i.e. could be interpreted by different people in different ways)

- the access method is not understood by the communication partner (e.g. how eye pointing, or partner assisted scanning works)

- the communication partner does not stop and provide the time for the person to communicate 

In addition, if the AAC user does not understand what has been said to them, they may attempt to give a response or communicate something that doesn’t quite fit with what was asked. This is because they likely know that a response is required, but are unsure what to respond. For instance nodding their head when they haven’t quite understood the question. This can also present as someone withdrawing from a conversation as they are unable to follow it.

Conversely, if the communication partner pretends to understand when they do not, this can also result in a communication breakdown.

How Can we Help Repair these Breakdowns?

Supporting adults with communication difficulties to use augmentative and alternative ways to communicate (AAC) may help repair some of these breakdowns when they happen. Having access to AAC provides the person with a consistent and reliable method of getting their message across and can include symbols/photos, low tech communication boards, PODD books, alphabet boards, yes/no cards  and speech generating devices. Try different problem solving strategies if you do not understand what the person is trying to communicate, such as asking the person to repeat their message, ask if they have another way to say the same thing (e.g. on their communication system), or ask if they can give you a clue or a hint. Acknowledge when you don’t understand, which in turn may assist the person to acknowledge when they do not understand. Pictures or symbols, both in the AAC system and in the environment, can also be a great way to support someone’s understanding of what is being said to them, as well as a way of them expressing themselves. Most importantly the AAC tools need to be readily available all the time, and not left in a bag or cupboard.

Useful strategies when working with Adults Using AAC 

There are lots of things a communication partner can do to support someone who uses, or is learning to use a communication system.  Some tips include:

Create Opportunities for Use: 

Use meaningful activities and interactions that are already happening in your communication setting.  Ways to do this include:

- having the communication system available at all times

- asking open ended questions

- communicating about what they want to talk about

- thinking about what is going on during that person’s day and how to incorporate AAC.

Use Their Way of Communicating/ Model, Model, Model:

Modelling is critical for the individual you are supporting to learn to use their system. By using the AAC tool yourself you are supporting the AAC user to learn their system better and where the vocabulary that they want to access is located. Don’t be afraid of making mistakes or being slow, just give it a go. Start by picking 10-15 core words that you could model in a number of different activities and build from there. By using their way of communicating it also gives you an idea on how long it can take to get what you want to say out. 

Assume Competence:

It is important to assume that the person is able to learn and to use their systems. However the level of support to do so may look different from person to person and what stage they are at within their AAC journey.

Look at me:

Ask the person whether they prefer you to look at them or their system whilst they are putting their message together. By asking the person, you can get a gauge on what they feel comfortable with.

Talk to Me Like You Would Anyone Else with Clear, Simplified Language:

For adults who may be experiencing cognitive changes, or for individuals who have an intellectual disability, cutting out the waffle and getting to the point of what you want to say is important as it reduces the amount of information the person has to process.

Be Comfortable in Silence:

Typically an individual using AAC may need extra time to process what has been said and /or time to formulate what they want to say using their system. Being ok with longer silences to allow the AAC user time is really important as a communication partner, and shows them that they are an active member in the conversation. Adults who use AAC often report feeling as though they are being left behind in the conversation, or by the time they have constructed what they want to say, the conversation has already moved on. By being aware that it may take them a little bit longer to get their message together, we are facilitating them to participate to their full potential.

Sometimes communication partners will be able to predict what the person is going to say, once they have started to construct the message. Always check with the person before predicting, as to whether or not they are comfortable with you predicting in order to speed up the conversation exchange. 

Different Tools for Different Times:

An AAC system may be only one of many tools that someone with complex communication needs may be using to get their message across. Also some tools may work better in different situations and environments than others. Acknowledging and accepting all ways that an individual may be communicating is important as a valid way of getting their message across. This may be particularly important for client’s who are new on their AAC journey or may be used to communicating in a different way. Clients with acquired or degenerative conditions may still be grieving their diagnosis and how it has impacted their ability to communicate.

Personalise Vocabulary:

Having access to vocabulary that is meaningful and useful for the individual and their specific needs is critical for a communication device to be functional. Making sure that those words are within their AAC system is really important as they can’t use them if they are not there.

References:

BEUKELMAN, D. R. & MIRENDA, P. 2005. Augmentative and alternative communication: Supporting children and adults with complex communication needs, Baltimore, Paul H. Brookes Publishing Co.

Supporting People who use AAC Strategies: in the Home, School & Community (fourth edition). SET British Colombia: https://www.setbc.org/Download/LearningCentre/Communication/AAC_Guide_V4_Revise_2008.pdf

Praactical AAC

To download PDF version of this Tip of the Month, please click here

Created by Shauna McCabe, Speech Language Therapist, September 2018

Why are Support Workers Critical in an AAC User’s Journey?

People using AAC should have the opportunity to say whatever they need to say, to whomever they want to say it to, whenever they want. However they may need support to get there, and this support comes from the people that interact with them the most. Often support workers are key communication partners and key facilitators, for individuals to learn and to use their AAC tools and strategies. Support workers therefore play a very important part in an AAC user’s journey in becoming a successful communicator.

This tip of the month focuses on these communication partners and things that they might experience working with an individual who has difficulties communicating. It also covers tips and strategies that may be useful in supporting someone who uses AAC.

Communication Break Downs

What is a Communication Breakdown?

A communication breakdown occurs when there is a misunderstanding between two conversational partners. This can happen for two reasons; a lack of understanding by the communication partner, or an inability for a person to communicate clearly what they want to say. This can be frustrating for both people involved.

What do communication breakdowns look like? :

Communication breakdowns can look different depending on why the communication breakdown has happened. For some individuals who are not able to effectively communicate through speech alone, communication breakdowns may happen for one or more of the following reasons:

- when the person is communicating about something out of context

- communicating with a less familiar person 

- having a limited way of communicating (e.g. through pointing and gestures, speech that is hard to understand) 

- their method of communication is not always consistent (i.e. could be interpreted by different people in different ways)

- the access method is not understood by the communication partner (e.g. how eye pointing, or partner assisted scanning works)

- the communication partner does not stop and provide the time for the person to communicate 

In addition, if the AAC user does not understand what has been said to them, they may attempt to give a response or communicate something that doesn’t quite fit with what was asked. This is because they likely know that a response is required, but are unsure what to respond. For instance nodding their head when they haven’t quite understood the question. This can also present as someone withdrawing from a conversation as they are unable to follow it.

Conversely, if the communication partner pretends to understand when they do not, this can also result in a communication breakdown.

How Can we Help Repair these Breakdowns?

Supporting adults with communication difficulties to use augmentative and alternative ways to communicate (AAC) may help repair some of these breakdowns when they happen. Having access to AAC provides the person with a consistent and reliable method of getting their message across and can include symbols/photos, low tech communication boards, PODD books, alphabet boards, yes/no cards  and speech generating devices. Try different problem solving strategies if you do not understand what the person is trying to communicate, such as asking the person to repeat their message, ask if they have another way to say the same thing (e.g. on their communication system), or ask if they can give you a clue or a hint. Acknowledge when you don’t understand, which in turn may assist the person to acknowledge when they do not understand. Pictures or symbols, both in the AAC system and in the environment, can also be a great way to support someone’s understanding of what is being said to them, as well as a way of them expressing themselves. Most importantly the AAC tools need to be readily available all the time, and not left in a bag or cupboard.

Useful strategies when working with Adults Using AAC 

There are lots of things a communication partner can do to support someone who uses, or is learning to use a communication system.  Some tips include:

Create Opportunities for Use: 

Use meaningful activities and interactions that are already happening in your communication setting.  Ways to do this include:

- having the communication system available at all times

- asking open ended questions

- communicating about what they want to talk about

- thinking about what is going on during that person’s day and how to incorporate AAC.

Use Their Way of Communicating/ Model, Model, Model:

Modelling is critical for the individual you are supporting to learn to use their system. By using the AAC tool yourself you are supporting the AAC user to learn their system better and where the vocabulary that they want to access is located. Don’t be afraid of making mistakes or being slow, just give it a go. Start by picking 10-15 core words that you could model in a number of different activities and build from there. By using their way of communicating it also gives you an idea on how long it can take to get what you want to say out. 

Assume Competence:

It is important to assume that the person is able to learn and to use their systems. However the level of support to do so may look different from person to person and what stage they are at within their AAC journey.

Look at me:

Ask the person whether they prefer you to look at them or their system whilst they are putting their message together. By asking the person, you can get a gauge on what they feel comfortable with.

Talk to Me Like You Would Anyone Else with Clear, Simplified Language:

For adults who may be experiencing cognitive changes, or for individuals who have an intellectual disability, cutting out the waffle and getting to the point of what you want to say is important as it reduces the amount of information the person has to process.

Be Comfortable in Silence:

Typically an individual using AAC may need extra time to process what has been said and /or time to formulate what they want to say using their system. Being ok with longer silences to allow the AAC user time is really important as a communication partner, and shows them that they are an active member in the conversation. Adults who use AAC often report feeling as though they are being left behind in the conversation, or by the time they have constructed what they want to say, the conversation has already moved on. By being aware that it may take them a little bit longer to get their message together, we are facilitating them to participate to their full potential.

Sometimes communication partners will be able to predict what the person is going to say, once they have started to construct the message. Always check with the person before predicting, as to whether or not they are comfortable with you predicting in order to speed up the conversation exchange. 

Different Tools for Different Times:

An AAC system may be only one of many tools that someone with complex communication needs may be using to get their message across. Also some tools may work better in different situations and environments than others. Acknowledging and accepting all ways that an individual may be communicating is important as a valid way of getting their message across. This may be particularly important for client’s who are new on their AAC journey or may be used to communicating in a different way. Clients with acquired or degenerative conditions may still be grieving their diagnosis and how it has impacted their ability to communicate.

Personalise Vocabulary:

Having access to vocabulary that is meaningful and useful for the individual and their specific needs is critical for a communication device to be functional. Making sure that those words are within their AAC system is really important as they can’t use them if they are not there.

References:

BEUKELMAN, D. R. & MIRENDA, P. 2005. Augmentative and alternative communication: Supporting children and adults with complex communication needs, Baltimore, Paul H. Brookes Publishing Co.

Supporting People who use AAC Strategies: in the Home, School & Community (fourth edition). SET British Colombia: https://www.setbc.org/Download/LearningCentre/Communication/AAC_Guide_V4_Revise_2008.pdf

Praactical AAC

To download PDF version of this Tip of the Month, please click here

Created by Shauna McCabe, Speech Language Therapist, September 2018