Issues in Decision Making

As illustrated, no single technique fits every individual. In general, the use of several techniques is vastly more effective than use of a single technique. (quiz #7) Like anybody else, individuals with ASD use a variety of techniques to communicate, depending on the situation. In certain causes, simple gestures or signs are the most practical while in other situations it may be critical to use a picture board. Use of a VOCA may be necessary in yet other situations. .

Before a specific technique is chosen, assessment needs to be conducted by a team of professionals who are knowledgeable about AAC and ASD. In addition to the child, the team typically includes the parents, a speech language pathologist, an occupational therapist, a physical therapist, special education teacher, and AAC specialist. (quiz #10) The public schools are required by the federal government to provide an AAC assessment and program designed to assist the child in obtaining an appropriate education. More information about AAC evaluations can be found at http://www.asha.org/speech/disabilities/disabilities.cfm.

Lets look at examples of children effectively using a variety of techniques to communicate.

Examples

Brady is a 7- year-old boy with ASD. He is nonverbal and appears to be functioning significantly below average. He demonstrates limited visual attention but is very motivated by voice output. Brady loves to go on walks and frequently walks to the door and signs “go.” In the bathroom he signs “help” to pull up pants. At group time he uses an eight key Cheeptalk, a simple VOCA, to tell the teacher what song he wants to sing. At snack each day he makes a choice of snack items with his VOCA and then spontaneously signs “more” to indicate when he wants another piece. As he leaves each day he waves ”goodbye.”

Mark is a 4-year-old boy who makes a few vocalizations but is very unintelligible. He becomes easily frustrated when he is not understood. He has learned to effectively use PECS each day to select play materials and snack preferences. Verbal speech is encouraged throughout all activities. For example, each day he exchanges a picture with his teacher to request a swing ride. He then lift his hands and vocalizes “uh” to ask to be lifted “up”. When he was tired of the swing he forms the sign “all done” and vocalize “da.”

Even when multiple techniques are used, decisions regarding primary techniques for training must be made. Specific choices will depend on numerous factors, including the following:

• Motor and sensory needs
  Some children lack the necessary motor skills to form signs. Others may not be able to isolate a finger to point to pictures. Vision may impact the use of graphic symbols.
• Environments where communication occurs
  Some children have a small core of people that they interact with regularly. Others may have a wide circle of family, friends, teachers, and classmates.
• Partners in communication
  Some communicative partners may be interested in learning signs, others not. Some individuals are frequently expected to communicate with persons who are unfamiliar to them.
• Special interests/vocabulary selection
  Some individuals are motivated to communicate very specific vocabulary (e.g., names of videos, games, places, snack, etc.). It will be necessary to have an AAC technique clearly expresses that vocabulary.
• Spontaneous skills
  Some children spontaneously gesture and use hand movements. Others show a spontaneous interest in pictures and are observed to spontaneously point to pictures in books or magazines.

These are just of a few of the issues that must be addressed before deciding on the best AAC options. Proper evaluation and planning is an ongoing process that takes time and commitment from team members. However, AAC users will tell you the time and effort is well worth it!