Every year I receive parent-initiated referrals for AAC consideration, but when I consult with the school-based team I’m told “He’s verbal. We understand everything he says.” In probing further, it is revealed that the student’s utterances are very short (1-3 words) and are only to request a few highly preferred items. So while intelligibility is good, expressive language is very limited. Would providing a form of AAC help to increase the quantity and quality of the student’s expression? That’s really what the parents are asking us to explore. In addition, I want to know if changes in the environment and adult interaction style will prompt improvement in the student’s communication skills.
The first step is to get a solid measurement of the student’s spoken language. For this purpose, I created a simple form that can be used to gather baseline data. In the first column, the data collector makes a tally mark each time the student speaks, entering that mark under “initiated” or “response/prompted.” The data collector then rates each utterance as “intelligible” or “not intelligible” and “meaningful” or “not meaningful.” The data collector can write some examples of the student’s spoken messages on the back of the form, along with any anecdotal information that might be helpful in analyzing the effectiveness of the student’s verbal communication. My Intelligibility Tally form is available as a free download at the Materials Exchange on Speaking of Speech.com.
The second step is to look at the communication mode(s) the student uses and the environment in which he communicates. Are there many and varied opportunities for communication (see my post about using “colorful language”), or are opportunities limited to stimulus/response interactions, such as making choices? Does the team employ a consistent least-to-most prompt hierarchy with adequate pausing to allow for initiation and response? When given opportunities to communicate, does the student have the means to do so, or are supports needed so the student can communicate effectively? Those supports can take the form of programming messages into a speech generating device, providing sentence strips or other visual representation of language, teaching needed words or signs, adult modeling of expressive interactions, and multiple opportunities to practice in a functional context.
To help teams become more aware of the need to provide both the opportunity and the means of communication, I created an Activity Analysis form, also available as a free download at the Materials Exchange on Speaking of Speech.com. This form enables teachers and SLPs to look at each activity in the school day in terms of communication partners, mode and functions of communication, the expected messages the student may convey in each situation, and whether or not the student has access to and the ability to use the needed messages. It can be quite illuminating when the team thinks through a daily routine and realizes that either there are no opportunities for communication, or that those opportunities are very limited in number and function. I encourage the teacher and SLP to use this analysis as a jumping off point for collaboration to raise expectations of the student, increase opportunities for communication, broaden the functions of communication, widen the student’s circle of communication partners, and develop the supports the student needs to be a more effective communicator. Scripting activities and posting reminders to the team about prompting and pausing can be very helpful when implementing changes to activities and adult behavior.
When adjustments are made to the daily activities based on the Activity Analysis, teams should use the Intelligibility Tally again to see if there has been an uptick in self-initiated, intelligible, meaningful verbal output. If sufficient improvement is noted in the student’s verbal communication, the team (including parents) may realize that changes in routine, the dynamic of adults’ interactions and expectations, and/or the training and implementation of supports already in place are key to increasing the student’s expressive communication skills. If these changes aren’t sufficient, various forms of AAC can be tried and measured systematically, providing a comparison of aided and unaided communication. Even with ample opportunities to communicate, it is quite possible that, although verbal and intelligible, the student cannot access the words he needs without some form of visual or auditory support which AAC can provide.