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Module No.: AAK 701

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Question 1

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An Introductory Presentation On Augmentative And Alternative Communication(AAC) At
Tiny Kids Preschool On 7th May 2012

Communication is a basic human right and a person’s inability to communicate will bring
about several challenges in every sphere of his life. This essay will shed some light on AAC
and its multifaceted benefits to people who might have to rely on it.

What is AAC?

Briefly, AAC is the use of augmentative and alternative communication to help individuals
with little or no functional speech (children, adults) express and communicate their needs to
the people around them.

Who will benefit from AAC?

AAC caters for people from all walks of life and as such it will benefit anyone whose
communication needs cannot be met by speech alone due to congenital (Autism) or acquired
defects (Brain stem stroke).

According to Von Tetzchner, 2003, three groups of people will benefit from AAC and these
are:

Expressive Group: these individuals have a good understanding of spoken language and
only need AAC as an alternative way to express themselves.

Supportive Group : these are mainly children whose speech is delayed and disturbed and
will need AAC to expand and enhance(scaffold) their communication needs.

Alternative Group: these are individuals who have no tangible comprehension of spoken
language and will need AAC for receiving and sending out of messages or information.

Importance of AAC

Firstly, AAC helps to ease a person’s communication interaction with the people in his
immediate environment, thereby reducing isolation, frustration and depression.

Secondly, AAC helps to fulfil a basic human attribute ( i.e. ability to communicate) most
especially in people who have to go a great length to pass messages across to others.

Also, AAC can facilitate speech and language development in individuals especially in
children who require early intervention in literacy and other aspects of their life.

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AAC, helps people to connect and communicate in different contexts and with different
partners from time to time.

Types of AAC Systems: Unaided and Aided

Basically, unaided system makes use of our body( or parts of it) to communicate. Unaided
systems can be either linguistic (i.e. making use of natural speech, sign language) or non
linguistic (facial expressions, idiosyncratic gestures) These forms of communication cannot
be stored, it has to be repeated again and again by users and partners.

Aided systems can either be linguistic or non linguistic; and are devices, gadgets or things we
use for communication outside our bodies. These type of system can be displayed or stored
and can be re-used again and again as they are selected. Examples of aided systems are:
objects and photographs (non linguistic) or Traditional orthography and abstract line
drawings. (Linguistic)

Incorporating AAC at School and Home

Why should AAC be incorporated in the class room and at home? It is simply to facilitate
communication, enhance development of language thereby aiding the acquisition of
literary skills. It is also necessary to foster participation, understanding and interaction
between the children using AAC and facilitators or partners in the school and home context.
The use of AAC in the classroom and home can help reveal the child’s level of understanding
in academic areas, helping the teacher to know what areas to concentrate on. At home, there
is continuity of efforts as AAC is also being used, thereby enhancing the child’s receptive
language.

Learners will benefit from AAC use in the classroom and home because AAC strategies and
devices can be adapted to suit each learner, according to their peculiar disabilities and
characteristics. AAC focuses on each learner’s unique strengths thereby giving the children a
sense of accomplishment in their daily activities.

How can AAC be incorporated in the class room and home

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Training of both teachers and parents in the basics of AAC will facilitate implementation.
Studying the child in both contexts and knowing what is expected of him and the reasons he
communicates will play an important role in incorporating AAC at home and school.

Five Ideas on Implementing AAC in the Classroom

 Teachers can implement AAC in their classrooms by integrating AAC strategies into
their work cycle for the day e.g., Using communication aprons or boards for themes .
 Simple techniques can be used to accommodate Users of AAC to participate in group
activities e.g., changing the child’s posture in order for him to have better access to
toys
 Using schedules to plan the day’s activities and allowing the children change or
remove them once completed.
 Taking note of a child’s mode of communication and quickly attending to him .
 Educating other learners in the class room about AAC and the children who need such
assistive mode of communication

Five ideas on implementing AAC at Home

 Parents can help their children by documenting their idiosyncratic gestures in a

communication booklet so that other people can know what the child wants to say.
 Familiar pictures of what the child likes or needs regularly can be pasted on different
surfaces around the home. E.g. pictures of juice, apples etc can be on the fridge.
 The children should be given the opportunity to do things themselves if they can
within the parameters of their motor skills.
 Parents should also get familiar with the type of AAC intervention at school so that
there will be continuity on both ends
 Behavioural problems can be addressed by modelling acceptable behaviour using
cause and effects technique.ie exhibiting good manners will earn the child a treat.

In conclusion, I hope I have been able to give a succinct overview of some aspects of AAC to
everyone present in today’s meeting and I hope that we will all work together as a team,
thereby creating an environment that is enabling, stimulating and refreshing for our children
now and in the future.

Question 2
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Iconicity simply means the visual relationship a symbol has with its referent, which enables
an AAC user to quickly make a connection between what is symbolised and the actual object
the symbol represents(referent). Example, using a clear picture of a any boy to represent a
boy or boys in general.

The Iconicity continuum or scale is divided into three parts respectively:

Transparent symbols: here the symbol used for representation can be easily guessed by
observers or users, even if the referent is not seen.

Translucent symbols : here the symbols used for representation cannot be easily guessed
except if the referent is also readily available in order to make a direct correlation.

Opaque symbols: here the symbols used for representation bears no resemblance to the
referent and observers cannot make a correlation between the two.

The different levels of symbol representation and the influence of Iconicity in my own
understanding ranges from Transparency(Objects) to Opaqueness(Print Awareness). These
are further discussed as follows:

a. Real objects: these can be said to be very transparent in the iconicity continuum as
they can enhance symbol understanding due to its concreteness. Users of AAC at the
object level can feel and touch real objects and experience its tangibility.
b. Photographs/ Pictures: at this level transparency also comes into play as photographs
and pictures are closely associated with the referent it symbolizes. Although black and
white pictures could be slightly difficult for a child to understand, as opposed to
coloured pictures which are clearer, and looks more natural.
c. Line Drawings/PCS: this could either be transparent or translucent as it depends on
the user’s cognitive development and his ability to process visual information.
d. Line drawing /Bliss: this level makes use of graphic symbols for communication. This
will fall under the Translucent range as Bliss is alot more dynamic in it representation
and its meaning cannot be easily guessed. Only when the rules governing Bliss is
thoroughly understood can it start making sense to AAC users.
e. Print Awareness: At this level of representation, the Opaque part of the continuum
will best describe this level. Written words do not bear a resemblance to the referent
whatsoever, thus making it very difficult for a child who is not literate to
communicate effectively.

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 Many factors come into play when assessing a child’s level of representation, most
especially if such children live with one form(s) of disability.
Generally, it will be good if the teachers in Thabo’s School consider the following
tips:
1. Cognitive skills of the children
2. Visual discriminating skills of the children
3. Motor skills of the children because Aided symbols require some form of direct
selection
4. Communication goals the teachers want to achieve, and further progression
expanding the children’s bank of vocabulary
5. Portability, safety , flexibility and durability of whatever type of symbol level
they need to use.

The Case study says the children in the various classes are cognitively age appropriate or
have a mild delay, therefore the teachers can assess children’s level of representation with
Photographs and Pictures.

I suggest that they:

a. Start with pictures and photographs which will be cognitively and visually less
demanding on the children.
b. Pictures and photographs also have a high transparency. They can be a less
complex way to transit to more abstract aided symbols like PCS and Bliss.
c. Picture can also be made to meet the specific needs of the learners, e.g size( it can
be Large, medium or small)

Ideas on How to use Photographs and Pictures

 Children can match pictures to referents, events or persons.
 Children can be taught that pictures represent three dimensional objects
 Several other alternative pictures of a particular referent can be introduced to
broaden the children’s ability to use their visual discrimination skills

Question 3

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The process of selecting AAC symbols for a client is not a casual decision but one that
involves a lot of strategic planning whereby the client’s needs and abilities are put into
perspective. Needs and Abilities will be briefly explained in subsequent paragraphs.

Needs are dynamic and will vary from one client to another. For example, the needs of an
eight year old (school going) autistic child in terms of communication will differ from
another autistic child who is 3years old and hasn’t started school.

Abilities reflect ones skills and aptitudes and these are crucial in selecting the most suited
AAC symbols for clients. For example a child that is severely mentally retarded will have
difficulties using a symbol set/system that requires a high level of cognitive skill compared to
a child who might be autistic and paralysed but is intellectually functional.

For the Client’s needs and abilities to be properly taken into consideration, a proper
assessment is required. The aim of the Assessment is to get a comprehensive guide to the
client’s communication environment, partners and other issues that are directly significant to
his prescribed AAC symbol selection process.

Assessment in( Cognitive, Communication, Literacy, Socio emotional, Motor , Sensory

Skills) is surely the first step in intervention, as this will reveal the strengths and abilities and
weaknesses of the client, and also guide the effective selection of the most suitable aided
AAC system.

Implementation variables: I strongly believe that implementation variables will vary from
one AAC user to another. These are factors that can assist, support or militate against the
optimal performance of the AAC system if not properly addressed. These variables can have
an effect on not only the user, choice of symbol set/system, device or aid selected, but also on
other environmental, cultural and technical factors unique to that User.

Some variables to consider are as follows according to

 Funding: cost factor is very important as this determines or limits to some extent
choice of AAC system and device within the financial power of the User.
 Knowledge and Skills: this can be a deterrent to implementation if no one has some
formal training in the use of the AAC system or the perception that the symbol is
difficult to learn.
 User Variables: these pertain to those factors that affect the User personally when
considering symbol selection. Examples of these factors are; Cognitive, motor,

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 receptive, tactile visual skills, cultural and experiential background. All of these are
paramount so as to have the best feature match.
 Acceptability Variables: involves factors which pertain to the users opinion
concerning the array of symbols selected for his communication functions, and how
others (communication partners, caregivers and peers) readily accept or perceive it.
 Use Variables: deals with the basic features of symbols. These are accessibility,
durability, portability display permanence, and reproducibility .These are important
factors when choosing aided AAC systems.
 Vocabulary Variables: size of vocabulary, (smallness or largeness of symbols size)
logic of presentation , expansion and representation range are factors to consider in
the choice of the AAC display for the user in question.
 Intelligibility: Here, the issue of iconity(transparency, translucency, opaqueness)
comes into focus. Clarity and ease of comprehension of symbols both to the user and
his partners is an important factor , also, time and skill required to learn the symbols.
 Linguistic Variable: here, similarity in linguistic structure of the symbol set or system
chosen compared to the spoken and written language in the AAC user’s community is
important. Linguistic variable also looks at how literacy can be developed in the AAC
user , especially in children who need to learn fundamental rules as it pertains to
language.
 Interaction Variable: the AAC user should find the symbol set/system easy to
communicate with to others, that is why this variable is important. Opportunities for
active participation, face-to-face interaction, should all be considered as necessary.
 Efficiency Variable: here, rate of communication(needed number of movements to
produce a word) and relationship between symbol and messages conveyed is very
important.

In Thabo’s case, the Symbol selection process will have to look into his needs which are:

 To interact with his peers

 To participate in group activities
 To communicate his desires with the people around him at school and with his family
 To have an AAC symbol system that will help build literacy skills.
 To have access to an AAC aided device that he can have with him most of the time.

Thabo’s abilities as deduced from the Case study are:

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  Motor Skills: he can’t walk, he is in a wheel chair, and he has high muscle tone in all
four limbs, but he is able to point using his index finger.
 Communication Skills: Thabo is interested in communicating as he uses natural and
idiosyncratic gestures to indicate yes and no. He points to get his message across
 Cognitive Skills: Thabo has the cognitive and receptive ability of a 3 year old, which
means he is delayed as Thabo is 5years old. However, he can identify pictures,
recognise people and objects in the environment.
 Literary Skills: he has some receptive language (Sotho), he has some expressive
language (ma, ja , wa).
 Sensory Skills: Thabo’s vision and hearing seem to be intact this will be of great
benefit to him.

Symbol Selection Process for Thabo as it complies with his needs and abilities

After considering Thabo’s needs and abilities, important factors according to Musselwhite
and St Louis (1982, pp.110-113) and Murray and Goldbart(2009) that are cogent in the
process of symbol selection(both aided and unaided) also applicable in Thabo’s case are:

1. Portability: As Thabo uses a wheel chair, he needs a device that he can use within the
confines of his wheel chair.
2. Adaptability: Fortunately, Thabo can point with his index finger, and most aided
systems are adaptable to suit differing physical abilities. Therefore, enhancing the use
of his index finger for selection is possible.
3. Message: Since Thabo has a fairly good understanding of Sotho at the cognitive level
of a three year old, his message content for now need not be too elaborate but
effective for him to use at home and school.
4. Communication Partners: Luckily, Thabo’s literate mother, his teacher and siblings
can be trained on how to support and encourage Thabo’s use of AAC. This will dispel
any preconceived ideas on the use of the chosen Aided system for him.
5. Flexibility: Thabo has the potential to grow with his choice of AAC system, even if he
starts with a few symbols, it can gradually be expanded as he grows and matures, all
things being equal.
6. Cultural experience: Thabo’s mother tongue is Sotho, and his understanding of Sotho
is as a result of his family members and his teacher speaking it to him. Therefore
symbols selected must reflect his cultural background and be meaningful to him.

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Based on the factors above, the appropriate unaided symbol set for Thabo will be
Vocalization, pointing, natural and idiosyncratic gestures that Thabo already knows and uses.

Our aim in the selection process is not to change Thabo’s style of communication but to build
on his established unaided set, however, his Mother and teacher can help him document(keep
a communication booklet) these gestures to help the people around him understand him
better, and meet his pressing needs.

For the unaided symbol system,(i.e. Sign language, finger spelling, manual alphabet,
keyword signing etc) Unaided symbols systems require some degree of stable gross and fine
motor coordination such as using both hands to relay a message or accurate representation of
letters by manipulating ones hands in different ways. In Thabo’s case, keyword signing
(which involves only signing of important concepts in a sentence) can be introduced as it is
less demanding than the other forms of Sign systems, and follows a grammatical order.

An appropriate aided symbol set for Thabo will be Picture Communication System(PCS).
This is cognitively less tasking for him, moreover he recognises pictures as stated in the case
study, PCS symbols especially the nouns are closely similar to its referents which Thabo
might recognise since he is able to function cognitively and receptively at the level of a three
year old.

Also his communication partners (family members, peers and teacher can also find PCS easy
to use.

For the aided symbol system, Blissymbolics will be appropriate to improve his
communication. This meets most of Thabo’s needs and abilities, as he has his vision intact,
Bliss enhances entrance into literacy, a growing vocabulary, cognitive level to start using this
system is +/- eighteen months, and Thabo’s cognitive level is at thirty six months. It is easy to
remember as it is conceptually based, not letter based.

The role implementation variables will play when implementing the above symbol
set/systems for Thabo cannot be overemphasized.

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Funding as a Variable: the choice of PCS (symbol set) and Bliss (symbol system) will not
give Thabo’s mum (a widow with limited finances) and the school too much financial
burden. These are easily reproducible and can be gotten off the internet easily if need be.

Vocalizations, gestures etc will not require any sort of funds, but learning to finger spell or
keyword signing might require some form of training. This can also be learnt by buying
Books for self teaching.

Knowledge and skills: this is important for effective implementation because none of
Thabo’s active communication partners (Family and Teacher) have a sound knowledge of
how AAC works. They might not know how to use PCS or BLISS which needs getting used
to. Also they need to know some sign language (especially one handed signs) before they can
teach Thabo. Their lack of knowledge and skill can affect implementation negatively.

User Variable: Thabo’s cognitive ability and his perceived readiness to communicate is on
the positive side. He will master the use of his symbols/sets if properly presented to him as he
has what it takes ( his ability to recognise pictures, people and objects). He only has to be
encouraged and motivated to use his abilities to the best of his advantage at this early age
until he finally becomes a competent AAC user.

Interaction: Thabo does not interact with his classmates due to his and their limited
functional speech. The role of this variable in implementation of AAC symbols/sets is to
create situations where Thabo can use his symbol/sets for normal class routines, on the
playground, to make simple requests, to make choices, and initiate simple conversation with
his peers and his family that will foster participation albeit his present state.

Use: Thabo needs something simple, reproducible, and durable because of his limited
movements due to a high muscle tone. In order for the implementation process to be
successful for Thabo, some form of adaptation must be put in place for him to use his AAC
set/system

Interaction: Thabo does not interact with his classmates due to his and their limited speech.
The role of this variable in implementation is to create situations whereby Thabo can use his
Symbol/Set in class routines, on the playground, at home, to initiate simple conversation and
to make requests.

Question 4:

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An unaided AAC system can briefly be said to be systems that uses body parts and
movements; especially arms, hands, heads to communicate, without the aid of devices or
gadgets. These systems are more linguistic and often more like language.

Examples of Unaided systems are: Sign language, finger spelling, natural speech, manual
alphabet, key word signing amongst several others.

Since Thabo’s teacher is interested in selecting an unaided system for her class, she needs to
consider the following factors according to Musselwhite and StLouis(1988), which will guide
her in harnessing the needs and abilities of the children she teaches.

Factors to consider are as follows and will be explained using the Case study as a backdrop

1. Motoric Capabilities: This deals with gross and fine motor movements, hand shapes
and other movements related to the production of signs for communication. Motoric
movements are different from one system to another,(i.e. finger spelling are
essentially one handed, while Paget-Gorman Systematic signs uses two handed non
symetrical signs extensively.)
Since Thabo’s can only rely on a little fine motor skills such as pointing with his
index finger, it will be extremely tasking to teach him signs where he needs several
gross motor coordination and stable hand control. Therefore his teacher has to
carefully consider this when implementing signs for use in the classroom. She can
work around the use of his index finger to teach him as many signs as he is able to
make based on this particular ability.
2. Cognitive Abilities: there are differing levels of cognitive abilities required for the
various types of unaided systems. Some are considered complex due to its
grammatical structure and literacy requirement from users, others seem simple to
learn as a result of its transparency (whereby the sign closely resembles its referent).
In relation to Thabo’s case, he is just five years old but has the cognitive ability of a
three year old child. Therefore, the signs Thabo is taught must be ones at his level of
cognitive skills, meant for use in different settings (school, home etc).
3. Size of Vocabulary: Accessible vocabulary varies from one system to another. Some
have only basic vocabulary about 500 signs while some others go as high as 3000-
5000 signs.
Thabo’s teacher can carefully have a choice of core vocabulary for him and gradually
increase it as he masters the signs, she will be modelling and presenting to him .

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 4. Grammatical Structure: Some systems have no grammatical structure (i.e. Amer-ind)
and others do, and some others have their own rules( SASL), however, it’s the user’s
needs that will determine what sort of structure to follow.
Regarding Thabo, he has the receptive ability of a three year old language wise, and
in the long run it will be good to enhance his literacy, academic and grammatical
skills, as soon as possible even though he only understands Sotho in the time being.
5. Ease of Learning: So many factors play a role in determining whether learning of
signs will be relatively easy or difficult. Transparency and translucency, availability
of teachers and communication partners, and access to training and support materials
are most crucial in this regard.
Thabo’s teacher needs to be supported by the school and all stake holders. Training is
paramount for her and parents alike. After this, can she understand the principles
behind the use of AAC and be able to present or model its use to children. Her
understanding of how to impact the children academically, socially and physically
will also allow her to deal with the various needs of the children in her class.

How Thabo’s Teacher can Introduce Key Word Signing in Her Class

Key word signing is not a language on its own but it represents the most important words in a
sentence with signs taken from an established sign language such as SASL, ASL, or
Makaton. Grammatically, it follows the rules of spoken language as acceptable in the user’s
community.

Thabo’s teacher can introduce key word signing in the following ways:

 Modelling: the teacher has to use the signs in day to day class activities and encourage
the children to do the same. If she is seen signing, the children will also pick it up.
Example: She starts the day signing e.g. Today is Monday and reinforces that all
through the day.
 Role Play: Acting out some signs with another adult or the children in class will also
be interesting to the children, as they learn quickly this way.
Example: She can role play a simple greeting that requires a corresponding response
such as; How are you today, response---------, good, thanks.

 Introduce key word signing in normal class activities such as nursery rhymes(one
little, two little Zulus……)

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  Introduce signs which have high transparency, as these have better visual similarity to
its referent. Example: ball, book,
 She can make use of visual and audio resources such as Dvd’s, and play it in class for
the children to watch, or paste large posters of the various signs taught to the children
in strategic places in the class where children can see it.

RERERENCE LIST:

Beukelman, D.R., & Mirenda,P.(2005). Augmentative and alternative communication:

supporting adults and children with complex communication needs(3rd ed.). Baltimore: Paul
H Brookes.

Murray, J.,& Goldbart,J.(2009).Augmentative and alternative communication: a review of

current issues. Pediatrics and Child Health.19(10). pp. 465-468.

Musselwhite, C.R.,& St.Louis, K.W.(1982). Communication programming for persons with

severe handicaps: vocal and augmentative strategies. pp.110-113. Boston: little Brown &
company

Musselwhite, C.R.,& St. Louis, K.W.(1988). Communication programming for persons with
severe handicaps: vocal and augmentative strategies. Boston: little Brown &company

Von Tetzchner, (2003), as cited in the CAAC (2012) AAK 701 Lecture Note. pp. 4

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