AAC and Belonging: Communication and Friendships

More About Our Guest

Dr. Susan Johnston is a professor of special education at the University of Utah. 

Podcast

Transcript

Intro: Thanks for joining us for a podcast from the Illinois Early Learning Project. Our project is part of the Department of Special Education at the University of Illinois at Urbana-Champaign and funded by the Illinois State Board of Education. On this podcast, we share information about how young children grow and learn as well as strategies adults can use to help them thrive. My name is Natalie Danner. 

Natalie Danner: Welcome to the Illinois Early Learning Podcast. Today, we are talking about AAC, which stands for augmentative and alternative communication. The idea of belonging and how AAC can support communication and help young children develop and continue friendships. We are joined by Dr. Susan Johnston. Dr. Johnston is a professor of special education at the University of Utah, with research interest in AAC, early language and literacy interventions, and early childhood special education. Thank you so much for being with us today. 

Susan Johnston: You’re welcome. Thanks for the invitation, Natalie. 

Natalie Danner: Great! Well, today we are eager to hear from you as an expert on AAC, because our listeners want to learn how AAC can support young children in friendship development and communication within early childhood classrooms. So let’s get started with the basics. What is AAC, or augmentative and alternative communication? 

Susan Johnston: Great, yeah, augmentative and alternative communication, or AAC, refers to all of the methods and tools that we can use to supplement or replace speech for children with complex communication needs. And we typically use the acronym AAC, because saying augmentative and alternative communication all the time is kind of a mouthful. But it’s helpful to remember that AAC stands for augmentative and alternative. So, augmentative means that there are tools or methods that we use to complement or supplement verbal speech. While alternative means that there are tools or methods that we use in place of absent or nonfunctional verbal speech. And I emphasize this so that we remember that AAC can serve as both an alternative to speech, but also augmentative. And recognizing that it can be augmentative is particularly useful for a child who’s verbal, but whose verbal skills are not meeting their needs in their current environments. 

Natalie Danner: That’s great, because I always, I guess, think of it mostly as the alternative side and not so much the augmentative side. So, it’s great to really come back to that definition and really think more on that augmentative side as well. So, thank you for that definition. 

Susan Johnston: You bet. 

Natalie Danner: So our second question is, can you describe some of the examples of different types of AAC devices used by young children? 

Susan Johnston: Sure, when we think about different types of AAC, we often divide the types of AAC into two main categories that we refer to as unaided and aided modes of communication. And unaided modes of communication do not involve the use of any additional equipment or materials. So things like facial expressions. A smile is a mode of AAC, because it’s not verbal language, but it certainly serves to communicate. Body language, like when a child tenses up when they’re very excited, or they slump over when they’re tired, is an example of an unaided mode of communication. And then even gestures like pointing to share information or to request a desired object is also an example of an unaided mode of AAC.  

And then the other category of AAC is aided modes, and aided modes of AAC do use additional equipment or materials. When we think about aided modes of communication that young children might use, we oftentimes think about them on a continuum from no tech (no technology), up to high tech or high technology systems. And so no tech systems might include things like picture communication boards. So these might be a laminated board that has pictures or symbols that represent words or concepts that the child can point to in order to communicate. No text systems might also include communication books. So this might be multiple pages that contain symbols and pictures that the child can use to construct sentences and to express specific messages.  

As we move down that continuum from no tech, we kind of cross into what we refer to as light tech systems that might also be very useful for young children. Light tech systems are devices that include simple voice output that a child can use and can press a button in order to generate prerecorded speech. So a child might have access to just one button that says, “I need help.” Or might be, they might have access to four different buttons, and those would be examples of light tech aided modes of communication.  

And then at the far end of the continuum, we have high tech systems. And certainly preschoolers can benefit immensely from high tech systems as well. High tech systems use technology that’s more complex and might include dedicated devices that were developed solely for the purpose of AAC that would include computer screens and software where the child can select symbols or type text as they’re gaining literacy skills that then allows the device to convert what they access into spoken language. High tech systems also include software and apps. And apps, like dedicated devices, are created that allow the child to point to symbols that can represent words or phrases so that they can communicate using a computer or a tablet.  

And as we think about these different types of AAC devices, I think it’s important not only to know about this full range of systems, but also to recognize that, regardless of the type of AAC system, it’s important to recognize that AAC is highly individualized. And so it’s not a one-size-fits-all kind of approach where a classroom or a home environment has access to one type of app or software and so, automatically, that’s what all children in the classroom are using. Instead, we really need to individualize AAC based on a range of factors such as the child’s motor skills, their cognitive abilities, and even their communication goals.  

It’s also really important that we recognize that we don’t have to just choose one AAC system. Instead, we need to recognize that children who use AAC can be multimodal. So they can use some existing verbal language that they have, if they have some existing words in their in their repertoire, but they can also use unaided modes, like gestures and body language, and they can use aided modes of communication—low tech all the way up to high tech. So we don’t have to lock ourselves into just one option for young children who use AAC. And in fact, you and I and all of the listeners out there, we’re all multimodal. And so it makes sense that when we’re supporting young children with disabilities, we also give them the ability to be multimodal as well. 

Natalie Danner: I love how you describe so many options in this continuum and how individualized this approach is. I think in many teachers’ minds they might be imagining a one size fits all, or maybe it’s just an iPad as an AAC device. And from the way that you were describing it, there are so many different options that are individualized to meet the need of a particular child who is having a particular struggle, and that’s such a unique approach. And I think that’s a great way of looking at it and thinking of matching the AAC device or the tool to meet the needs of the child. So, I love that thought process. So thank you for answering that. 

Susan Johnston: You bet. 

Natalie Danner: Let’s look at our next question, which is a big one. What makes a person a good candidate to use an AAC device? 

Susan Johnston: Yeah, this is such an important question, Natalie. And you know, in my opinion, any person that’s experiencing challenges and effectively using natural speech to communicate is a good candidate for AAC. And I think oftentimes we most commonly think of AAC for individuals who don’t have any speech. And certainly individuals who have limited or no speech are great candidates for AAC.  

We might encounter individuals who have limited speech due to motor limitation. So, for example, young children with cerebral palsy. We know that verbal speech requires a whole lot of complex motor movements, which could be very difficult for an individual who has cerebral palsy. And so for those individuals AAC might be great, both as a way to augment their existing verbal language, or as an alternative if their motor limitations are so significant that they’re not able to effectively and efficiently use verbal language.  

Another group of individuals that might benefit from AAC are individuals with cognitive limitations. You know, we know that language is very abstract, and spoken language in particular is not permanent. So the spoken word is there one minute, and it’s gone the next. And so for some individuals with cognitive limitations, using AAC, for example picture symbols, can make language less abstract because pictures can be made to be more iconic or more representative. Also, because the AAC system is via a graphic mode of communication, those picture symbols are there all the time. And so, it’s not like verbal language that’s there one second and gone the next. So, for individuals who need more visual supports, oftentimes AAC can help support that use of communication and language.  

And even though, as you and I talked about earlier, oftentimes the focus of AAC is on supporting individuals who have limited or no speech, AAC can also be very helpful for individuals whose speech is not intelligible. So this kind of goes back to multimodal modes of communication. So, it might be beneficial for a child who does use verbal language, but is sometimes unintelligible, to have AAC available as a way to support when a communication breakdown occurs. So they may start by using verbal language, but if there’s a communication breakdown, they know that they have another mode that they can use that’s successful.  

Which leads us to kind of another group of individuals that in my work have really experienced a lot of success in using AAC. And that’s for young children who are experiencing frustration with communication. And so, if a person, a child is kind of frustrated because they’re not able to communicate their needs or thoughts or their emotions verbally, AAC can provide an alternative means of expression for them. And this is often the case when we’re working with young children who might have language delays, that they do have verbal speech, but it’s slower to develop and requires more support. Young children can oftentimes use visual modes of communication or AAC as they’re acquiring their verbal language to help decrease the frustrations that they’re experiencing in communication. 

Natalie Danner: I’m so glad that you brought up that frustration level, especially with young children. We know that when they have communication challenges, this can sometimes bring up challenging behavior as well, because we know that behavior is related to communication. But when we’re talking about young children, especially those within the ranges of ages 3 to 5, can they actually use AAC devices and other modes of communication appropriately and successfully? And if so, can you describe what that might look like in their home and their school environments? 

Susan Johnston: You bet, you know, in answer to your first question, a huge, resounding “yes.” Much of my work in the area of AAC has focused on preschool-age children, and even birth to age 5. So, young children birth to 3 as well as preschool-age children. And so I have had a front-row seat in terms of seeing and supporting the successful use of AAC. And this success is not just limited to my experiences. We actually have years of research and practice that have demonstrated that young children with a wide range of complex communication needs can increase their ability to communicate effectively and efficiently using AAC.  

And so then to move to the second part of your question in terms of what this may look like. For preschool-age children, it might look like a child who’s using low tech visual support, such as a free time choice board that has photos representing activities that are available during free choice time in a preschool classroom. And so I’ve used this very successfully with some young children that I’ve worked with in preschool settings who really benefit from a little bit of structure in their environment, and during free choice time they really struggle. They kind of are bouncing all around, having a bit of a hard time figuring out how to navigate all of the choices available during free choice time.  

And so, we’ve created low tech, visual support communication boards that allows a child to see the options that are available, choose from among those options, go play in that area, and then when they are done in that area, they’re able to access their choice board again, in order to choose where they want to go next. And so that might be one way that you might see the use of AAC being used in a preschool classroom.  

You might also see communication being, communication boards being used in different activities. And we sometimes refer to this as activity-specific displays. So, for example, if you have a preschooler who is benefiting from AAC who loves going into the block area of the preschool classroom. You might have an activity specific display that is always available in the block center, for not only that child, but all children and adults to utilize, and that picture board or symbol board could include vocabulary that’s very specific to the activity of playing with blocks. So things like “up” and “down” and “fall down,” or “more,” “put,” “some,” “all,” “truck,” “crash,” “kaboom,” could be vocabulary that’s included on that activity specific display.  

Another way that we’ve used AAC successfully in the classroom is to create high interest vocabulary books that are very individualized to the children in the classroom. And so children make their own conversation or experience books that have vocabulary that’s very relevant to their interests and daily experiences. Those are made into user-friendly books that the children can access when they just wanna talk about the things that they love to talk about. So a child who really loves talking about snow and skiing might have a book that’s all about skiing and snow. It might have photos of themselves when they were taking ski lessons. And when the child just wants to share their love of skiing, they can go to their high interest vocabulary book, and point to those symbols as a way to initiate that conversation. And then I can respond by saying, “Oh, yeah, I love skiing, too. I went yesterday, you know, I fell down a lot. The powder was really deep.” So that can be a great way, and it allows the child to share their high interest experiences and vocabulary.  

Other examples might include the use of, maybe an example that many listeners have seen, is the picture exchange communication system or PECS, and PECS is an intervention strategy that utilizes pictures and symbols to help children communicate. And the actual strategy is very systematic. It goes through multiple stages. But in the early stages what it looks like in a preschool classroom would be a child who exchanges a picture card or a symbol that represents something that they really are interested in, in order to request and exchange. They exchange that symbol for access to the desired item or activity.  

And this is a great systematic strategy that utilizes AAC. And for all of these examples, I know I’m gonna sound a little bit like a broken record. But for all of these examples it’s important to note that it must be individualized. And so, rather than thinking of, let’s use PECS with all kids in a classroom, or let’s use a activity-specific display with all kids in a classroom, instead what we should think about are what are the communication needs of an individual child in the classroom? And then how can we design AAC systems and supports to meet those needs? 

Natalie Danner: I think that’s a great way of thinking about things. And I’m also thinking of how, especially when, in your block example, of how the words that are on the wall really draw, not only that child into that play space, but allows them access to their peers, and allows their peers access to them in that play space. So it allows them access to both the friendships and access to that play environment with their peers. It’s just this wonderful way of giving them access to that community as well. I’m getting so many ideas from your answers here. Thank you so much.  

Susan Johnston: You’re welcome. 

Natalie Danner: So, as we move on to our next question. I’m curious about when a child should have access to their AAC. So you’ve talked a little bit about within the classroom and within the home, but now I want to talk a little bit about as we move outside of the classroom. So, many teachers have this question about when they move from within the classroom to maybe, as they move into the playground, or they move into the hallway, or they start doing a messy activity like an art project or a meal. How could an AAC device be used in situations like this outside of the classroom? 

Susan Johnston: Yeah, great question. And you know, to answer the first part of the question about when should a child have access to their AAC, I and others believe that a child should have access to their AAC whenever and wherever communication is needed. And so, if communication is needed at home, at school, outside, on the playground, in the community, in the bathroom, on the bus. If communication is needed, then we need to find a way to make sure that AAC is available and accessible to the child.  

And one way to determine when communication is needed is to observe same-age typically developing children. And those of us who get to hang out with a lot of preschool-age children know that preschool-age children communicate all of the time. They’re working on their receptive and expressive, understanding language and using language all of the time. From the time they wake up in the morning when they’re picking their clothes, and expressing preferences at breakfast, and talking about how excited they are about what’s happening during the day, to school time, to after school, when they’re at the park, to the evening when they’re tired, and they want to cuddle, and tell their mom or dad that they wanna spend some time cuddling, or to tell their sibling that they want the sibling to stop bothering them.  

So, communication with preschoolers happens literally from the time they wake up until the time they go to bed, and it’s our responsibility to make sure that preschoolers who use AAC have access to communication during all of those times. And so when we think about times, like you mentioned Natalie, playground and hallway and messy activities, the AAC must be available during those times. And what we wanna think about, are what are some opportunities for them to use AAC? And how can we make that AAC accessible? So the opportunities, for example, on a playground, there’s opportunities for preschoolers to request. You know, “I wanna turn. I want to swing. I wanna go on the slide.” There’s opportunities for them to initiate, to say “Hi,” or to ask a friend, “Do you wanna play together?”  

There’s also opportunities for them to comment. You know, if a child goes down a slide really fast, being able to say “that was awesome!” In the hallway, you know, opportunities walking up and down a hallway. There’s opportunities to communicate by saying, “Hi!” To say, “excuse me.” We need to recognize that in the hallway, many times those opportunities are kind of very fast. They’re kind of driven by communication. So we wanna make sure that the child has easy access. Maybe to a switch that says, “Hi, how you doing” as they pass by, which is very similar to how you and I interact when we see people passing in a hallway.  

During messy activities, so many opportunities to communicate. Many preschoolers simply love messy activities; the messier the better. And so those are prime opportunities for communication to occur for kids to say “Yucky,” or “this is fun,” or to make choices about the type of, or color of paint, or the paint tool that they’ll be using. And the same at meal time. And so what we wanna think about are, if the child’s gonna have access to AAC, from the time they wake up until the time they go to bed, we want to simply make sure that if the device needs to be mobile, how can we make it mobile?  

So things like making sure that the AAC device is portable, or has a carrying strap, or has an easy way for a child to access their system from, you know, a fanny pack that they might have with them during the day. And also making sure that during messy activities and outdoors activities that the AAC system is durable. And so, thinking about how to make the AAC system resistant to environmental factors and easy to clean.  

So, for example, you know, if you’re at a swimming pool with a child, you might think about having, again, a multimodal AAC system. So maybe when they’re at the pool they have their communication board is laminated with that hard laminate, or it’s in those waterproof pouches that a lot of us use when we’re at the ocean with our iPhones and our tablets. So that they can, the child can still access AAC during all of these different opportunities.  

And it’s so important because we use and young children use their communication all day long. And that’s how young children who are verbal language users become proficient in verbal language. So if we want AAC users to become proficient with their use of AAC, we need to provide them with that same opportunity. And those powerful learning opportunities to utilize their communication systems. 

Natalie Danner: So it sounds like it’s very important for a child to have consistent access to their AAC. Is that right? 

Susan Johnston: It is so important, Natalie. 

Natalie Danner: So, what are some of the benefits of AAC that you’ve seen with young children? 

Sarah Johnston: Yeah, you know, some of the benefits that I’ve seen are that when we provide children with access to AAC, it facilitates attachment. And so, using AAC when we think about AAC being used between a child and their caregiver, those opportunities for communication to occur really facilitates that attachment. And you know a child being able to use AAC to say, “I love you” to Mom or Dad or other caregivers is such an important message and such an important attachment opportunity. It promotes social engagement with peers. As we’ve mentioned before, it reduces frustration, and then, equally important, it allows young children and preschoolers to actually participate in the learning activities that are occurring in the preschool classroom. 

Natalie Danner: So, how do you see AAC making an impact on friendships and on a child’s sense of belonging? And do you have any encouraging examples of AAC use that you’ve seen on the playground or during lunch that you’ve seen related to friendship? 

Susan Johnston: You bet. You know, some of the ways that I’ve seen AAC make an impact on friendships is that it facilitates communication with peers. And we know that through communication and interaction, that’s how friendships developed by kind of recognizing shared interests and shared experiences. It also promotes joint play and activities. So it gives kids who use AAC an opportunity to engage with their peers.  

AAC also boosts self-esteem and confidence. And you know, we know that fostering a positive self-image and a greater willingness to engage socially is so critical to a child’s sense of agency and self-esteem, and AAC can really provide that support for students who have communication challenges. And finally, AAC simply strengthens friendships. When children are able to engage in meaningful interactions with each other, it strengthens social bonds.  

Some examples that I’ve seen that have been really meaningful include teaching a child who uses AAC to initiate interactions into play groups. So providing an AAC user a way to say, “Can I play too?” and we’ve done that with some of our research. And what we’ve learned is once the child who uses AAC enters into the play group by saying, “Can I play too?” then the magic really happens. Because now they’re there, present and engaged, and that’s where kind of the fun happens. The children are engaged, and the friendships developed.  

I will say it’s also important to ensure that AAC users have a way to invite others to join and play with them. So, providing an AAC user with a way to say, “Come sit by me,” or “Do you wanna play with me?” I think oftentimes we provide support to children with disabilities, and they oftentimes are the recipients of that support. But I think we can really empower AAC users by allowing them to be the ones to provide that support by offering to other peers an opportunity for them to play with them. So those are a couple of examples that have really shown the power of AAC in supporting friendships and engagement with peers. 

Natalie Danner: I love those examples, and it really shows that communication is key in both building those friendships and promoting play with their peers. So I love that. And finally, is there anything else you’d like to leave our listeners with regarding AAC and young children’s friendships? 

Susan Johnston: Yeah, I guess I’d just like to conclude by emphasizing that AAC plays a really critical role in fostering and supporting young children’s friendships. I think we oftentimes think about using AAC to overcome communication barriers. But we may not think about the collateral impact of supporting the child’s communication on things like friendship and feeling a part of community. You know AAC supports play and learning, which is so critical in early childhood. And it’s through play and learning opportunities that friendships develop and that the opportunity for children with disabilities to kind of gain communication confidence also develops. And that confidence is really foundational to building and sustaining friendships, because it positively influences those social interactions. 

Natalie Danner: Wow! So many tips have been shared here about AAC. So, thank you Dr. Johnston, for being our guest on the Illinois Early Learning Podcast. 

Susan Johnston: You are very welcome. Thank you again for the invitation. 

Natalie Danner: So until next time, thank you and keep early learning at the forefront. 

You have just heard a podcast by the Illinois Early Learning Project. For more information, please visit us at illinoisearlylearning.org where you can find evidence-based, reliable information on early care and education for parents, caregivers, and teachers of young children. Thanks for listening and for helping the children in your home, classroom, and community have a strong start in their early learning. 

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