For most people, the ability to talk is taken for granted.
Unless you have struggled with speech yourself or have a family member who has struggled with it, you don’t necessarily understand the hardship involved. When a person can’t communicate in a way others understand, there is frustration… on both ends. If a mode of communication is never established, this frustration can lead to the person having no desire to communicate. If, no matter what you do, someone isn’t going to understand you, you eventually stop trying, and many patients who are nonverbal or have highly unintelligible speech do just that.
When a highly unintelligible or nonverbal child sees a speech therapist for the first time, their world changes. They are now sitting in front of a person who is trained to understand them. We figure out patterns in their speech, how they are using their body language, what their sounds mean… because there are a lot of things that go into communication that don’t involve words. But not everyone they encounter will be a speech therapist, so they need other options.
Most children will (eventually) grow to become verbal communicators, but what about the children who take much longer or who will never gain the ability to speak?
What do you do for them? For those children, we try an augmentative-alternative communication (AAC) device. An AAC device can be anything that is used to help a person communicate; it can be as simple as a communication board or book or as high-tech as an electronic device which generates speech and/or written output. The types of AAC devices are endless.
Recently, I did an AAC evaluation on a patient who is considered nonverbal.
When I first started working with Ava, her communication included knocking me out of the way to get to the item she wanted. When she wasn’t able to get to it, she clearly communicated her displeasure by “yelling” at me. Her “yelling” included loud grunts that were usually accented by her hand hitting the table. There was no way that I did not understand her message. She was mad. However, this was not a good way to communicate and something needed to change.
Because I needed to know what Ava wanted (without getting knocked over), we moved to yes/no buttons. This simple option created both a way for her to show her interest and a way for me to figure out what she wanted. Essentially it allowed her to say “Yes, I want that” or “No, I don’t want that.” It was a tough start because she didn’t understand why I kept putting these buttons in front of her so she would just push them away. In her view, it was so much quicker for her to go and get the item herself. But with persistence and thankfully very few bumps along the way, she started to get it. Her mom was ecstatic! In fact, Ava’s mom has allowed me to share her Facebook post about it:
I just witnessed something amazing with Ava’s speech therapy. Ava was able to answer appropriately “yes” or “no” with the help of push buttons to receive her preferred items. I know it seems like nothing but I have waited 9 years to see Ava be able to communicate. Answering simple yes or no questions was unheard of for Ava. Thank you, almighty God, for hearing our prayers and blessing me with this today. It was amazing to see.
It is as if something inside of Ava clicked. She started pointing to items and then pushing yes. The yes/no push buttons were a lot better than knocking me down, but eventually she grew impatient – she wanted even faster communication. She didn’t want to wait for me to pull out each item to only figure it out through the process of elimination. At that point, I knew we needed a more advanced communication system and we needed to do it fast.
Christine, a consultant from Prentke Romich Company (PRC), a provider of AAC devices, came into our office to assist me with the AAC evaluation and showed us some of PRC’s options. All of the options consisted of an electronic device that generates speech, but different options exist for operating the device. The user can make word choices using their pointer finger, an eye gaze tracking device, switches, or a joystick, among others (if you’ve ever watched the ABC comedy Speechless, the character of JJ – played by Micah Fowler, an actor with cerebral palsy – uses an AAC board with a laser pointer that he wears on his head, although his board produces written words and he has an aide who reads from the board).
We went through several different items to see what Ava preferred.
After going through eye gaze and touch items, we tried out the switches. Switch systems are ideal for patients who have auditory attentiveness but not visual attentiveness or those who may be unable to use their pointer finger well enough to choose their word. The board is outfitted with two switches; the first one scans through the available options and the second switch is used to confirm the word once you’ve selected it. There is a voice for “scan switch” for the first switch and a voice for the “confirm switch,” and it’s pretty easy for the patients to catch on to the difference between the two.
Since the switches seemed like the best option for Ava, we decided to model it for her. We were playing with toys and Ava was doing really well at using the switches to tell us “more” but we weren’t quite sure how well she understood the switches at that point. It was possible she was simply following our lead. We’d been working for about 30 minutes and as I said before, Ava can be impatient. While Christine and I were discussing the pros and cons of the device, Ava took the switches and pushed the scan switch until she heard “go,” hit the confirm switch, then got up to go sit in her stroller.
Christine and I were stunned.
After we got over our shock and processed what just happened, we were thrilled! We both knew that a breakthrough like Ava’s doesn’t just happen – it was a truly great moment for Ava. She just communicated and did it in such a way that no one could mistake what she wanted. She not only put us in our place (for not paying attention to her) but proved to us a person’s communication needs – and abilities! – should be continuously reevaluated.
It had taken Ava just under a year to use the yes/no buttons correctly. When we brought in the switches I was hopeful that she would be able to use them, but braced myself for the amount of training that would need to go into it in order for Ava to start to use it independently. It can take weeks and even months of training for our patients to do learn to use an AAC device. I have never had a patient just pick up the switches and use them appropriately on the first try.
Never stop evaluating options in communication.
You never know when someone will “pull an Ava” and blow you away with what they are able to do. She had more comprehension and potential to communicate than anybody in that room would have ever realized.
If you’re interested in learning more about the various types of AAC devices and how they might help your child with limited speech ability, contact us by phone (770-888-5221) or email (firstname.lastname@example.org) for an evaluation.
Jessie Nelson Willis, M.Ed., CCC-SLP