Before We Jump to AAC...

So many affordable and glamorous choices are available these days for the iPod Touch and the iPad, that it is difficult for many to resist giving them a try. Previously, as stated in my prior article, parents or treatment/education teams had to go through a lengthy and comprehensive process to match the technology to the individual and to secure funding.
With the new availability, we are at risk for selecting electronic AAC too soon or for selecting electronic AAC solutions that are not appropriate for the child. Below are some of the factors we must consider before choosing to use an electronic AAC solution.

•  Does the child show communicative intent? For example, does he or she reach to be picked up, wiggle or bounce to request continuation of a knee-bouncing song or movement activity, etc.? If no, do not begin AAC.
• Does the child direct communication to a communication partner, or communicate "to the air?" A child who says an approximation of "juice," for example, may not intend it as a message to an individual, but rather may have learned that upon that utterance, juice appears. This is an example of a child who should not have electronic AAC. Picture Exchange Communication (Pyramid Educational Solutions) is more appropriate for such a child, as it teaches him or her to seek out communication partners.
• What kind of system is needed to support language development? If the child has clear understanding of language structure and has sufficient receptive vocabulary, the choice will be different than for an individual who needs language development support. This question, to be answered correctly, really must be investigated and supported by a speech and language pathologist with experience in AAC.
• What level of symbolic representation can the child comprehend? 
• Does the child require object-based transition support? AAC, unless object-supported, is not appropriate.
• Does the child comprehend photo-based representation? Line drawings? Boardmaker-type symbols? Text? Be sure to match the symbolic representation format to the level in which the child has fluent, automatic recognition. In other words, if the child's comprehension of a symbolic level is emerging, back down to a more concrete level (text may be paired at any point unless it is distracting). Do not use AAC or, for that matter, schedules, as a vehicle to teach a level of symbolic representation.

• Are the individual's fine motor skills compatible with the device? Some solutions, such as those on an iPod are too small. If a child cannot modulate or coordinate touch, the iPod/Pad solutions are not appropriate. For example, some individuals tap, push too long or too hard, slide or miss the buttons altogether. Some individuals require a key guard or even a switch interface to support motor precision. An occupational therapist should be involved if there are questions regarding access.
• Is the individual's vision sufficient to support the use of picture-based AAC? Are vision skills such as tracking appropriate to support efficient use of the technology? An occupational therapist should be able to assist with evaluating the efficiency of vision skills. An opthamologist should be consulted to test acuity, especially with children who are unable to participate in traditional screening activities.
• What is the field (number of buttons) the child can manage? One thing at a time? Two? Multiple? How many? What size?

This is by no means an all-encompassing list, but should convince the reader of the importance of involving a speech and language therapist and either an occupational therapist or an AAC specialist before making the decision to use an electronic AAC device.