Manual AAC For Caregivers 2019

MANUAL
Contents
Introduction ................................................................................................................. i
Strategy 1 Aided Language Stimulation .................................................................. 1
Strategy 2 Following Your Child’s Lead (4Ls) ......................................................... 3
Strategy 3 Teaching Core Vocabulary .................................................................... 5
Strategy 4 The Art of Waiting .................................................................................. 7
Strategy 5 The Hierarchy of Prompts ...................................................................... 9
Strategy 6 Our Daily Routine ................................................................................ 11
Strategy 7 Personalizing Your Child’s Voice ......................................................... 13
Strategy 8 I Always Have My Voice ...................................................................... 15
Manual - AAC for Caregivers
Introduction
Alternative and Augmentative Communication (AAC) refers to all forms of
communication that enhance or supplement verbal speech or writing. It is an
internationally recognised area of clinical and educational practice that attempts to
compensate, temporarily or permanently, for significant speech, language, and writing
disabilities (NIDRR Consensus Statement, 1992).
The AAC for Caregivers program was borne out of the strong conviction that AAC has
to be implemented at home and in other natural settings for real success. The AAC for
Caregivers material has been used with caregivers who support individuals who use
AAC in one-on-one and group settings. The group facilitation approach saw caregivers
coming together in small groups to learn, discuss and share their experiences of using
the AAC strategies with each other.
This resource is produced by the Specialised Assistive Technology Centre (ATC),

SPD in conjunction with their AAC for Caregivers program. SPD is a charity in
Singapore set up to help people with disabilities of all ages to maximise their potential
and integrate them into mainstream society. The Specialised ATC in SPD conducts
assessments and intervention for people with disabilities who need Assistive
Technology to live, learn, work and play. They also provide training for caregivers and
professionals who actively engage with persons with disabilities. For more information
about the AAC for Caregivers program, please email [email protected].
This resource can be used as a manual or as separate handouts for caregivers or

professionals working with individuals who use AAC. You can…
 Download the manual and try out the strategies with your child/ the individual
under your care
 Guide caregivers through strategies in this manual and follow up with them in
AAC intervention sessions
There are eight strategies covered in this manual:

1. Aided Language Stimulation
2. Following Your Child’s Lead
3. Teaching Core Vocabulary
4. The Art of Waiting
5. The Hierarchy of Prompts
6. Our Daily Routine
7. Personalizing Your Child’s Voice
8. I Always Have My Voice
i
These strategies have been trialed and adapted to the local Singaporean context.
There are also suggestions for where, when and how to use the strategies. As this
manual was developed in Singapore, illustrations and video examples are relevant to
Singapore, Malaysia and possibly the South East Asia region/ culture. The strategies
are designed to provide caregivers with a set of practical tools to be able to facilitate
more effective communication with their children/ individuals under their care. The goal
is better, stronger relationships through more effective communication!
‘For my kids to be able to use AAC, is worth more than striking Toto (lottery). I am very
happy! Within a few months they learned so much. Through AAC for Caregivers, we
caregivers have really benefited from learning together’
– Vivian, mother of Anders and Jonas, twins who use AAC
Written and compiled by:

Deborah Yong Xinyi, Speech-Language Therapist, ATP
Acknowledgements
Deborah would like to thank everyone in the Specialised Assistive Technology Centre,
SPD for their ongoing support and guidance in realising AAC for Caregivers. She
gratefully acknowledges Sarah M. Yong for her valuable contribution. This resource
was also made possible by the generous #ISAAC2018 Conference AAC Lightning
Pitch cash prize, supported by @ISAACinternational and Deakin University.
Please note: throughout this manual ‘the individual’ will be referred to as ‘he’.
ii
Strategy 1 Aided Language Stimulation

WHAT
Aided Language Stimulation is an approach in which the facilitator points out picture
symbols on an individual’s communication display in conjunction with ongoing
language stimulation. Through the modeling process, the concept of using the pictorial
symbols interactively is demonstrated for the individual.”
– Goossens’, Crain, & Elder (1992)
WHY
Individuals who use AAC require models to learn how to communicate effectively.
Just like how a child learning how to talk has models in the form of adults, siblings and
peers who talk to him, an individual learning how to use his AAC system requires
models too. This means that communication partners should use the same AAC
system when communicating with the individual who uses AAC.
Image taken from Gayle Porter, 2004
1
HOW
1. Make sure that the individual is attending to the AAC device. Get down to the
individual’s eye level if needed!
2. Create a message with the selected icons and repeat it verbally to the individual.
We need to OPEN (point to the symbol for OPEN)
the BAG (point to the symbol for BAG)
and PUT the DUMPLINGS IN (point to the symbol for PUT, DUMPLINGS, IN)
the BOWL (point to the symbol BOWL).
To better understand how to provide Aided Language Stimulation, visit the following
link to view a video starring Lim En Ting and family: https://bit.ly/2KBG6Ze
Siblings make great communication partners too as they can provide Aided
Language Stimulation and are great fun to be with!
WHEN
I will try to use Aided Language Stimulation in…
Situation 1:
_____________________________________________
Situation 2:
_____________________________________________
REFERENCES
Goossens’, C., Crain, S., & Elder, P. (1992). Engineering the Classroom Environment for Interactive Symbolic
Communication – An Emphasis on the Developmental Period, 18 Months to Five Years. Birmingham, AL:
Southeast Augmentative Communication Publications.
Porter, G. (2004) Young children developing language using AAC, AGOSCI National Tour, Australia
This handout is part of an information package produced by the Specialised Assistive Technology Centre, SPD in
conjunction with the AAC for Caregivers program. For more information, please email [email protected]
This handout may be reproduced for teaching purposes/use with clients and families.
© Specialised ATC, SPD 2019
2
Strategy 2 Following Your Child’s Lead (4Ls)

WHAT
Following Your Child’s Lead is a strategy in communication that suggests being
present, observant & responsive to your child. This is as individuals of all ages have
their own agendas, including the individual who uses AAC. We all learn best when we
are interested in something.
WHY
Features of this minimally intrusive model have been shown to effect language
development in the following areas
- the advancement of children’s vocabulary, morpho-syntax, semantic and
pragmatic skills (Wong et al., 2012; McDuffie & Yoder, 2010)
- improved parental language facilitation skills (Kim & Mahoney, 2004)
- generalisation of intervention outcomes (Roberts & Kaiser, 2011)
HOW
at what the individual is interested in and the

gestures they use
to what they say with their communication

system/ word approximations
about their interests and hopes
the way in your caregiver-child interaction
3
Let’s live out the 4Ls!
WHEN
I will try to follow my child’s lead in…
Situation 1:
_____________________________________________
Situation 2:
_____________________________________________
REFERENCES
Wong, T.-P., Moran, C. & Foster-Cohen, S. (2012). The effects of expansions, questions and cloze procedures on
children’s conversational skills. Clinical Linguistics & Phonetics 26(3): 273-287.
McDuffie, A. & Yoder, P.J. (2010). Types of parent verbal responsiveness that predict language in young children
with autism spectrum disorder. Journal of Speech, Language and Hearing Research 53(4): 1026-1039.
Kim, J.M. & Mahoney, G. (2004). The effects of mother’s style of interaction on children’s engagement implications
for using Responsive Interventions with parents. Topics in Early Childhood Special Education 24(1): 31-38.
Roberts, M.Y. & Kaiser, A.P. 2011. The effectiveness of parent-implemented language interventions: A meta-
analysis. American Journal of Speech-Language Pathology 20(3): 180-199.
4
Strategy 3 Teaching Core Vocabulary

WHAT
Core Vocabulary
- refers to words used with high frequency
- are vocabulary that make up about 75-80% of the words we use everyday
- should be a main part of all AAC systems because it allows for most flexibility
across most situations
- examples include: I, WANT, HELP, OPEN, MORE, LIKE, GO, STOP, IN,
YES, NO
Fringe Vocabulary
- is used in a continuum of low-frequency to lower frequency situations (e.g.
‘kopitiam’, ‘Redhill MRT station’)
- includes personal vocabulary for individual needs, interests, work, school, or
even community
WHY
Core Vocabulary allows individuals to communicate across all situations, in all settings,
and with all their communication partners. Intentional teaching of core vocabulary in
the home setting or in daily routines can help individuals learn to use core vocabulary
for more effective communication.
HOW
5
Teaching Core Vocabulary OPEN

Steps (Zangari, 2012) My plan
1 Introduce the new I will ensure that the individual is looking at the AAC
word(s) using focused device when I provide Aided Language Stimulation. E.g.
AIDED language OPEN THE BOTTLE, OPEN THE DOOR
stimulation
2 Teach the new I will emphasize the word OPEN by using a slightly
word(s) with explicit louder tone and exaggerating my movements while
instruction activities; turning the bottle cap or opening the car door
3 Elaborate on the new I will also model the word OPEN when opening the
word meanings with refrigerator/ cupboard to retrieve the individual’s
engaging practice favourite foods or opening a drawer to access a
activities; favourite toy.
4 Provide repeated I will repeat OPEN daily and use OPEN in different ways
exposure to the new – including opening an app on the iPad and going to a
word(s) on an shop that is OPEN.
ongoing basis; and,
5 Check for I will monitor if the individual understands OPEN and
understanding and responds accordingly in our interactions at home. I will
reteach, as necessary. also observe if the individual starts using OPEN
independently.
WHEN
Core Vocabulary 1: I will try to teach ________ in…
Situation 1: ________________________________
Situation 2: ________________________________
Core Vocabulary 2: I will try to teach ________ in…

Situation 1: ________________________________
Situation 2: ________________________________
REFERENCES
Zangari, C (November 3, 2012) Vocabulary Instruction In AAC [Web log post]. Retrieved Nov 21, 2018, from
http://praacticalaac.org
6
Strategy 4 The Art of Waiting

WHAT
Everyone who uses AAC needs enough time.
Caregivers and communication partners need to provide enough of it for the person
using AAC to
- claim their turn in the conversation
- process what was said and what they want to say
- compose their message
Provide a wait time (up to 45 seconds) to support people who use AAC to claim more
conversation turns and use more words (Mathis, 2010).
WHY
In AAC intervention, sometimes a pause is more powerful than anything we can do or
say. It is more effective than us repeating or rephrasing, because those can interfere
with processing. Waiting is also more helpful than a question or a command, because
overuse of those can build prompt dependency or learned helplessness (Zangari,
2014).
HOW
1. Wait for the individual to talk, don't say a word, and keep looking at them.
2. Show how interested you are (you can arch your body towards the individual).
3. Count in your head (One a thousand, Two a thousand…). That may feel like a
long time, but it is okay.
7
Note: At the Specialised ATC, Clinical Manager Sarah Yong has found that it is often
when the silence becomes awkward and she feels pressured to say something that
the individual initiates a conversation/ takes their turn.
Wait! Because magic can happen.
WHEN
I will practice the Art of Waiting in …
Situation 1:
_____________________________________________
Situation 2:
_____________________________________________
REFERENCES
Mathis, H.J. (2010) The effect of pause time upon the communicative interactions of young people who use
augmentative and alternative communication (Master’s thesis). Retrieved from Dissertations and Theses
database (UMI No 3248)
Zangari, C (July 29, 2014) On Not Talking [Web log post]. Retrieved Nov 21, 2018, from http://praacticalaac.org/
conjunction with the AAC for Caregivers program. For more information, please email [email protected] .This
handout may be reproduced for teaching purposes/use with clients and families.
8
Strategy 5 The Hierarchy of Prompts

WHAT
Prompts support us in remembering what to do and are adapted to our needs. They
ensure that learning takes place and goals can be achieved. This is true of using AAC
to communicate too.
As the individual’s abilities improve, the amount and type of prompts needed decrease.
Therefore, we follow a hierarchy of prompts to ensure we are always working towards
maximizing the individual’s independence with that particular skill. (Rocky Bay, 2010)
WHY
We often naturally use prompts to help our children achieve success in AAC because
they are still learning how to use their AAC system to communicate.
However, we need to consider the danger of prompt dependence and learned
helplessness. We have seen too many individuals who use AAC seek prompts even
though they are able to do it independently.
In daily communication, we utilise the least-to-most prompting sequence.
HOW
Wait for him to talk, don't say a word, and keep looking
at him. Show how interested you are. Count to five in
your head. It may feel awkward at first, but it is okay.
If there is no initiation, glance down at/ touch his talker
(AAC device) and smile encouragingly. This is a
reminder, that he should be taking his turn.
Make a general statement. You can also ask 'Do you
have something to say?'
Be more direct or use Partner Assisted Scanning (read

out and point to a few choices to suggest to the
individual what he can say).
Tell the individual what to say and point to that particular

symbol.
Physically take the individual’s hand to touch the symbol

for play.
9
WHEN
I will practice using the Hierarchy of Prompts in …
Situation 1:
_____________________________________________
Situation 2:
_____________________________________________
REFERENCES
Rocky Bay (October, 2010) Prompting Techniques to Support AAC Use [Web log post]. Retrieved Nov 21, 2018,
from: https://www.rockybay.org.au/
10
Strategy 6 Our Daily Routine

WHAT
The daily routine the individual has is the best place to start looking for opportunities
to put into practice all the AAC strategies you have learnt so far. Just like us, they
become proficient in activities they do every day!
WHY
Skills learnt in AAC intervention sessions are often not well generalized into the daily
lives of people who use AAC. Research by Raab & Dunst (2004) and Jung (2007) has
shown that early intervention services provided in natural environments more
effectively promote children’s development than traditional intervention models
provided in clinic offices or specialized programs.
When care providers use daily routines as the context for a child’s developmental
interventions, they can integrate them into natural activities without disrupting the flow
of what children are doing and learning (Csikszentmihalyi, 1998). This also helps to
ensure that the individual gets plenty of Aided Language Stimulation, teaching and
opportunities to communicate. It is also a good place to look out for vocabulary to put
into the individual’s AAC system! Our ultimate goal is for individuals who use AAC
to demonstrate autonomous communication in all settings.
HOW
11
1. Think through the individual’s daily routine and fill up the table below (3 examples
have been provided). Attach a separate sheet of paper for extra space to complete
the table.
2. Decide on the best times to practice your strategies at home

Strategy Recap: Aided Language Stimulation; Following Your Child’s Lead; Teaching
Core Vocabulary; The Art of Waiting; The Hierarchy of Prompts
Time Activity Strategies Comments
9am Breakfast -Aided Language Morning Greetings: GOOD MORNING WEI YI
Stimulation
Talk about breakfast choices: WE HAVE PORRIDGE OR
KAYA PUFFS FOR BREAKFAST. WHICH ONE WOULD
YOU LIKE?
10am Play time -Aided Language I will take out a bunch of toys and see which toy Wei Yi
Stimulation chooses. I will model language around that activity. I will
attempt to comment about her play.
-Follow Your
Child’s Lead
12pm Lunch -Aided Language LUNCH IS READY. TIME TO EAT!
time Stimulation
I will model the word EAT in a sentence and then repeat
- Teaching Core EAT occasionally when I bring my spoon to my mouth. I
Vocabulary will also exaggerate my chewing slightly. I will repeat this
again during snack and dinner time.
3. Think of the difficulties you may face and how to overcome them
WHEN
I will try strategies 1-5 in parts of my daily routine. I will start with the following routines:
Routine 1: ____________________________________
Routine 2: ____________________________________
REFERENCES
Csikszentmihalyi, M. (1996). Creativity: Flow and the psychology of discovery and invention. New York: Harper
Perennial
Jung, L.A. (2007). Writing individualized family service plan strategies that fit into the ROUTINE. Young Exceptional
Children, 10(3), 21-27.
Raab, M., & Dunst, C. (2004). Early intervention practitioner approaches to natural environment interventions.
Journal of Early Intervention, 27, 15-26.
12
Strategy 7 Personalizing Your Child’s Voice

WHAT
Personalizing Your Child’s Voice refers to editing the individual’s AAC system to
make it their voice.
It may involve the following…
1. Inserting information about the individual in the folder ‘About Me’
2. Adding important names, specific words, personalized social phrases etc to
the individual’s AAC system
3. Changing the voice, speech rate, number of rows required for the message
bar etc on the individual’s AAC system
4. Co-constructing personal stories to share with others
The individual who uses AAC should be involved in the process too by determining
the placement of additional symbols/ preferred symbol for a certain word/ speech
rate etc.
13
WHY
A personalized AAC system is important so that the individual is able to communicate
his needs efficiently and for him to realize that using AAC is fun! It helps reinforce the
fact that the AAC system is indeed his voice!
Caution: Good AAC systems come with research-based core word vocabularies
designed for individuals who use AAC. It is suggested that with robust AAC systems,
editing of the AAC system can focus on the 4 areas suggested under the ‘WHAT’
section and movement or deletion of core words and the general template should be
avoided if possible. This is as it will affect motor planning in accessing the AAC system
and may affect efficacy of Aided Language Stimulation by professionals in a group
setting (due to the huge difference in an individual’s AAC system when compared to
the general template of the same AAC system). Do review why we provide Aided
Language Stimulation in the first place!
HOW
1. Find out from your AAC team on how to edit the AAC system
2. Search for the AAC system manual online and refer to it (if applicable)
3. Add a button in the AAC system that says ‘Please add a word to my device’.
The individual who uses AAC should be taught how to use the button effectively.
WHEN
I will start to personalize my child’s AAC system by…
(Tick all that apply)
□ Inserting personal information in the folder ‘About Me’
□ Adding important names, specific words, personalized social phrases etc
□ Changing the voice, speech rate, number of rows required for the message bar
etc
□ Co-constructing personal stories with my child to share with others
14
Strategy 8 I Always Have My Voice

WHAT
I Always Have My Voice refers to the individual having his AAC system with him at all
times! This includes school time, outdoor play time, mealtimes and the list goes on.
This strategy requires us to ensure that the AAC device gets charged when the
individual is not using it or attaching a power bank to it. It also means that even if the
individual is repeatedly pressing buttons on his AAC device instead of listening in class,
you should teach him to use a ‘quiet voice’ (just like how you would with other neuro-
typically developing individuals) and not take the AAC device away from him.
WHY
Just as you shouldn’t (and can’t) take away an individual’s voice, you shouldn’t take
away an individual’s AAC device. This ensures that they always have a voice in any
situation and allows them to seize any communication opportunity that comes up.
If the individual is using sign language, you don’t need to worry about it because his
hands are always there. However, if the individual is using picture symbols or a device
of some kind, you will want to make sure the device is with him and functioning at all
times (Clark, 2013).
15
HOW
1. Refer to the individual’s routine in the handout - Strategy 6 (Our Daily Routine)
2. Plan how the individual can carry his voice or retrieve his voice independently
in all situations
3. Think of possible hurdles to the individual carrying his voice wherever he goes
4. Come up with a plan on how to tackle the hurdles when they happen
WHERE
A) Indoors
How will the individual retrieve his voice independently/ always have his voice?
Solution:
___________________________________________________________________
___________________________________________________________________
B) Outdoors
How will the individual carry his voice?
Solution:
___________________________________________________________________
___________________________________________________________________
REFERENCES
Clark, C (March 12, 2013) Teach your child to use an AAC device [Web log post]. Retrieved Nov 21, 2018, from
https://www.speechandlanguagekids.com
16
CONGRATULATIONS!
You have now learned 8 strategies that can be used to support communication with
your child/ the individual under your care.
Do always remember
1) to encourage autonomous communication
2) to support full and effective participation (in your child's various social roles)
3) to trust that you have what it takes to be your child's best advocate
“If all my possessions were taken from me with one exception,

I would choose to keep the power of communication,
for by it I would soon regain all the rest”
― Daniel Webster
17

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MANUAL

This resource is produced by the Specialised Assistive Technology Centre (ATC),

This resource can be used as a manual or as separate handouts for caregivers or

There are eight strategies covered in this manual:

Written and compiled by:

Strategy 1 Aided Language Stimulation

Image taken from Gayle Porter, 2004

Strategy 2 Following Your Child’s Lead (4Ls)

at what the individual is interested in and the

to what they say with their communication

about their interests and hopes

the way in your caregiver-child interaction

Let’s live out the 4Ls!

Strategy 3 Teaching Core Vocabulary

Teaching Core Vocabulary OPEN

Core Vocabulary 2: I will try to teach ________ in…

Strategy 4 The Art of Waiting

Strategy 5 The Hierarchy of Prompts

Be more direct or use Partner Assisted Scanning (read

Tell the individual what to say and point to that particular

Physically take the individual’s hand to touch the symbol

Strategy 6 Our Daily Routine

2. Decide on the best times to practice your strategies at home

Strategy 7 Personalizing Your Child’s Voice

Strategy 8 I Always Have My Voice

“If all my possessions were taken from me with one exception,

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