AAC in ASD:
Three Journeys from
Assessment to Outcomes
Gwendolyn Meier, SLP, MT
Speech Pathologist, Music Therapist
gmeier@villaesperanzaservices.org

Wednesday, February 5, 14

Find the companion AAC Goal Bank and
timeline handout at www.scaacn.blogspot.com
ATI 2014 page


Gigi

Nicolas

Student photos removed for posting online
in the interest of privacy

3 Students with ASD
• Assessment
• Goals
• AAC Therapy
• Progress
• Outcomes

Gigi

Communication Goals
2010-2011
1. Respond using picture communication
book with phrases “I have ___”, “I see ___”,
“I want ___”, “I am ___”
2. Indicate a need/want by constructing a
phrase strip “I want ___ please” with
attributes (color, numbers 1-5), concepts
(big/little), travel, deliver message
3. Given the question “Is this a ___,” answer
yes/no using her picture book
4. Identify emotions in a ﬁeld of four pictures

60 min
individual/
week

1st order of business:
Picture Communication Book


30-day IEP, 5/2011
1. “I have ___”, “I see ___”, “I want ___”, “I am ___”
1. Given questions (What do you/ the girl/ character names/etc. have?
want? doing?) respond using her picture book with phrases (agent
+action) (action+object) (agent+object) with gesture prompts, 80% as
measured by data/observation.
2. Indicate a need/want by constructing a phrase strip “I want ___
please” with attributes (color, numbers 1-5), concepts (big/little),
travel, deliver message
3. Given the question “Is this a ___,” answer yes/no using her
picture book
4. Identify emotions in a ﬁeld of four pictures
4. Exchange or indicate a single symbol to direct the actions of others
using 10 core vocabulary (e.g., open, in, out, what, go, stop, more, put, that,
on, off, done, take, want)
5. Increase number of manual signs by adding 5 to her baseline for
communicating wants & needs to control her environment

SLP Recommendations
- 5/2011
• 60 minutes individual/week
• 60 minutes consult/month (for picturebased communication)


*District-approved trial*

Requesting, Locating Vocab


10/2011 - Progress
1. 2-word phrases (agent+action) (action
+object) (agent+object)
2. “I want ___ please” for wants/needs and
point to pictures as she delivers the message
3. Answer yes/no to “Is this a __”
4. Direct actions w/one symbol
5. 5 new signs for wants/needs


Proposed -10/11
1.

Given prompting ? 3-component descriptive phrases (e.g.,
agent+action+object) using her picture book
2.

Replace symbols in her communication book according to
category
3.

Search the pages of her book to ﬁnd a named symbol card
and complete a sentence started for her
4.

Answer YES/NO to conﬁrm or deny requests (Do you want
this?) and label objects related to familiar vocational tasks
5.

Create 2- and 3-word phrases to request or direct actions
using 10 core vocabulary phrases (e.g., put in, put on, take off,
open it, I do, you do, etc.)
6.

10 signs to her baseline for communicating wants & needs
to control her environment

Annual IEP, 10/11
•
•
•


AAC Evaluation requested by parent
Assessment plan signed
Conducted by an SLP in the assistive
technology department of her district of
residence

AAC Assessment - 2/12
Statement of Need
Gigi’s
Gigi

• Hearing,Vision, Motor skills within
functional limits

• Behavior - some history of repetitive
movements, some mild self-injurious


Symbol ID Nouns
in F:4-128

Categorization

Symbol ID
Actions, Locations F:8

Syntactic Performance-


Sequence symbol phrases

AAC Evaluation
Genie - $9.99


Symbol ID Nouns
6/6 from F:66
4/6 in F:128

Categorization
16/16 Simple

(transportation, food, clothes,
animals)

0/16 Complex

(people, verbs, things, places)

Symbol ID
7/8 actions F:8
4/8 adjectives & nouns
0/4 (little, big, more, in)


Sequence Symbols into
Phrases
(given a direct model)
4/4, 2-word phrases
0/4 3-word phrases

Literacy Skills
Teacher report:

• Matches letters
• Copies words
• Some spelling during typing activities

Device Trials
• Tobii S32 Touch/Scan
• Springboard Lite 32
• iPad 2 with Proloquo2Go app
• iPad 2 with TouchChat with WordPower app


Tobii S32 Touch/Scan
• Features: lightweight, 32 locations, 192

overlays, digitized voice output, keyguard,
scan accessible


Tobii S32 Touch/Scan
• Not a match for her ability to scan 66+
locations, emerging literacy and
categorization skills


Springboard Lite 32
• Features: lightweight, 36 locations, dynamic

display, pre-stored vocabulary, Unity
Language System, focus on core vocabulary,
digitized and synthesized voice output


Springboard Lite 32
• Not a match. Some difﬁculty with touch
pressure, did not appear to understand
Unity symbols and activity rows


Boardmaker PCS
eat

drink

sleep

Unity Language System

Proloquo2Go
• Version 1.7 (released Nov 2011)
• Features: lightweight; customization options
for number of locations per page, message
window size, space between cells, border
color; 7000 SymbolStix symbol library; 16category locations with page links trialed


Proloquo2Go
• A match!
• Able to access screen through touch
• Produce requesting sequences (I want

more) and sharing opinions (awesome! I
like it) after a brief model


TouchChat with
WordPower
• Features: Similar to PLQ2G 1.7 plus

Customization options, SymbolStix,
Vocabulary packages (MultiChat 15,
WordPower 24 & 42), color coded cell
backgrounds, cell location control, intuitive
navigation, next word prediction

• Not actually trialed

AAC Recommendation
Gigi
Gigi

Gigi


Signs Tracking Sheet


Sign Tracking Key
S
=
Spontaneous
(initiation
of
the
sign
to
request
action
or
item
with
no

prompt
or
following
an
open-‐ended
question,
“What
do
you

want
to
do?”)
I
=
Independent

(shown
a
visual
of
someone
eating,
learner
INDEPENDENTLY

signs
EAT
without
a
direct
verbal
prompt
“eat”)
V
=
Verbal
Prompt

(shown
a
visual
of
someone
eating,
learner
only
enacts
the

sign
EAT
when
given
a
direct
verbal
prompt
“she’s
eating”

etc.)
M
=
Model

(learner
only
enacts
the
sign
EAT
after
you
perform
the
sign)
H
=
Hand-‐over-‐hand

(learner
requires
your
touch
in
order
to
enact
the
sign)


VIDEO:
Indep Multi-word Request

Listen to music


VIDEO: Augmented Input

uh oh...stop...I don’t like it


10/2012 - Progress
1.

3-component phrases (agent+action+object) MET
2.

Replace symbols in communication book EXCEEDED
3.

Search to ﬁnd a named symbol card EXCEEDED
4.

Answer YES/NO to conﬁrm or deny requests NOT MET
5.

Create 2- and 3-word phrases - MET given
MOD cues
6.

10 signs given minimal cues - NOT MET

Proposed - 10/12

“Using her communication system...”
1.

Appropriate greeting (i.e., Hi vs. Bye) with familiar persons
including their name and facing the communication partner
2.

2- and 3-component phrases each in 2 different contexts
(e.g., open it to refer to the cupboard and also the microwave)
to direct the actions of others and/or describe actions
3.

Functional communication statements or questions
appropriate to the scenario (e.g., listen to music, something
else, want water, need bathroom, take a break, etc.)
4.

Given 3 rehearsal trials, navigate two screens to comment;
including making an announcement (e.g., “time to go on a
walk” or “I have a note for the teacher”), a single-button
interjection (e.g., be careful, sorry, oh man!), or sharing an
opinion (e.g., I like that, that’s funny, that’s gross)
5.

ID 4 pieces of personal bio information

!

VIDEO: Core Words to
Request

Put on pink

VIDEOL: Desribe to Request

Look funny dance

10/2013 - Progress
1. Greet using names - MET
2. Direct/describe actions - NOT MET
3. 8 functional phrases - NOT MET (only 3)
4. Making announcements & commenting NOT MET (MOD cues needed)
5. Answering 4 bio questions - MET


Proposed - 10/2013
1.

When asked “What do you want/
need?”...retrieve her communication system and
make a request
2.

(continued) 2- and 3-component phrases: close
it, put it away, turn it on, turn it off to direct the
actions of others and/or describe actions
3.

(continued) functional communication
statements
4.

Comment or answer questions about activities
performed in the classroom setting (academics,
cooking activities, vocational training, etc.)

SLP Recommendation

•
•


90 min/week indiv
540 min consult/year (9 hours)

All students at Villa
Esperanza School
on identical 42location vocabulary
with hidden buttons

2013
Hide Mode


Today

AAC System:Vocalization, gestures, sign,
Sequencer, TouchChat 42 Phase 1
Prompting: Independent for greeting,
requesting, verbal prompt to retrieve
device, visual picture-phrase cards for
core vocabulary

VIDEO: Cooking with
core vocab

Open it, take it out, more

Nicolas

Summer 2011
• Age 6:4, Kindergarten
• 20 Compensatory hours of NPA speech
therapy

• AAC Assessment and Independent Speech
& Language Assessment agreed upon in
mediation with school district


Present Level - Communication
•
•
•
•

Verbal approximations for yes/
no
Primarily uses vowel sounds in
his attempts to speak words
Communicates by pulling or
pointing
50 sight words, matches letters,
some numeral ID
Imitates (approx) of two word
phrases


Behaviors that Impede Learning
•
•
•
•
•
•
•
•

Task avoidance
Non-compliance
Dropping to the ﬂoor
Touching/moving items not
related to lesson
Squeezing others’ hands
Running away from work areas
Eloping attempts (leaving
classroom)
Tantrum behaviors
Taking off shoes

Communication Goals
(2010-2011)
1.

Imitate/spontaneously produce the /m/, /t/, /k/,
and /p/ sounds at the end of CV, CVC words
with 50% accuracy (tactile/verbal cueing
provided).
2.

Sustain joint attention for a period of 5-7
minutes during a clinician directed task
3.

Receptively ID common objects and actions (w/
objects or pics - no more than 3 choices)
4.

Use/imitate head nod/shake or verbal
approximations for YES/NO when asked
questions regarding personal preference (e.g., Do
you want the balloon?) with 70% accuracy with
mild verbal/gestural/tactile prompting provided

Barriers to
Progress in Therapy:
Off-task behaviors are exhibited in transitions and
without close attention (when parent and clinician
are talking) including:
• touch the clinicians’ face, run away, close and
lock doors, climb onto tables, drop to the ﬂoor
or under chairs or tables, pull at or tear the
clinician’s shirt, and remove his own clothing
Functions:

• negative attention seeking
• escape

Behavior Support Plan (Informal)
• Respond to maladaptive behaviors by asking
•
•
•
•

“Do you need help?”
If ‘yes’ (“ess”) provide assistance
If ‘no’ (“oh”) and behavior persists, inform
that “I’m going to help you” and physically
assist him in keeping his hand in his lap
Direct him “quiet hands” and ”tell me when
you’re ready” while giving no eye contact or
attention other than physical cue.
Nicolas will indicate that he is ready and will
again participate in the presented task.


AAC Assessment
•

Conducted by district independent
contractor (trusted colleague)

•

Observed:

•
•
•

•

Classroom, clinic-based speech, home ABA

Extremely little productive work in classroom
Attention seeking and escaping behaviors in
all environments
History of attempts at PECS in home ABA
(played with Velcro) and speech (hit cards on
his chin)

AAC Assessment
•

Fleeting attention and no engagement
with examiner

•
•

No direct assessment due to non-compliance

•
•
•

Used both hands to access iPad screen (games)


Ambulatory with adequate motor skills to
access technology.
Exited apps often, no sustained attention
Reported computer skills (Bailey’s Bookhouse)

AAC Recommendation
• Maximize oral speech

through intensive

instruction

• Strong behavioral program
• Visual Supports (Visual Schedules, Work
Systems, addition of picture supports to
language input)

• Links to Language program
• No augmentative communication system
!

Proposed Goals - 10/2011
1.

Imitate 6 early developing consonant sounds (m, b, w, d, p, h)
in CV and CVC syllables for a set of functional vocabulary
words (e.g., mine, bye, want, don’t, please, hi, etc.) tactualkinesthetic-proprioceptive cueing for oral motor placement
2.

Anticipate and continue 3 of 3 steps within a predictable,
motivating sequence or routine by producing a word or action
spontaneously for 5 routines
3.

Spontaneous requests, object or action label & visual gaze
toward his communicative partner when the desired object or
context for the action is visible in the environment
4.

Respond verbally to conﬁrm (i.e., speak ‘yes’)
5.

Refuse (e.g., “no” or “all done”), protest (e.g., “mine”), or
request an alternate activity (e.g., “ball” while working on a
puzzle) total communication
6.

Point to pictures in books to answer concrete WHO and
WHAT questions

IEP Outcome
•

Independent Speech Assessor NOT in
agreement with AAC recommendation

•

Recommendation for NPS placement (Villa
Esperanza)

•

Agreement that AAC systems will continue to
be trialed in the NPS classroom and services

•

150-min/week individual (30 min daily
sessions) to address articulation
!


AAC Trials @ Villa
•
•
•

GoTalk 9+
GoTalk 20+
iPad with TouchChat

Independent:

•

2- and 3-button messages (2-3 screens)
to request items and activities

Emerging:

•
•

Describe what he sees
Give bio info in response to questions

TC - Initial vocab set, totally custom


AAC Trials (cont.)
• Passive communicator in any mode
(sounds, gestures, iPad)

• Resistant to prompting/assistance (escape
or lose interest)


5/2012, 6-mo Progress
1. ARTIC - 50-70%
2. Sequence actions in routines - 2/3 steps MOD
cues
3. Requesting w/ eye gaze - INDEP in iPad phrase
composition, cues for eye gaze
4. Conﬁrm w/approx. “yes” - MET In sessions
5. Protest, req. alternative - MET
6. Rec WH-questions (Who What) in books MET

Impressions - 5/2012
“Since his admission at Villa Esperanza
Services’ Non-Public School...behavior and
participation in the curriculum has improved
dramatically, and has allowed him access to
provided augmentative aids that incorporate
visual and voice-output support for his
communicative intent.”


1.

ARTIC - goal continued
2.

Gain attention and greet others, using names
3.

2- and 3-word phrases to make requests within
daily classroom activities (e.g., I need pencil, where
chair, do again)
4.

Rec ID person in response to “Who” questions
(e.g., Who do you want to work with?, Who did you
work with? Who is sitting with you? Who do you see?)
5.

ID 5 items of personal/biographical information
6.

ID10 common actions
7.

ID appropriate modiﬁer (e.g., color, size, action, adjective)
and noun to describe pictures
8.

* Follow a verbal instruction delivered to the
class as a group (e.g., everybody line up, it’s time for
music, etc.)
9.

** 3 new oral motor movements

SLP Recommendation - 5/2012
•
•
•
•

iPad 2 with the TouchChat HD app
Protective case
Across all daily environments (school-home)
Continue150 minutes of individual/week (30 per
day)
Add 720 minutes of speech and language
consultation/year

• Programming, training (classroom, home),
implementation support


Answering “Who?”


Moved up to
WP24-ish


VIDEO: 2/13 Intro to Social Scripts


5/2013 Progress
1. ARTIC - MET for /p,b,m,h/ NOT MET for /w,d/
2. Greeting using names - MET Independent
3. Request needed items - MET given prompting question “What do you
need?”
4. Answer “Who” questions about familiar persons - PROGRESSING needs
MOD
5. Bio questions - EXCEEDED, mixes “...brother” and “...father”
6. Labeling actions - EXCEEDED in pics
7. Rec ID modiﬁer - MET for colors, big, little, open,close; PROGRESSING for
good, bad, yummy, gross, cool, clean, dirty, hot, cold, pretty
8. * Follow group instruction - MET
9. ** Non-speech oral motor movements - MET added suck, blow for 2-3
seconds, close lips on tongue depressor

Triennial Testing - 5/2013

• Expressive, pragmatic, and articulation skills
were assessed informally


Triennial Testing - 5/2013
• Uses eye gaze alone when needing help
• Requires verbal prompt “What do you
need?” to initiate requests

• Agent + action sentences
• Uses he/she accurately
• Picked up plural -s
• Recently started scripts for errands
• Cues for pragmatics in interaction

1.

ARTIC - mastered sounds in CVCV
reduplicated syllables
2.

Sentences using he, she, they and present tense is
verb-ing
3.

Answer simple WH type questions (“What is it?”
“Who is eating?” “Where are they?”) regarding
books and/or his activities
4.

Use 3 social scripts, 3 turns in length in interactions
around campus, including non-verbal skills
5.

GROUP - Use name, direct turns, label and
comment
6.

5 new location prepositions (under/over, top/bottom,
in between)

SLP Recommendation - 5/2013

• 120 min/week individual
• 30 min/week group
• 360 min/year consult (denied)


VIDEO: Group!


VIDEO: Social Scripts Today


Today

AAC System: Gestures, eye gaze, simple 1syllable words (buh), TouchChat WordPower 42
Prompting: Model required for greetings, very
responsible with device, independent with
phrase-based scripted interactions (jobs on
campus), verbal prompt to use device to
request, very independent with navigation, some
self-taught morphology

Different roads


Destination:
Communication!

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