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Dr. Caroline Ramsey Musselwhite

Tuesday, April 24, 2018

Building Multi-Lingual AAC Skills: Perspectives of an Evaluator/Interventionist

I composed these ideas when asked to contribute an article for the ASHA Special Interest Groups Perspectives.  After reading the fine print about copyright, I learned that I can’t publish a blog that matches the article I submit.  So instead of re-writing my submission, I am re-writing this blog.  I hope you find the information, ideas and resources in this blog helpful. And that you will look for the upcoming edition of the AAC Special Interest Perspectives with Gloria Soto as the editor.  I am excited to be invited to contribute to this important and timely topic. I’ll let you know when it gets published. 

Wagner, D. (2018). Building augmentative communication skills in homes where English and Spanish are spoken: Perspectives of an evaluator/interventionist. Manuscript submitted for publication.

Introduction


This article uses the personal experiences of Deanna Wagner as a second language learner and AAC Specialist to explain how she uses experiences with language as the basis for AAC learning.  In homes where English and Spanish are spoken, children are having experiences with fluent speakers that will eventually shape their communicative competence.  As skills are emerging, it is a matter of personal choice to engage with another partner enough to learn the language.  Without fluent partners who speak that language with the person, a second language is unlikely to develop.  When starting to do this with AAC, therefore, it is helpful to give children and parents the options of choosing English or Spanish every time a word is shared.  Speaking with AAC and using words that occur frequently will increase the amount of engagement.  This article shares resources for finding robust bilingual AAC systems, strategies for learning core words each month, and ways to incorporate both paper-based and electronic-based AAC tools.

1. After considering my examples, readers will be able to describe at least 3 personal experiences that have shaped their perspectives with regards to language development. 

2. Readers will be able to point to at least 3 research-based supports for using a developmental approach to AAC in conjunction with aided language by fluent speakers

3. Readers will be able to describe at least 3 practical activities for teaching high frequency words in whatever language the learner and his/her family chooses to use


My name is Deanna Wagner and I am an AAC practitioner living in Phoenix, Arizona. I am a collector of languages. I am fluent in some and a contextual communicator in others. I was born in Wisconsin and my only fluent models of Spanish were my instructors (and Maria on Sesame Street) until I went to Mexico for one week and had my first immersion experience. I was 17 years old. The sister and her mother spoke with me and helped me learn about the difference between listening to the language (of people in the city, younger sibling chatter, etc) and being spoken with.  Since then I have been collecting immersion experiences, some with more success than others, mostly dependent on who my communication partners were and whether they took time to phrase what they wanted to tell me in ways I could understand. I am now a fluent communicator in English and Spanish; I can speak, read and write in both languages. I meet with families and talk with them in English and Spanish about how AAC can help their child’s communication skills grow. I write text messages, notes, summaries, and action plans in Spanish or English, depending on the preferences of my communication partners. Some of the parents, like me, are learning English as a second language. All of them are learning AAC as a second (or third, or fourth) language. So when people ask me how I learned Spanish or how I learned to be so fluent with AAC, the answer is the same: I studied the rules, I practiced, and I had real life experiences with people who are fluent.  That includes hanging out with adult AAC users at conferences and really talking with them. With my adult friends who use AAC, they let me practice with them, passing the device back and forth between us. Thank you so much, Krista, for helping me learn what a valuable experience that can be. She and her friend bring one device between the two of them when they meet me at the mall. In addition to the device, I listen to their speech and body language and am getting better at understanding that, too.  Through real life experiences speaking with people who have or need AAC, my ability to express myself using that language system has grown. The people mentioned in this article have given me permission to use their names.

My love of languages is what guided me to study speech language pathology and eventually specialize in AAC. I learned how to follow a child’s lead, to speak with him (or her) at his level, and to help build language and literacy skills (in English, Spanish, or AAC). I now provide speech/languages services for an average of 10 new device evaluations per month and support an active caseload of about 100 people who use AAC. Around 75% of the people I work with come from families where English and Spanish are spoken in the home.

Readers can study more about my perspective about language learning by reading articles and books by various authors who describe principles related to bilingualism, whether simultaneous or sequential (ASHA 1997-2015; Gerber, 2012; Goldstein, 2012; Gutiérrez-Clellen, 2009; McCord, 2004), Perozzi, 1992; Robinson, 2009; Sheng, 2014; Soto, 2014 and 2009).  From works by Kroll and others (2010), referring to the Revised Hierarchical Model, I found validation in my approaches with families to speak with their children at their level using whatever language is natural for them. Conceptual knowledge of a child’s world can be mediated through Spanish, English, and AAC.  I encourage parents to learn the AAC system: keyboard, then some words, then how to add some words to make phrases. We practice asking simple questions using the device. And I don’t tell them whether to use English or Spanish when they speak with me or when they speak with their child. I let them decide. And I only recommend robust AAC systems that allow the child to choose on his own whether to speak English or Spanish, using AAC device or body language. 

I have conversations with families and their support team about the difference between body language and sign language. I draw my perspective from personal experience here, too. I was interested and took a class to learn fingerspelling and some signed words. But I never really learned the language because I didn’t have a fluent partner (other than my instructor) until I met Julie. She is the sister of my college roommate and now has been my sister-in-law for more than 20 years.  She is profoundly deaf and uses ASL for communication with her friends, her mom, her sister, her husband and her children. When she speaks with me, she slows down and supplements with a lot of fingerspelling because my vocabulary is limited. Imagine having a conversation letter by letter!  Based on our experiences together, I have learned to sign more words, but without having studied ASL, I am unable to follow the conversation she has with other fluent speakers of ASL. I am a competent communicator because I can fingerspell, but I am a contextual communicator in ASL because my vocabulary is limited to certain words and topics based on my experiences.  The reader can learn more about AAC competencies by using and studying the AAC Profile available from Linguisystems by Tracy Kovach (2009).   

Some families of the families I work with were told by their pediatricians or other professionals that using a second language will be confusing and they should try to speak only English at home in order to make it easier on the child when he/she goes to school.  I believe that many of these families receive misguided advice twice: once by being told they should only use one language, and again when they are told that it is best to wait to introduce AAC until a child has demonstrated certain pre-requisite skills (such as knowing/using a few signs or matching pictures to objects). More information about dispelling AAC myths can be found in an article for the Infants and Young Children Journal (Romski & Sevcik, 2005). The greatest hope we can impart to parents is the belief that their children can learn language.  In order to do so, we must recommend a robust communication system and work on strategies to teach the child about the symbols and rules that make up that system.

The families I work with also vary in their competencies with English and AAC, based on the context. Many have learned both the English word and the signs for “more” and “all done.” So when we start using an AAC device, I show them how they can use these words on the device with their child, without the need to force a choice about how to say it, just offering more options and experiences in real life situations, remembering to speak with the child, not at or for him/her. For more insights into this theory, the interested reader can look at articles on aided language input.  There are many, with a summary by Sennott, Light & McNaughton (2016) available in Research and Practice for Persons with Severe Disabilities. The interested reader can find more information about using aided language displays with young learners with autism spectrum disorder from guest blogger, Laura Tarver, on the website www.praacticalaac.org (dated August 28, 2014).

For those families who are able to join us, we offer additional experiences to use AAC during our Out And About activities in the community.  A guide for starting this type of group can be found for free at www.teacherspayteachers.com.   Some of the most important communicative functions that we practice are social greetings/manners, commenting (including giving opinions) and requesting.  We also try to design activities where we can practice with core words used to describe or tell about the event or items we are using.  When I go on these outings, I bring my iPad and at least one low tech flip book. I come prepared with many options and when speaking with people will decide which way to say a word depending on the situation and the language level of the person I am speaking with. I may open Proloquo2Go and switch between English and Spanish to say a word in both languages. I am not as fluent, but I am also learning to do this in Snap + Core First.  When I model using the bilingual Words For Life, I tend to use phrases because it is faster and flexible, but I do need to remember to clear the message window when switching languages.  I also have families who are learning to use WordPower 60 Basic. To switch to Spanish independently requires the NovaChat, so I can only model fluently choosing which language to use when I borrow somebody’s device. On my iPad With TouchChat I save profiles for each language and need to enter programming menus to switch. But it can be done. More often, however, I turn to the printed displays and speak Spanish while pointing to the symbols on my English language low-tech WordPower 60 SS book with flips (available from https://saltillo.com/downloads/chat/low-tech-communication-board-options/FLIP%20BOOK%20WP%2060%20SS.pdf). My current version does not have Spanish on it, but when making these boards for families I often add the single page with Spanish on the back (available from https://saltillo.com/downloads/chat/low-tech-communication-board-options/96%20location%20manual%20communication%20board%20based%20on%20WordPower60%20Español%20Básico.pdf). 

When instructing a class of AAC users that includes two bilingual adults at ValleyLife Adult Day Program, I use the Smart Board loaded with NuVoice PASS software (available from https://www.prentrom.com/support/accent/download-nuvoice-pass-software). I programmed buttons to switch users so that I can display Unity 45, Unity 60, Unity 84 and Unidad Spanish. Depending on the lesson, I may use one or all of these as I speak with the members on a variety of topics of interest to them (shopping, eating, watching videos, listening to music, reading books, etc.). Having the option to switch to a 45-location display shows larger icons when we are studying the word associations and patterns. Is is also the best match for Maggie, who needs a keyguard.  Maria also uses a keyguard, but her language levels are different. I have loaded her device with Unity 84-sequenced, Unidad 84, and Words For Life English/Spanish. She also switches between areas depending on the situation and the word she needs to express herself to a specific communication partner. We added a “save text to button” tool so she can quickly retrieve a message she had been working on but was interrupted by the need to say something else. 

Another question I have been asked by parents and other practitioners has to do with what words are the best place to start. I struggled with this for some time, knowing that I wanted to follow a developmental framework as recommended by Gail Vantatenhove (2016) and Gayle Porter (webinar available at  http://www.dynavoxtech.com/training/online/recorded-web-classes/details/?id=4269), but was struggling to figure out how to share that theory with parents. It is even more challenging when parents also need to decide when to use English or Spanish with their children and are looking for a specific plan of action. I was so thrilled when I found the Year of Core words on the blog by Carole Zangari and then discovered that the vendors are using these lists to create month by month smart charts to help us find the words in the language system on some devices.  Here is a link to the smart charts for the WordPower Basic 60 SS (SymbolStix) version: https://saltillo.com/chatcorner/content/31.   The smart charts for icon sequences (Unidad, Words For Life) can be found at www.aaclanguagelab.com.  Finally, explicit month to month guidance for appropriate aided language input! 

Actually, these words are only in English, so there is still discussion about second language learning and what words should come first. However, I have distributed these smart charts in English and practiced with families until they are fluent with the words in both languages. We practice single words and simple phrases, starting with WHAT WANT, and not worrying about grammar. Beginning communicators should be encouraged to use telegraphic speech (reference AAC Do’s and Don’ts, Farrall & Niemeijer)!  I just tell the parents that repeating verbally with fluently models using good grammar is also part of the learning process and will assist in getting the intended meaning across while making selections on the device.  The interested reader may also find resources related to using telegraphic speech with aided language input by watching webinars and following Jill Senner’s group on Facebook.  I have also written suggestions in my blog for 40 Spanish words to choose to go along with the first 4 months. 

The most important message we can give our children is that we believe they have something to say. How they choose to say it should be up to them. To get to that point, they will need lots of experiences with partners who can use the methods fluently. These partners need to know how to adjust their language to the level of the learner so they are talking with and not to or for somebody who needs AAC. 

Table 1 provides a list of the most functional top 40 words in English, chosen with the intent of combining these words when modeling language.  Note that many of these words are used when teaching young children to read English.  Therefore, picture books and books for young children will offer multiple opportunities to practice these words.  

I
like
not
want
help
it
more
different
who
she
you
he
where
up
on
in
me
make
get
look
what
need
are
is
some
put
all
this
don’t
that
go
do
when
finished
can
here
open
turn
stop
over



Focusing on just five core words during an activity, especially at first, gives more opportunities to practice.  

Working from these lists, I have begun to encourage families to target 40 Spanish words over 40 months, to be as consistent as possible across languages as we are introducing new words to an AAC user.  Due to the differences in how the words are used in both languages, I do not encourage them to translate the following words from English when first introducing a device with bilingual support:  do, get, turn, put, in, on, out, busy, away.  I also add earlier introduction of a few words that were not in the original first four month list:  di (tell), da (give) and look (mirar).  This will be written up as a Tip of the Month for 2018 at Caroline Musselwhite’s website www.aacintervention.com 

Table 2. Year of Core Words – 40 Spanish words in 4 months

Month 1
Month 2
Month 3
Month 4
Again – otra vez
Eat – comer
Away
Big – grande
All done – (no más)
Get
Bad - mal
Busy
Different - diferente
Go – vamos
Come – ven
Do
Help – ayuda
Happy – feliz
Good – bueno
Drink – beber
Mine – mío
Here – aquí
It - lo
Feel - sentir
More – más
I/me – me
Make – hacer
He – Él
Not/don’t – no
Like - gusta
Now – ahora
In
Stop – parar
On
Off
Make - hacer
That - eso
Play - jugar
Read – leer
Out
Want – quieroquieres
Put 
There – allá
Some – poco
What – qué
This - esto
Thing – cosa
Tell – di
You – 
(Give) – da
Where – dónde
(Where)  adónde
Who – quién
(help) - ayuda
 (Tell) - di
(Look) - mira




           Table 3. Symbol-Based Robust Bilingual English/Spanish AAC Apps
Vocabulary
OS
Website
Bilingual Design
Organization
Avaz
iOS,
Android
no
Similar apps are available for both languages
Crescendo on Proloquo2go
iOS
Yes
Message window is bilingual and code switches with all languages
Basic Fitzgerald home page layout; Alphabetical for adjectives, verbs & fringe (in both languages); some core pronouns and verbs repeat on category pages;
Grid 3
iOS, Win10
no
Page sets are available for both languages, not bilingual by design
LAMP WFL
(bilingual ENG/SP)
iOS, Accent (Win10)
Yes
Clear the message window when switching languages
Starts from home page with icon sequencing – Similar motor plan for all words; Spanish is translated from English. Category pages are alphabetized in English and maintain position on Spanish pages
Snap + Core First
iOS & Win10
Yes
Message window is bilingual, maintains accurate pronunciation when switching
Fitzgerald core page; Topics and Lists (Categories) are in alphabetical order in English and don’t change position when switched to Spanish
Unidad
Accent (Win10)
Yes, but message window is not bilingual
Designed for bilingual semantic support with a similar motor plan across languages
WordPower 60 Basic/o
iOS and
NOVA chat
Yes
Only NOVA chat has user access to switch languages.
Message window must be cleared before switching languages.
Basic Fitzgerald layout; Alphabetical order for adjectives, verbs & fringe; some core pronoun phrases repeat on category pages; some Home page verbs link to category pages

References

Adams, M. J. (1990). Beginning to read: Thinking and learning about print. Cambridge, Mass: MIT Press.

Angulo-Jiménez, H. (2018). Bilingualism and Autism: Addressing Parents' Frequently Asked Questions. Perspectives ASHA SIGs, 3 (SIG 1), 98–105. doi: 10.1044/persp3.SIG1.98

ASHA collection of resources from the Office of Multicultural Affairs offers policy documents, guides and tips for addressing the needs of CLD students in schools, titled “Working with Culturally and Linguistically Diverse (CLD) Students in Schools.” © 1997-2015 American Speech-Language-Hearing Association. http://www.asha.org/slp/CLDinSchools/

ASHA Practice Portal on “Cultural Competence.” © 1997-2015 American Speech-Language-Hearing Association. http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935230&section=Key_Issues#Developing_Cultural_Competence


Farrall & Niemeijer (2015).  Do’s and Don’ts of AAC [handout].  Downloaded from https://download.assistiveware.com/assistiveware/files/dos-and-donts-aac-by-assistiveware-jane-farrall.pdf

Gerber, S., Brice, A., Capone, N., Fujiki, M. & Timler, G., (2012). Language Use in Social Interactions of School-Age Children With Language Impairments: An Evidence-Based Systematic Review of Treatment. Language, Speech, and Hearing Services in Schools, 43, 235-249.

Goldstein, B.  (2012).  Bilingual Language Development & Disorders in Spanish-English Speakers.  Baltimore: Paul H. Brookes Publishing.

Goldstein, B. (2011). Cultural and Linguistic Diversity Resource Guide for Speech-Language Pathologists.  NY: Delmar, Cengage Learning.

Gutiérrez-Clellen, V. F., & Simon-Cereijido, G. (2009). Using language sampling in clinical assessments with bilingual children: Challenges and future directions. Seminars in Speech and Language, 30(4), 234.

Hoversten, L., & Traxler, M. (2016). A time course analysis of interlingual homograph processing: Evidence from eye movements. Bilingualism: Language and Cognition, 19(2), 347-360. doi:10.1017/S1366728915000115.

Kohnert, K., Yim, D., Nett, K., Kan, P. F., & Duran, L. (2005). Intervention With Diverse Preschool Children: A Focus on Developing Home Language(s). Language Speech Hearing Services in Schools, 36(July), 251–263.

Kroll JF, Van Hell JG, Tokowicz N, Green DW. The Revised Hierarchical Model: A critical review and assessment. Bilingualism: Language and Cognition. 2010; 13:373–381.10.1017/ S136672891000009X

Martin, C.D., Dering, B., Thomas, E.M., Thierry, G. (2009). Brain potentials reveal semantic priming in both the 'active' and the 'non-attended' language in early bilinguals. Neuroimage 47, 326–333.

McCord, M. S., & Soto, G. (2004). Perceptions of AAC: An Ethnographic Investigation of Mexican-American Families. Augmentative and Alternative Communication, 20(4), 209–227.

Perozzi, J. A., & Lourdes Chavez Sanchez, M. (1992). The Effect of Instruction in L1 on Receptive Acquisition of L2 for Bilingual Children With Language Delay. Language, Speech, and Hearing Services in Schools, 23(October), 348–352.

Pickl, G. (2011). Communication intervention in children with severe disabilities and multilingual backgrounds: perceptions of pedagogues and parents. Augmentative and Alternative Communication, 27(4), 229–44.

Robinson, N.R. & Solomon-Rice, P.L. (2009). Supporting collaborative teams and families in AAC. In G. Soto and C. Zangari (Eds.) Practically Speaking: Language, Literacy, and Academic Development for Students with AAC Needs, (pp.289-312). Baltimore: Paul H. Brookes Publishing.

Romski, M. & Sevcik, R. (2005).  Augmentative Communication and Early Intervention Myths and Realities.  Infants and Young Children, Vol 18, No 3, pp. 174-185.  © Lippincott Williams & Wilkins, Inc.

Sheng, et al (2013). Semantic Development in Spanish-English Bilingual Children: Effects of Age and Language Experience. Child Dev. 2013 May ; 84(3): 1034–1045. doi:10.1111/cdev.12015.

Soto, G., & Yu, B. (2014). Considerations for the Provision of Services to Bilingual Children Who Use Augmentative and Alternative Communication. Augmentative and Alternative Communication, 30(March 2014), 83–92.

Soto & Zangari (2009).  Practically Speaking:  Language, Literacy, & Academic Development for Students with AAC Needs.  Baltimore: Paul H. Brookes Publishing.


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