A Study in Augmentative Communication in Distance Learning
by Rebecca Eisenberg
AAC, middle school, high school, special needs, Autism, speech and language, complex communication needs, communication, speech therapy, teletherapy
JA is an eighth-grade student who is both verbal and uses augmentative communication. He is diagnosed with autism and presents with significant sensory needs and a mixed receptive-expressive language disorder. He thrives on a written schedule, visual prompts, and consistency. When his routines are altered, he can become very upset, which often leads to negative behaviors. JA is a kind and sensitive teenager who needs reassurance, consistency, and intellectual stimulation to be an effective communicator and participant in teletherapy.
His verbalizations are sufficient for basic requests and needs, but other communicative functions are difficult for him to access verbally. He uses the app Proloquo4Text to communicate in addition to his verbalizations. With this augmentative and alternative communication (AAC) app, he is able to use pre-programmed phrases, a full keyboard with word prediction, and quick phrases. Within this customized robust app, personalized messages have been programmed to allow for quick communication. He also uses the Zones of Regulation curriculum to communicate his feelings. These emotions are programmed by color in his talker for quick access.
Transition to Distance Learning:
I spoke with his mother at length about triggers that lead to negative behaviors. JA has had previous virtual sessions with other therapists that ended with negative behaviors (aggression). His mother was very apprehensive about moving forward with any more virtual sessions.
I have been working with JA for approximately two years, so I already have an established rapport with both JA and his mother. I discussed how the sessions will run differently from JA’s previous virtual sessions. The most important way that they would be different is that we needed JA’s consent. Also, he would be given choices throughout the session to improve overall motivation. If JA did not give consent to have the meeting, the clinician would work only with his mother in a parent coaching session. So far, JA has chosen to participate in each session, with his mother present.
During conversations with his mother, we reviewed motivating activities that he can do, not that he can’t do. Due to the current pandemic, JA is not allowed to go to restaurants, shop in stores, etc. He thrives on these activities and when they’re discussed, it triggers negative behaviors. These topics need to be avoided. Activities need to incorporate and target writing, expanding vocabulary and communication, while focusing on motivating activities that can be completed safely during the pandemic (e.g., baking, going to the drive-through, visiting his country house, etc.).
To improve overall communication via verbalizations and/or AAC communication system to access a variety of communicative functions, including:
Clarifying communication breakdowns via AAC
Expressing actions (finish, stop, keep working)
Engage in a two- to three-turn conversation
Writing and speaking in more grammatically correct sentences
Transition to distance learning
Face to Face
Reading age-appropriate books about community activities
Reading age-appropriate stories about hotels
Using apps about community and vocational activities
Playing physical games (dominoes, bingo, Uno)
Having conversations about recent events during the day
Checking in about emotions
Sensory activities as breaks
At a Distance
Using Clicker Writer software with remote control access via Zoom to create sentences about his week/weekend (sentence sets, Cloze docs)
Using EDpuzzle with videos about restaurants with drive-throughs, cooking activities, baking activities
Using online coloring pages for break time
Using check-in visual available through LessonPix to check on emotional state. When he says “feel green,” the clinician continues the session (green means, happy ready to learn).
Using screen mirror of Proloquo4Text when needed
Face to Face
At a Distance
Face to Face
Movement breaks (would walk for a break)
Sensory breaks when needed
Check-in about emotional state
Prompts and modeling as needed
At a Distance
Written schedule on PowerPoint
Coloring as a break
Check-in with visual of Zones of Regulation
Having Mom to support student
Consistent positive reinforcement
Prompts and modeling as needed
What worked well
Overall, the sessions have gone well. I think the success of the sessions was due in part to my being sensitive to JA’s needs and getting him involved in the process of being an active participant. I also think that structure, knowing technology well, and visual check-ins have helped immensely. I’m in contact with his mother twice a week before sessions to check in about what they’ve done over the past few days and to find out about any activity that has been motivating. For example, if he’d like to make cupcakes this week, we’ll work on “making cupcakes” and incorporate language goals into the activity. I’m also doing increasing check-ins with JA to make sure he’s feeling OK about continuing. He knows that he can stop if he wants to, and that makes a big difference.
I was surprised by
I was most surprised about how well we transitioned into virtual therapy. Based on his negative experience with virtual sessions in the past, I was anticipating that our sessions would be more difficult. Our sessions have been productive, and seeing him smiling on my computer while he completes the activities successfully makes me feel so happy and proud of him.
Next time I’ll try
Based on how he feels that particular day, I’ll challenge him more with repairing communication breakdowns via his AAC system. Often, when he isn’t heard, his mother will translate for him. Over time, I want him to be more independent, repairing communication with fewer prompts.
My big picture takeaways
Teletherapy can be very successful for students with complex communication needs and behavioral challenges. Being empathetic, knowing how to use technology quickly and efficiently, and having appropriate activities are key. When we can’t use technology in an efficient way, our students get frustrated. It’s important to set up your tabs and test out activities before trying them in the session. I also think collaboration with parents is absolutely necessary for success. We’re a team with the same goal!
With regard to materials and activities, I have found several private telepractice groups for speech-language pathologists that have been a wonderful resource. Join them and check out what everyone else is doing. You’ll get many good ideas and you can also share your own. I have also invested a lot of time in creating personalized materials for my students, as well as attending webinars to learn about new software programs.
Clicker Writer: Suggested by Rebecca Eisenberg, Clicker Writer is the word processor she used with the student in this case study.
EDpuzzle: Suggested by Rebecca, EDpuzzle is the program used to assign and track video assignments on topics of interest to her student.
Attainment Company Apps: Suggested by Rebecca, Attainment Company apps are excellent for teens with developmental disabilities.
PowerPoint: Suggested by Rebecca, PowerPoint was used as part of this case study to share links.
Zoom Account: Suggested by Rebecca, Zoom is the videoconferencing software used during virtual learning.
Becca’s Website: Language During Mealtime: This resource is Rebecca’s website dedicated to speech-language topics and resources, including the Language During Mealtime Blog and the Language During Mealtime Podcast.
Language During Mealtime YouTube Channel AAC Parent Training Playlist: This resource links to a playlist on Rebecca’s YouTube channel, all of which is worth exploring!
Autism Society: This case study is focused on a student with autism. The Autism Society has compiled links to various educational resources focused on the switch to virtual learning.
Vocabulary Board for COVID-19 Coronavirus: The student Rebecca works with in this case study uses an augmentative and alternative communication (AAC) device. This resource is a vocabulary board that includes vocabulary specific to COVID-19.
Supporting Families With PBIS at Home: Rebecca’s student has behavioral challenges that can be triggered by a disruption to routine. This document from the Center on Positive Behavioral Interventions and Supports provides recommendations for families and caregivers on how to use PBIS to support their children and minimize behavioral disruptions in the home. It includes sample schedules, which can serve as models for home routines.
Autism Circuit Toolkit: In this case study, a student with autism transitions to teletherapy from in-person sessions. This resource provides tools that parents, teachers, and practitioners can use to provide structure and prompting to students.
Tips to Decrease Anxiety of Diverse Learners: Rebecca includes student emotional checkpoints in her sessions, using the vocabulary he’s accustomed to. This resource provides strategies to decrease anxiety in students, including an emotional check-in tool.
Using Tele-Intervention to Deliver Early Intervention Services: What to Say to Families: Rebecca attributes a portion of the success of her sessions to the strong communication between her student’s family and herself. This resource provides a script that practitioners can adapt when beginning a telepractice relationship.
About the Author
Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, certified autism specialist, board-certified telepractice specialist, author, instructor, and parent of two children.
She began her website, Language During Mealtime, and her podcast to create a resource for parents to help make mealtime an enriched learning experience. Her YouTube channel is also a resource for parents of children using augmentative and alternative communication (AAC). She is the author of several published games for children with special needs, a story time workbook, and four children’s books. Her first two children’s books are The Monkey Balloon and A Tale of the Monkey Balloon, which she co-authored with special educator Mindy Winebrenner. Her third children’s book, My Second Year of Kindergarten, is going into its second print. Her most recent children’s book is titled Bluebee Pals Techie Rangers. She is also the author of the parent’s guide, Improve Your Child’s Language and Learning in 20 minutes, Evidence-Based Tips for Reading During Mealtime.
Since 2001, she has worked with children and adults with varying speech and language delays and disabilities. She’s on the technology team at the Westchester Institute for Human Development in Valhalla, New York. She works in a variety of contexts, including public and private schools, outpatient clinics, and day habilitation programs, improving communication skills for children and adults who have complex communication needs.