Speech and language expert shares tools, ideas for multilingual learners who use AAC

This spring, members of the Advancing ALTELLA team met with Anne Page, a speech and language professional and expert in augmentative and alternative communication (AAC). Anne joined the team to demo some of her go-to tools and share creative ideas that help multilingual learners who use AAC.

Read this interview between Anne and Shea Head, WIDA inclusion researcher, to get insights and tips for how to best support multilingual learners who use AAC.

As you read, look for some of these top takeaways from Anne.

• It’s our job as educators to make sure all students are heard and find their place as valued members of our society. We all can learn so much from each other – we just need to listen!
• It can be difficult to get staff and teachers to be powerful communication partners with students and speech language pathologists. But it’s the key to making everything work!
• Keep investigating and going back and trying things. And make sure you talk to students’ families.
• When you’re first getting started with a student, begin with core vocabulary. Then, choose a system that the student can physically access.

The following interview has been lightly edited for clarity and length.

Shea: Anne, on your website, Beautiful Speech Life, you talk about what to do as a speech language pathologist (SLP) when you have a student that you’re struggling to support. Is there a specific situation or student that you worked with over the years who helped you to grow in your ability to support students with complex communication needs?

Anne: When I first started working with students with significant cognitive disabilities, it was kind of scary because I didn’t know what to do when a student didn’t have a way to respond. I learned that what you do is keep investigating and going back and trying things. And you have to talk to the student’s family. Ask them things like, “How do you know when your child is uncomfortable?” Then you learn that there might be different cries, or they might be able to look at what they want. We figure out a student’s baseline, and then how to build on it. We try to teach them a system of communication that we all understand – something that can take them throughout their lives.

Here’s an example: With one student, we started noticing that he makes clicking sounds with his tongue and that means “I’m talking.” If you click back, he’ll click back. Now we’ve got a little conversation going on and we’re trying to build on that.

Other students might have Cortical Visual Impairment (CVI) and all the symbols we show them end up being all mushed together. We’ve learned that it helps to use a black background and make the symbols yellow or red. And then we’ll partner with the student’s vision teacher. With all of the kids, we use core vocabulary as our foundation. When they learn that word in school, that word will mean the same thing everywhere. We choose the power words to focus on for that. And then depending on the student, we customize their high-tech or low-tech boards or switches.

Something that I encounter as I talk with speech therapists all over the country is getting staff and teachers to become powerful communication partners – it’s difficult. And that’s the key to making everything work because the speech therapist is only in with the student 30 minutes a week – if you’re lucky. We have more power consulting with the teachers and the staff, showing them what to do – and families. It is an uphill struggle, that’s for sure.

Shea: Can you tell us more about core vocabulary?

Anne: Researchers did a study and found the 200 or so words that a developing toddler would speak the most. These words also make up about 80% of our conversation – even as adults. They are pronouns, action words, question words (like who, what, when, where) and some preposition words. The rest of the words, like the nouns, are called fringe vocabulary, which I find people tend to try and teach first. It’s not as valuable for the kids. Although, I always recommend picking a couple of power fringe words, which are words that are personally important to each child. If they love SpongeBob, then you want to make sure they have a way to say or ask for SpongeBob.

Shea: When you work with students who have more significant communication needs, where do you start in terms of trying to support communication? What are the tools and processes you use?

Anne: I start with core vocabulary. Some students have an eye-gaze based device that's funded through insurance, but it can be difficult to get staff to support that because they’re scared they are going to break it or do something wrong. But those devices are amazing! So, we choose the system that a student can physically access. I work with the physical therapist to make sure that we’ve got the position right. I work with the occupational therapist to talk about things like how far the student can reach or whether they can isolate a finger. From there, we choose our field of core vocabulary words. It’s up to us to model those words as often as we can, in a functional way.

I want to model those core vocabulary words during something that’s of interest to the child. We’ll pick a fun activity and a couple of core words that go with it. If a child is farther along, I would give them a device like an iPad that has TouchChat, a communication app, on it. The app can help make predictions for students based on what they click on and where they want to go.

There are bigger devices that have a keyboard. For assessment purposes, I would think a device like that would help a student who can spell. For other students who might just use a few symbols, I think we have to consider their language ability and their communication ability. And whether the student can answer questions and/or how they answer questions.

Shea: For families of multilingual learners, are there apps they can use that are in multiple languages?

Anne: If we know that a student is bilingual then we’ll choose an app like LAMP Words For Life, which is English/Spanish – and it’s just one button to press to switch back and forth between the two languages.

Shea: Are there ways for families of multilingual learners to learn about how tools like AAC devices help their students?

Anne: I’ve led parent support groups and I offer to show them how to use the devices and how they can support their child at home. Unfortunately, very few people take me up on that. But I keep trying! In the ideal situation, the child would have a parent modeling the device at home and then we would be modeling at school, and we would be communicating back and forth. Like, “he touched the ‘go’ when he wanted something to go, and that was incredible!”

Shea: Staying on this topic of collaboration, how do you support school teams with things like modeling? What works, what doesn’t work?

Anne: It’s a slow process, so the more you can connect with other team members and build trust, the more they’ll be open to your suggestions. Something that’s been super successful in one school is AAC Club – I have all sorts of info about it on my Instagram. It all started with a student who had a device and was learning yoga. The student expressed an interest in leading yoga; however, nobody could understand her. So, we programmed some yoga poses into her device. Then, we brought in another student who uses a device and… another student… After a while it became a club. Students who use devices get together for 30 minutes a week and the physical therapist and I model different words and then the kids get to check out other kids’ devices. They love it!

Back to your question, for Halloween one year, the kids took their devices and offered candy to the office staff. The office staff were able to respond on a device, which was a huge win! As I work with the physical therapist, we started taking the devices outside for recess, so people see them more. As people see the devices and get to know them better, you can make “gentle” suggestions, like "Why is their device over there on the shelf? It needs to be right here."

Shea: What do you think the barrier is to getting staff to use devices?

Anne: It could be a fear of technology and not wanting to “mess it up” if they click the wrong button. Or it could be a fear of looking unintelligent because they don’t know what to do. Plus, staff are already so busy and overwhelmed, they don’t want to have to do one more thing.

Shea: Switching gears, let’s talk about AAC and assessment. At WIDA, we want students to use their devices, but we don’t want educators to preprogram the device with words specific to the assessment. What kind of guidance should we give educators on how to work with a student who doesn’t have the words for the test on their device?

Anne: If you have a student who can’t point, then maybe you show them the pictures and say “Is it this one? Is it this one?” If they have a reliable yes/no, then at least they have a shot. On the story comprehension piece, they could go through their device and find a few images that might be in a sentence. On the writing piece, if they don’t have a keyboard on their device, you could have a printed letter board. Then they could point to some letters, and at least they’re showing that they understand what the letters are.

Shea: With the use of AAC, students may not use complete sentences but can convey understanding and communication through an image. What should we keep in mind for students using AAC as we think about their English language proficiency?

Anne: With a keyboard, there’s word prediction (if you have it enabled – maybe turn it off for a spelling test) when you start to spell something. The thing to consider about AAC is it’s so slow. Anything we can do to make it faster. That’s what’s so great about word prediction – a student types in a few letters and it will bring up a lot of choices.

Shea: Since everybody has word prediction on their phones, what are the parameters you use to define AAC?

Anne: AAC is anything augmentative for communication. So, word prediction is technically AAC!

Shea: What’s the most common misunderstanding about AAC?

Anne: Sometimes parents think that by getting AAC for their child it will make them speak less. There is evidence that is not the case at all. I have witnessed the opposite, where having a communication board gave the student the foundation to build their speech. And kids are speaking more because we’re giving them this visual language – they hear something and connect it with a picture and a pattern. They’re able to have that multimodal communication by touching the device, hearing the device speak and having the communication partner speak.

Another misunderstanding is thinking that you have to start with low-tech AAC and then move to high-tech AAC. That's not the case. It’s about whatever works for the child, and whatever you have. You can do so much with core words!

Ultimately, I think our world is moving toward being more accepting of neurodiversity. We’ve been in a place where if someone can’t speak, we make them feel like they aren’t important, and we brush them to the side. As a society that’s not right. It’s our job to make sure all students are heard and find their place as valued members of our society. We all can learn so much from each other – we just need to listen!

Related resources

Check out these related resources from Anne and members of the Advancing ALTELLA team.

• A Day with No Words is a picture book for young readers about communicating in a nonverbal way.
• Aided Language Stimulation Explained is a video that shows the importance of modeling AAC.
• Anne’s website, Beautiful Speech Life, has an abundance of tools and resources.
• Anne’s YouTube channel is full of instructional videos.

Note: WIDA as an organization does not advocate for or endorse any of the non-WIDA technologies for instruction. Schools, districts and states are responsible for making choices about appropriate and applicable technologies and products.