Are We Missing the Boat in AAC Intervention?

Over the past 30 years of working in this field, I have often had sleepless nights when meeting a student in elementary, middle, or high school who has no or very limited means to communicate in spite of having access to a device or iPad with a communication app. I keep asking myself how it is possible that a student can reach middle or even high school without the ability to express themselves when we have trained teachers and therapists to provide intervention and support? Despite these resources, it still seems rather easy for students with severe communication problems to fall through the cracks.

Although the reasons for these dilemmas are complex, looking at the way in which we formulate IEP goals can be illuminating. IEP goals are often written to reflect outcomes that show the student has learned or gained (that is, variables that are easy to measure, for example, how frequently students respond correctly to certain stimuli or use language structures correctly within context), without due consideration of how what they have learned impact on their daily interactions.

The primary emphasis in ABA-type interventions, where students are drilled to learn certain concepts and tasks, often seem misplaced if students have limited means to communicate. Although the use of ABA strategies has a place in these students’ education, my concern is that it is becoming the first (and often only) consideration in the development of a daily curriculum for these students. Do we really reflect on why we use these task-focused learning activities, or have these activities just become the easy go-to “solutions” in dealing with students with severe communication problems?

Even SLPs tend to focus on “teaching” concepts to students rather than ensuring that students can use the concepts they already understand to engage in natural communication interactions. How can we expect students with severe communication problems to become interested in interacting with others if they do not experience the benefits of natural (i.e., symmetrical, open) interactions? Can we blame students for getting frustrated or uninterested when their interactions with others are characterized by regimented routines?

We often seem to “teach” or prefer “task-oriented” goals as speech-language pathologists and teachers to avoid having to engage in the process of communication with our clients or students. Although task-focused interaction is also a type of communication, it represents a one-way flow of information controlled by the interventionist. We seem to have lost the art of engaging these students in meaning-making with others. If our students do not experience the joy of interacting with others, why would they be inclined to want to interact or use their AAC devices to engage with others?

Communication with others is about interacting with another in an open and symmetrical way while engaging in the process of developing meaning. This joint interaction event can include non-verbal symbols (e.g., facial expression or eye gaze) accompanied by the joy of meeting each other, albeit short and fleeting. Most important, however, is that at this time the attention of both partners is focused on the other. Although this short interaction could seem too short and unimportant, it provides the initial glue for the development of further interactions.

This is a risky process in which the professional has to relinquish control and be willing to develop an openness and interest not only in her own, but also the student’s behavior and demeanor to develop joint meaning. It requires a focus on listening and observation of self and other to facilitate engagement in the process of interacting. After all, communication is not about initiation and response, it is about the subtlety of negotiating meaning in our relationships with each other.

How do we expose our students to meaningful interactions? Well, we could start by adding an IEP goal focused on promoting naturalized interactions with the student by monitoring his/her engagement in interactions with the therapist, teacher and peers.

What do you think?

For those who are interested in reading more about the difference between “task” and “relational” oriented interactions, please see my book, AAC: Engagement and Participation. Chapters 1, 2, and 3 of the book deal with issues surrounding engagement and participation within interpersonal and classroom contexts. In particular, Chapter 3 describes teachers’ perspectives in dealing with students with severe communication problems and their experiences.