The Myth of Prerequisites

The world of Augmentative Alternative Communication has made tremendous gains in recent years. The use of AAC has opened up a whole new world for so many who had no options to communicate with the world around them. From low tech picture exchange systems to high tech eye gaze systems there are endless possibilities for finding an effective communication system. For many years you may have heard a teacher, SLP, OT, or Psychologist say in order to use a robust communication system the individual had to master a lower-tech system first like a picture exchange or simple cause and effect. I have been guilty of it myself before I knew better, but now I do know better and after reading this you will too.

The golden rule of selecting AAC is to ALWAYS PRESUME COMPETENCE. This affects how we make choices around AAC and how we provide opportunities, access to words, communication functions, and the alphabet.

When we presume competence, we still understand that opportunities and instruction are needed. This is known as the “least dangerous assumption” because it is far more dangerous to not believe and do nothing. (Emerson & Dearden, 2013)

It is so important that we start with the presumption that the person is a learner! Learning takes time and sometimes a good amount of patience. Always presume they are on their way to developing competence in learning this new language.  We have to understand and advocate for understanding that it takes good intervention, consistent language modeling, the right tools, and immense amounts of practice to help move them along the journey toward improved communication. Because of this fact, it is so important for all of the person’s communication partners be part of, familiar with, and believe in the communication system.

It is also important to remember that it takes time, often lots of time to become proficient at something. We aren’t born knowing how to communicate with others. It takes years for us to be able to have a conversation and that is with practice, exposure, and the right tools for verbal language. So, it’s not hard to imagine that the person without the “right” tools to effectively communicate using speech will take much longer to learn how using a whole new set of tools. This new set of tools is a whole new language system. Research suggests that when learning a second language it can take up to 5 years for the individual to learn that language when they have a strong foundation in their native tongue, are provided explicit instruction on the second language daily, and supported in their native language for academics. Apply that knowledge to AAC users and you can begin to understand how difficult it can be for a person to learn this whole new language system.

We practice communication every single moment of every single day that we are around others because we have a voice and the ability to practice it. We need to give these individuals the same opportunity to practice their communication skills throughout their entire day.

Where did this idea of presumption come from you ask…… Well here you go!

Presuming competence is based on two principles that apply to all human beings regardless of the degree of difference from the typically developing norms.

1. Everyone has something to say
2. Everyone can learn
   
   

Every person has a unique and rich inner life regardless of how they appear to the outside observer. People are full of feelings, observations, preferences, opinions, stories, memories, and dreams. Whether the person has the means to express that inner life in consistent way or not, that inner life is real, and it is there.

It is important to understand that this rich inner life extends beyond just requesting and it should be our goal to allow everyone the ability to communicate their inner life in a way that is accessible and understood by others.

When a person cannot communicate using verbal speech, there is no way for us to have a completely accurate picture of what that person understands using tests and measurements, nor their ability to use language given in an alternative format.  We really can’t know with 100% certainty the cognitive abilities of an individual who has little or no means of communication. The only way we can know a person’s potential is by providing them with accessible tools, the time needed, and the training needed to learn and use those tools. Research indicates that developing language skills can lead to functional cognitive gains (Goosens, 1989) and that impaired cognition doesn’t prevent communication from happening (Kangas & Lloyd, 1988; Zangari & Kangas, 1997).

In the spirit of dreams, practice, and access, I would like to tell you a dream of mine. Growing up I wanted to be a championship ice skater. Yes, it’s true, it is my favorite Olympic sport, and as a kid that was one of my many dreams. I grew up in Southern Louisiana so as you can imagine there was a significant shortage of snow. I improvised, I would jump around my room and practice with my roller skates on in the driveway every day for what felt like months. I can tell you this, I became a pretty proficient roller skater, but I would not be making my way into the championship arena for ice skating. Why you may ask? Well, the day came when I finally got to try it out… the real thing… a legit ice rink!! I was pumped because I couldn’t wait to see what I could do on the real thing! So .. what happened you ask? Well, I didn’t break any bones and I was able to skate without falling (much)… I also learned something else, I wasn’t exactly prepared for an actual ice rink because I never had the right tools….but even if I had optimal conditions with the right skates, the perfect ice rink, and immense amounts of practice, I would likely still never be a championship ice skater because I just don’t have the innate grace, agility, or balance needed to conquer the sport. I would likely gain a good bit of competence in being able to ice skate efficiently enough to not get hurt, maybe do a trick or two, and even stay in rhythm to a song. But there would never be an Olympic Gold Medal in my future……And that is OK!

So with AAC, the individual may not become a communicator who will, or even want to, give you speeches or have hour-long conversations about topics with peers, but we have to allow them enough practice and the right system to be able to attain increased communication skills on their terms.

LAST BUT NOT LEAST!!!!!!!!!!!!!!!

Our goal with AAC should always include self-advocacy for these individuals. Perhaps the one that speaks to me the most is the right to say “No!”.  To say “No!” when they don’t feel comfortable, when they are hurting, when they are angry, or when they are upset. It is our job as their communication partners to help them learn to exercise that basic human right. It is our job to support their growth in letting people know what they like and don’t like and we must give them the tools to do it! It is our job as their communication partners to respect the “NO”!

References

• Beukelman, D., & Mirenda, P. (2013). (Eds.), Augmentative and Alternative Communication (4th Ed.). Baltimore: Paul H. Brookes.
• Farrall, Jane. (2015). AAC: Don’t Demand Prerequisite Skills. [Blog post]
• Jorgensen, Cheryl. (2005). The Least Dangerous Assumption. [Presentation]
• Kangas, K. & Lloyd (1988) Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for?, Augmentative and Alternative Communication, 4(4), 211-221
• Lanier, Heather. We’re Presuming Competence. [Blog]
• Niemeijer, David. Presuming competence: the only prerequisite to AAC. [Blog]
• Romski, M.A. & Sevcik, R.A. (2005) Augmentative communication and early intervention: myths and realities. Infants and Young Children 18 (3), 174
• Sheldon, Erin. Presuming Maggie’s Competence. [Blog]
• Zangari, Carole. (2014). Engaging the Learner. [Blog]

About the Author: Lorna Boudreaux, MS, CCC-SLP is the owner of Look Who’s Talking Therapy Services, LLC, and has been a Speech-Language Pathologist in Southern Louisiana for 12 years in the school system, the majority of those years serving as a founding member of the AAC Team and Team Leader. Lorna graduated from Nicholls State University with a Bachelor’s Degree in Communicative Disorders and from the University of Louisiana at Lafayette with a Master’s degree in Communicative Disorders.  Throughout her years in the school system and private practice, Lorna has had the privilege to work with a wide range of ages and a variety of needs. When her husband and she became parents almost a decade ago, they were blessed with an extraordinary little boy who changed their lives forever. Ms. Boudreaux is the mother of a Neurodivegent child and she has learned so much as a Speech-Language Pathologist from him. He taught her that his brain is just wired differently, not less, not abnormal, just different. Lorna is lucky enough to have discovered a passion for working with AAC, complex communicators, Neurodivergent individuals including Autistic individuals, children with high support needs, fluency, and Semantic/Pragmatic Language support needs. Lorna’s goal is to spread awareness to colleagues, educators, clients, and parents on the use of AAC, ethical therapy practices, strengths-based assessments, and parent/student rights in Special Education. Look Who’s Talking Therapy Services, LLC – Facebook Page

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