How many times have you heard someone say, “They’re just stimming on their device”? 😬

It’s almost always said with a sigh. Dismissively. Like it means the student is doing something wrong.

Like it means they’re not using their AAC “the right way.”

But what if we’ve been looking at this all wrong?

In developing this blog post, I teamed up with the brilliant Laura Hayes to zoom in on how AAC learners “stim” and what these behaviors can actually teach us about their communication, sensory needs, and learning style.

Stimming Has a Purpose

For AAC users, pressing buttons repetitively can serve as a regulatory or expressive purpose, just like bouncing a knee, flapping hands, or repeating a script can be. 

And when we redefine stimming, we unlock a whole new way to support AAC learners—both with self-regulation and meaningful communication.

Let’s break it down by looking at four common types of AAC stimming—and why they matter.

1. Exploration & Babbling

Just like babies babble before they talk, AAC users need time to explore their devices. Repetitive activations, off-topic selections, and seemingly “random” button presses are often a way to learn language and figure out how communication works.

Repetition isn’t “wrong.” It can be developmentally appropriate.

As AssistiveWare puts it: “Exploration is how learners figure out what their words mean.” 

We wouldn’t stop a toddler from babbling, so let’s not discourage an AAC user from doing the same

Tip: Attribute meaning to their selections. Respond as if they said it on purpose—even if you’re not sure. That’s how we build intention over time.

2. Specific or Preferred Vocabulary

You know that one button your student presses all the time? Maybe it’s “cookie,” “silly,” or “go.” Before you assume it’s just stimming, ask yourself:

Could this word be meaningful to them?

According to PrAACtical AAC, repeated use of certain vocabulary may reflect a motivation, emotion, or a favorite concept. This is a strength we can build on—not something to redirect.

Tip: Use their favorite word as an anchor. Model related words. Turn it into a game. Use it as a bridge to expand language.

When we ignore or discourage these patterns, we risk frustration, device abandonment, and missed opportunities for connection.

3. Echolalia & Scripting

Daniel Tiger. Baby Shark. “Let it gooooo.” Sound familiar?

Some AAC users script or use delayed echolalia—repeating chunks of language they’ve heard from songs, shows, or real-life conversations. If you're seeing this on an AAC device, it might reflect gestalt language at work..

Instead of shutting down these scripts, we should get curious. 

“What is the intention behind this repetition? What are they trying to say?”

By acknowledging the message, even when it’s scripted, we show our AAC users that their voice matters—and we give them the safety to keep exploring it.

For more on this, check out the Natural Language Acquisition Framework by Marge Blanc and follow @meaningfulspeech for practical tips.

4. Auditory Self-Stimulation

Some learners are drawn to the sound of their device. It soothes them. Regulates them. Or simply brings joy.

Repeatedly activating a message isn’t always communication—sometimes it’s self-stimulation. 

But here’s the key: that doesn’t make it less valid.

As AssistiveWare explains, “Regulation is a prerequisite for communication.” A student can’t engage in expressive language until their sensory and emotional needs are met.

So instead of choosing between regulation or communication—we can support both.

So… What Should We Do?

When we see repeated AAC behaviors, we don’t need to correct them. We need to get curious.

Here are some go-to questions:

• Is this helping the student regulate?

• Is this part of learning or exploration?

• Is this a favorite word or script with personal meaning?

• Could this be an attempt to communicate?

If the answer is “maybe,” we listen harder. Get into some detective work to try to understand it better.

If the answer is “yes,” we validate and model.

Stimming isn't the problem. Dismissal is.

Final Thoughts

Whether it’s joyful button tapping, a favorite phrase on repeat, or a soothing script from Bluey—every behavior tells a story. When we slow down and pay attention, we can turn those moments into powerful opportunities for connection.

Let’s stop labeling AAC behaviors as “non-functional.” Let’s redefine stimming as part of a learner’s voice—and give it the respect it deserves.

Want to Learn Even More?

If this is resonating, don’t miss Laura Hayes’ incredible presentation, “Stimming or Not Stimming, That is the Question” from AAC in the Cloud. It’s one of the best resources out there for understanding why AAC stimming happens, how it’s often misinterpreted, and how to support learners in neuro-affirming ways.

And her Talking with Tech episode gives a deeper look into why reframing AAC stimming is so important.

Interested in sharing this with your team? I created a free 16-page handout. Click the image below to access my freebie vault where you can find it alongside of lots of other helpful AAC resources.

Enjoyed this post?

I send out blogs like this regularly, offering my expertise and useful tips for parents about all things related to child learning, speech and language development and the use of technology to help children’s communication.

Parents: download the AAC Coaching Bundle resource for free!

SLPs: Download my free communication board.

Subscribe to my SLP podcast, Talking With Tech, which I co-host with fellow SLP Chris Bugaj. We talk about the latest developments and best practices on using AAC for people with complex communication needs! 

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]]>How to Redefine Stimming on an AAC DeviceAACRachel MadelWed, 28 Aug 2024 19:00:00 +0000https://www.rachelmadel.com/blog//attributing-meaning-with-babbling54144566e4b03a1356f912f4:542b3958e4b01d8f6abe5133:6296871a2f7b3751569911b4

Have you ever worked with a student who appears to be randomly activating icons on their AAC?

You may hear people say that the child is “just stimming” or that they're “just playing with it” or they “aren’t using it functionally”. When in actuality, they're engaging in a very crucial part of language development!

I want to share a story about a student of mine whom everyone said was “stimming” all day on their device. I set this student up with high-tech robust AAC and she started activating every single word on that device on repeat. Everywhere she went she brought the device and would not stop activating all of the buttons. The team was calling, emailing, and texting me, saying, “She's not using it functionally!” and “She's distracting the other students in class!” or “She won't stop stimming!” 

One day after four months of intense exploration and non-stop babbling, the student stopped. She started acutely listening to what the adults around her were saying. We realized that any word we said, she could find on her device. Even obscure words like “grasshopper,” “island” and “receipt.” These are words we had never taught her. It was UNBELIEVABLE. The whole team was in shock.

I share this story for two reasons:

1. We can never assume that what a child decides to do on their AAC system isn't purposeful or meaningful. In this case, the child was learning where every single word was located on her device. It was truly incredible that she had taught herself this skill!

2. This child knew where every single word was on their AAC --- BUT she still very limited understanding in how to use all of those words in meaningful ways. Memorizing the words on the device did not translate to her magically being able to communicate with us. This illustrates how CRUCIAL it is for the adults around an AAC user to model language in meaningful ways.

AAC learners sometimes explore their devices by pressing buttons and saying words out of context. This exploration is similar to the “babbling” stage that infants go through when acquiring language. Just like when babies explore producing sounds to say words, AAC learners explore their devices to learn the meaning and power of their words.

When a baby says “da” for the first time how do adults typically respond? “DADDY! You said DADDY, DADDY is coming home soon!”

That “da” could have been completely random —- but over time when we respond to that “da” as intentional then the baby learns that’s how they say “daddy”. It’s no different when it comes to AAC.

So what do we do when a child is “babbling” on their device? We attribute meaning to what they are communicating in the exact same way.

If a child says “shark” even though you are holding up the “dolphin” you can attribute meaning by taking what the child says and responding naturally.

EXAMPLE: “Should we try to find a shark?” or “This DOES look like a shark —- but it’s actually a dolphin.”

By attributing meaning, it validates what a child is saying. It also demonstrates that there is a cause-and-effect relationship between what a child says on their device and the actions of their communication partner.

Instead of expecting our students to have immediate intention and accuracy with their AAC, how do we cultivate space for more explorative learning of language? We can shape their language learning and see more progress if we actually pull back on our expectations and let the process flow more freely.

Read more about Stimming and AAC on my Instagram with my 5 part collaboration with Laura Hayes. (1, 2, 3, 4, 5)

Watch my YouTube video on What to do When a Child Makes a "Mistake" on their AAC device

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The reality with any AAC system is that we can only program so many words into a device. Inevitably, we can’t possibly know or program every word an AAC user might want to use. 

That’s one of the reasons having an AAC system with a built-in keyboard is so important, and in order to use that keyboard, we need to teach AAC users literacy skills. 

All children, regardless of their disability, CAN be taught how to read and write. 

If you’re looking for a deep dive into this subject, I highly recommend listening to Kim Albrecht’s podcast LOMAH in which she does a 12-part series following the book Comprehensive Literacy for All by Karen Erickson.

Here are some ideas if you’re not quite sure how to get an AAC user started with literacy: 

Set up a regular time for shared reading

Find your child’s favorite book, sit down and read together. You don’t have to get caught up in reading all of the words on the page. You can simply talk about what you see. The focus should be on having a meaningful and positive interaction with your child where there are lots of communication opportunities. 

Teach letter sounds and names

During shared reading, you can also start building out letter sounds and names. This can be done by highlighting a specific word or letter on a page and opening up a child’s keyboard to type it. We can do lots of talking about letters and sounds so a child can begin to understand these concepts.

Start practicing independent reading and writing

We need to start cultivating a child’s interest in reading and writing. This can be done by scheduling specific times to practice. Make sure your child gets to choose what they want to read or write about.

If your child struggles sitting and reading traditional books, you can try using digital books where the text is read out loud. You can even try short video clips on YouTube with the closed captioning on. We want to give kids motivating experiences with text in whatever modality they’re most interested in. 

If your child isn’t able to hold a pencil or doesn’t enjoy the process of writing, then you can have them write using a keyboard or alternative pencil. 

When it comes to independent writing, it’s important not to tell a child what to write or to have them copy or trace words. We want them to write completely independently and give them feedback on whatever they put on paper. 

When we are thinking about our literacy instruction, there are two things to keep in mind: 

Choose activities that have an authentic purpose

Make sure we’re doing reading and writing activities that have a goal -- not just worksheets and busy work.

Follow a child’s lead

If you let a child decide what they want to read and write about, they are more motivated and invested in learning to become better readers and writers.

Would love to know what you think...

Leave a comment below or you can reach out to me on Instagram @rachelmadelslp - I’d love to hear from you! 

Watch the YouTube version of this post here.

When we’re teaching vocabulary to children with complex communication needs, we need to be highly strategic about the words we’re choosing. I’m going to break down exactly how I figure out what words to start targeting for children using AAC. 

First, we need to determine what the child’s current spontaneous language looks like. 

When I say spontaneous, I mean a child has a thought in their head and they communicate it without any support from adults. And the child could be communicating any modality -- verbal speech, sign language or through AAC. 

Track a child’s spontaneous language for a week to figure out exactly what they are communicating independently and in what context. We want to build off of the communication a child is already showing us. 

The next step is determining what types of words a child is using: what nouns, core words or phrases are they using? What are the toys, foods and activities they’re most motivated by?  

The last step is to figure out how a child is communicating nonverbally. 

This could be making eye contact, smiling, crying, reaching or pushing something away. These are all situations where a child already has intent to communicate a message; they just don’t have the words to convey what they want or need. These are the best opportunities to model language on an AAC system. 

For example, if your child is constantly pushing away foods they don’t want, it's a perfect opportunity to model “NO” on their device. 

When we start getting more strategic about the words we’re teaching AAC users, they can make faster progress because we’re building off of their strengths and choosing vocabulary that’s relevant and meaningful to them. If you need more guidance, I’ve created the AAC Vocabulary Bundle, which is a tool to use with your child’s communication partners to select the appropriate vocabulary.

If you enjoyed this post, check out my Vocabulary Strategy video on my YouTube channel.

Would love to know what you think...

Leave a comment below or you can reach out to me on Instagram @rachelmadelslp - I’d love to hear from you! 

Utilizing this least-to-most prompting hierarchy (see photo below) helps give children the scaffolded support they need to become more independent and autonomous communicators.  Often times I find communication partners jump halfway down this hierarchy by giving directives (e.g. "Say 'train' on your talker") or asking specific questions (e.g."What do you want to play?"). There's magic that happens when you tempt a child with a fun activity or desired item and you simply pause to see what they come up with completely on their own. Remember: if we are constantly prompting our communicators, then we are teaching them to only communicate when someone tells them to. To check out our AAC Vocabulary Bundle (prompt hierarchy included), click here.

STEP 1: Choose a word or phrase and provide direct instruction 

Before we can expect children to independently communicate with us, we need to provide lots of opportunities where children see words being used on their device. EXAMPLE: If a child is highly motivated to be pushed on the swing we can set up the activity and provide numerous opportunities where the child sees us model the words "STOP" and  "GO" on their device. Practice lots of different exciting activities where you can target "STOP" and "GO" and include lots of modeling on the child's device. Once you have provided lots of different experiences where you use the target words, you're ready to utilize a least-to-most prompting hierarchy to elicit more independent communication of those words. 

STEP 2: Find something a child is jazzed about 

Children who are really motivated will surprise you with how creative they can get with their communication. Without a high level of engagement, we are forced to rely heavily on modeling and explicit teaching. Having a child answer questions like "What color is it?" likely won't get us very far when we're teaching children to become independent communicators. Often times, motivation is inversely correlated with how much support a child requires. EXAMPLE: If a child has a low level of motivation, they require more support from communication partners. Conversely, if a child is highly motivated, they are typically more inclined to communicate with more independence.

STEP 3: Tempt + Pause 

When we tempt children with an activity or highly desired item, children are often eager and determined to communicate with us. The goal here is to have a child spontaneously initiate communication using their device.  The level of accuracy (i.e. which word they selected) is less important in the initial stages of learning how to use a new word; we want to teach children that all of their words have power. Not getting any response? Move one level down on the hierarchy.

STEP 4: Use Body Language 

After waiting 10-15 seconds (yes, that long!) you can try to tempt again by presenting an item or activity. You then use some type of gestural cue  (e.g. shrugging your shoulders or giving a quizzical facial expression) to indicate to a child that a response is expected. Still no response? Keep movin' on down! 

STEP 5: Open-Ended Question 

If there's still no response, tempt the child again with the super fun and exciting activity or item and pair it with a vague question like "now what?" or "what should we do?". You can even make a general comment like "Hmm".  Still nothing? Move (with caution) to the yellow zone of the hierarchy. 

STEP 6: Ask for a Response 

This area of the hierarchy is where many communication partners accidentally spend most of their time. They jump directly to giving directives (e.g. "Tell me what you want") or asking a specific question (e.g "What do you want?"). These types of demands for communication should only be used as an absolute last resort. Still not getting a response? We can provide some visual supports in the next level of the hierarchy. 

STEP 7: Point to Device or Symbol 

You can start by simply looking at the device or gesturing to the device to encourage a child to communicate with you. If that's not working, you can try pointing to a general area of the child's device or even to a specific symbol to get a child to communicate. This level of prompting should be used with extreme caution. The more children are spoon-fed what to say, the more likely they will be to rely too heavily on these types of supports. We want children formulating novel thoughts and communicating them with us, not going on auto-pilot while we point to the words we think they might want to say.  Are you STILL not getting any communication?! You might want to reassess the child's motivation. If you feel confident that the child is highly motivated you can jump down to the next level of the hierarchy. 

STEP 8: Model 

We know the importance of modeling a variety of words for children so they are able to learn how to use them on their own. This portion of the hierarchy is in the red zone because there is a difference between modeling generally to expose children to language vs. modeling a specific word or target with the expectation that a child says the word after us. If a child continuously requires direct models, it's possible they haven't received enough modeling exposure to that specific word in a way that is motivating and solidifies meaning for them. 

STEP 9: Physical Touch 

We're officially in the red zone, and this zone is red for a reason. We don't have the capacity to force a verbal child to talk, so why would it be acceptable to take a child's hand and force them to activate words on their device? I like to use the phrase "Inspire, don't Require" when thinking about working with children who have complex communication needs. As the adults who are responsible for teaching children how to communicate, it's our responsibility to create language opportunities that are so exciting and fun that children can't wait to communicate with us.  Spoiler Alert: physical prompting rarely translates into communication that is independent. Be patient, and try finding something that is so motivating to the child that they are inspired to communicate!  

Need a more in-depth training on least-to-most prompting? One of my favorite AAC experts Rachael Langley has a presentation on this topic that's completely free! You can also find amazing AAC resources on her website. 

Citation

Finke, E. H., Davis, J. M., Benedict, M., Goga, L., Kelly, J., Palumbo, L., . . . Waters, S. (2017). Effects of a Least-to-Most Prompting Procedure on Multisymbol Message Production in Children With Autism Spectrum Disorder Who Use Augmentative and Alternative Communication. American Journal of Speech-Language Pathology, 26(1), 81-98. doi:10.1044/2016_ajslp-14-0187

Watch the video version of this post here.

One of the most common problems I see in my practice is that kids are stuck using carrier phrases like "I want…"  or “I see…” We call these “carrier phrases” because you simply rotate different words into the rote phrase.

EXAMPLE: “I want ball," “I want playground," “I want juice."

Kids pick up these phrases somewhere along their therapy journey; typically from well-intentioned therapists who are trying to get children to start speaking in sentences. 

The problem is that kids sometimes get stuck in these carrier phrases and don’t fully comprehend their meaning. 

How did we get here?  

When kids have limited language skills, we first teach them how to request highly motivating nouns (e.g. “cookie”). 

The next step is to expand on those single words and <drumroll please> this is where the carrier phrase is typically introduced.

Educators are interested in expanding beyond single words so they embed learned nouns into chunked phrases, usually starting with “I want."  Once a child has sufficiently memorized “I want + noun,”  then a variety of other carrier phrases are typically introduced (e.g. “Can I have the…”, “Let me see the…” or “It’s my turn…”). 

The end result might be more overall words but the comprehension isn’t always there. 

How do you know there are comprehension difficulties? 

There are two red flags that can tell you a child isn’t comprehending these chunked phrases. 

Using multiple carrier phrases at one time

The first is when a child starts using ALL of their carrier phrases at once. I have a 6-year-old that I work with who loves playing with toy keys. To request the keys he will start by saying “I want keys.” If I pause and don’t give them to him right away then he might say “let’s play keys," followed by “I see keys,” “more keys” and “open the keys”. He rattles off every memorized phrase he knows because he’s not sure what the expectation is. 

Overgeneralizing one phrase

The second tell-tale sign of comprehension difficulties is when one phrase is overgeneralized in contexts where it doesn’t make sense. When I first started seeing the 6-year-old with a key obsession, I began by showing him a picture of a child jumping on a trampoline and asked “What’s he doing?” He responded by saying “I want jumping." The next photo: “I want driving car," and the next photo: “I want singing.” He simply memorized to put “I want” in front of everything he said because he was taught early on that he will get what he wants.  

Teaching chunked phrases is also problematic because we’re not breaking down these phrases into the most basic components. The phrase “I want” is typically taught together. However, early language learners don’t understand that “I want” is actually two separate words. Babies who are learning language go from single words (e.g. “juice”) to 2-words (e.g. “want juice”). When we skip ahead we don’t allow for valuable teaching moments for children to learn the difference between these individual words. 

What’s the solution? 

Core Words.

Not sure what core words are? I’ve already covered that in an earlier blog post and one of my videos. 

Core words are fantastic because they are the most frequently used words AND they allow children to easily combine words into novel phrases and sentences. 

Below I’ve listed 5 of my favorite core word combinations to teach instead of simply having a child say: “I want…” 

1.) “See it”

I tend to use this with iPad activities or preferred videos on YouTube. Start watching their favorite video and then PAUSE. Turn the iPad away from them and start modeling the core word “see” or “see it” as an alternative way to request watching the video. The nice thing about the word "see" is that it can also be used for commenting.  

2.) “Like it” 

Instead of having a child always tell us what they want, it’s powerful for children to tell us what they "like". I love this because commenting is powerful. It’s intrinsically reinforcing because when a child tells us what they like then we typically give it to them more often.  

3.) “Me/You”

I like to keep it simple when teaching personal pronouns since they can be so challenging. Instead of “my turn,” it can be effective to practice turn-taking with a simple “me” or “you” to talk about who will take a turn next.  

4.) “I do”

Children are often quite adamant about doing things on their own terms, so helping to teach a child say “I do” grants immediate independence. This is more specific than simply saying “I want." I make sure to contrive scenarios with materials and activities that a child is used to doing solo. When I intervene, it’s a perfect opportunity for them to declare their independence.  

5.) “No”

Nothing is quite as powerful as allowing a child an opportunity to tell us what they don’t want. “No” can easily be combined with a variety of fringe vocabulary as well as other core words (e.g. “no go," “no more," "no help”).  It also can be used to stop an activity that they really don’t like. 

Instead of teaching a child a 3-4 word carrier phrase that a child might memorize, start introducing core words to ensure true comprehension. Eventually, we can build vocabulary skills so that a child can spontaneously say “I want ___” but they also will be able to say “you want," “don’t want” and “want more” because they truly understand the meaning behind these words.

If you're interested in core words then be sure to follow me on instagram or facebook because I'm constantly posting photos that can give you lots of ideas on how to incorporate more core words into the mix!

OVER TO YOU

Now---Would love to hear from you. Is your child stuck in the "I want" phrase? Tell me about it in the comments below!

If you’ve spent any time here on my website or follow me on social media, then you’ve probably noticed that I love visual resources. Visual supports are imperative for child learning, and there are few visual supports that I love more than a communication board (you can download my FREE Core Communication Board).

I love communication boards because they are the best way to give children the visual supports they need to learn language. So what exactly is a communication board?

A communication board is a visual representation of language—all organized in a very strategic way. In short, it helps children, and especially children with autism, better visualize and understand language. The communication board I created focuses on core words, and is set up to help children easily combine words into sentences.

So to help you get started with using a communication board, I’ve outlined some tips for you below.

1.)   Always have your communication board available

My first, and most important recommendation when using a communication board is to remember to use it all the time, since children need lots of experiences to learn new vocabulary. The more you use it, the more exposure your child will have to various words. Then you’ll be able to continuously introduce new vocabulary.

2.)   Find something motivating

When you're getting started with a communication board, it’s essential to find a motivating activity. This should be something that makes your child smile and laugh. It could be as simple as a special toy or playing their favorite video on YouTube. A lot of my kids LOVE sensory input, so tickles and squeezes work too. The key, however, is for the motivation to be there. Otherwise, we won't have kids buying into this new way of communicating.

3.)   Choose a word

Next, make the communication board easily accessible and visible to your child and choose a word that makes sense. I love to start with “go,”  because there’s so many different ways to use that single word. You can make the train “go.” You can say “go” to have them turn on their favorite TV show. They can say “go” to play outside.

If your child likes to eat (who doesn’t?!), then you use a word like “eat,” or if they are thirsty you can use the word “drink.”  Just choose a single word and then start modeling. All you have to do is touch the word on the communication board and then say it at the same time. For example, if your child is really motivated by ice cream, I’d use the word “eat.” I put the communication board next to the child and I say “eat” while pointing to it on the board. Then, give them a bite of ice cream! After a bite I would stop and model it again, “eat,” while holding the ice cream up. I keep repeating this until the child starts to understand the association.

Another fun and engaging way to target core words is through the use of GIFs! Using GIFs gives children a fun and novel moving picture that inspires communication.

4.)   Pause

After you do this for a few times the next step is to pause. You should have your child primed and ready for a bite of ice cream, but then, instead of modeling, just wait and see what happens. A lot of times kids will look up at you, expecting you to continue the routine. But this is the moment when you provide them the word to ask for what they want. You can point to the word “eat” and see if they point after you, or see if they try to say the word on their own.

Additionally, when you're working on communication, I always tell parents two very important things.

First, I tell them to praise every communication attempt. Communication attempts can be as simple as making a sound, making eye contact, or touching anywhere on the board. They don't have to touch the right word, it just has to be some type of initiation.

Secondly, my favorite phrase is “inspire don't require.” We never want to force a child to communicate with us. Instead, we want to be strategic about choosing highly motivating activities and then tempting them to communicate. Some kids pick this up right away while others may need time and lots of repetition before they get the hang of it.

It’s important to remember that this is a completely different way of communicating. The only way a child will learn is if adults around them show them how to do it. Start small with one activity for 15 minutes a day and then slowly build up from there.

And finally, don’t be afraid that using a communication board will prevent your child from talking. I find it’s actually quite the opposite. The more strategic exposure to language we give a child, the more likely they will be to start verbally communicating. I find that once a child starts understanding language, then they are more apt to start using it on their own. Visual supports such as a communication board help children with autism begin to understand language better.

Now you’re ready to download my free communication board. Once you download it, you’ll also receive access to a really helpful video that shows you exactly how to use it!

If you’ve already downloaded your free “Lite” version mentioned above then it might be time for an upgrade! My “Communication Board Bundle” includes both a “Mid” and “Full” version of the board along with a bonus “Food” board to help your child communicate during meal times.

Is your child stuck using single words? My “Building Sentences Board” can help your child start communicating in sentences.

OVER TO YOU…

Have you used a communication board yet? Let me know how it went in the comments below!

I'm living in Hawaii! I'd love to say that it's because I just wanted a tropical getaway. 

The real story behind my relocation? 

 I discovered I've had severe toxic mold poisoning. 

 My beautiful Venice beach apartment, where I have lived the last 5 years, was full of invisible mold.  

 My health has been rapidly declining the last 5 years and in 2018 I was diagnosed with mast cell activation syndrome. Basically, it means my body has become hyper-reactive to foods, medications, and chemicals as if I had severe, life-threatening allergies.

 I can be sitting in a meeting or having lunch with a friend and suddenly my body goes into overdrive and my skin feels like it's on fire. I've had to become hyper-vigilant about my environment and I carry an epi-pen everywhere I go for fear of anaphylaxis. 

 In the last 5 years, I have been to 16 different doctors, desperately trying to figure out what was wrong with me. At the beginning of this year, I started losing my vision (which still hasn't fully returned), having numbness and tingling in my hands and feet, and have been riddled with debilitating pain.

 The root cause?  Neurotoxins from mold. 

 When I discovered I was unknowingly living in mold, I left all of my belongings behind in LA and hopped on a plane to Hawaii--- a place I've always thought has magical healing powers. 

 My recovery is slow and requires a high level of patience and determination. But every day I feel a little better. I’ve been so grateful to be surrounded by the majestic beauty of Hawaii. 

 As I finally see light peeking out from the end of the tunnel, I've been overwhelmed with emotions and reflection. The lessons of this long, arduous journey have given me even more compassion for the families and students I serve.  

 Lesson #1: 

Give grace. You never really know what’s going on in someone’s personal life. I’ve spent the last 5 years secretly suffering. On the outside it appears like I’ve got it all together: I’ve built a private practice, started a podcast, created a YouTube Channel, presented at conferences, developed a library of resources and launched courses. My family and close friends are the only ones who saw my immense struggle both physically and emotionally. The fear and uncertainty of not knowing if I would ever live a normal life again chipped away at my resilience and hope and some days it took every ounce of willpower for me to get out of bed. 

It’s easy to get frustrated that a family isn’t using a device at home or modeling throughout the day. We don’t really know what’s going on beneath the surface with the families we serve, especially when they have medically fragile children. Be patient and recognize it takes bandwidth to stimulate growth and change. Sometimes families need to deal with more pressing medical issues before they can even think about prioritizing communication. 

 Lesson # 2: 

Have compassion. Up until recently, I never fully understood what it meant to not have control over my own body  --- this is something that our kids with complex medical needs experience every single day. And they often don't have the communication skills to express what's happening to them. When a child isn’t showing up fully to our sessions, we need to be careful about blaming this on inattention or poor behavior. We have no idea what’s going inside a child’s body at any given moment, so I prioritize teaching kids how to self-advocate for what they need and how they feel.  Once kids learn to communicate what’s happening in their bodies then we can help support them in getting to a place where they are ready to learn. 

 Lesson #3: 

Don't give up. Sometimes the first thing we try doesn't work. I was unrelenting in my quest to find answers. If I had listened to the first or second or 10th doctor my health might still be rapidly declining. Sometimes our students with complex communication needs require a high level of trial and error to determine what supports they need to learn and grow. They need a clinician that is patient and works tirelessly, believing that eventually, hard work will reveal information that can help us better support them. 

I debated sharing this post because I feel exposed and vulnerable. I chose to be brave because I truly believe that sharing authentically and openly can help others who might also be struggling. This journey has helped me cultivate even more empathy and compassion for the students and families I work with… and that feels like an amazing silver lining to all of my struggles.

If you suspect you might be exposed to toxic mold checkout these linked resources:

• Urine Testing for Mycotoxins

• Dust Sampling for Testing your Home

• Great Resource for Mold Remediation 

• Finding Hotels/Safe Spaces that aren't Moldy

• Great Podcast Episode about Nutrition
  

Without question, the following line is one of the biggest challenges I hear from parents: “My child isn’t speaking in sentences.” After all, building sentences is central to a child’s communication success. This skill develops as babies listen to adults around them having conversations. Then over time, babies slowly start to emulate adults by first producing single words and eventually short phrases.  As language skills grow, their sentences become more and more sophisticated.

Unfortunately, this process isn’t quite as simple for children. A lot of my clients might be able to repeat words or phrases, but they are mostly using scripts and aren’t formulating their unique thoughts and ideas into sentences.

This is where I find visual supports to be incredibly helpful. And it’s because of this that I created a “Building Sentences” board to help support my clients who were having challenges expanding their communication beyond single words. It’s quickly become one of my most popular resources at talks and during consultations, so I wanted to make it available for parents and speech therapists.

I use this tool as a way to help children learn basic sentence structure so they can start creating sentences on their own. This is perfect to use with children who are minimally verbal using AAC or for children who are talking but are using a lot of scripted language.  

Many of the kids I see in my speech therapy practice are stuck using the “I want” phrase. They can get their basic needs met, but aren’t expanding to more complex sentence building.

I use a test to judge if a child has challenges creating sentences. What I do is show a child a picture and ask them to tell me what the person in the picture is doing. Often times children are able to label all of the nouns in the photo but aren’t able to answer the question (i.e. “She’s eating an apple”). This indicates that formulating sentences is a challenge and that's where the "Building Sentences" board comes into handy. 

How I use this board... 

The layout in this resource supports both building sentences and answering questions. This is done through strategic color-coding and visual support that help children understand the four basic building blocks to sentences:

People

Actions

Things

Places

It’s important to break down the sentence-building process so children start understanding the various parts of speech and how to follow a basic sentence structure: subject + verb + object.

Depending on the child’s skill level, you can start off with a simple sentence structure such as “Person” + “Action,” and then expand to more complicated sentences as their language skills grow.

After a child successfully creates a sentence using the board, I typically follow up with a “WH” question.

For example, if the child built the sentence, “The girl is eating,” then I might follow up with “Who is eating?” or “What is the girl doing?”

I always recommend starting this activity with highly-motivating family photos from a vacation or a child’s daily routine (e.g., eating their favorite snack) so that the sentences are meaningful and relevant. You could also try this activity while reading a familiar story or watching their favorite YouTube video. The key is to keep it fun and engaging.

Are you interested in learning exactly how I use this resource? Head over to my Facebook Group because that’s where I release all of my resources first!  

Over to you

Have you tried out this resource? Let me know what you think in the comments below!

Podcasts= Life. Especially in LA traffic. There’s nothing better than the efficiency high I get when I’m driving around AND learning some new strategies, therapy ideas and get updates on the latest research. Below you’ll find 15 SLP podcasts that you have to check out on your next drive.

SLP Happy Hour

https://itunes.apple.com/us/podcast/slp-happy-hour/id1342995231?mt=2

“SLP Happy Hour” is a podcast for caring SLPs who want more calm and less chaos in their workday. Sarah and Sarie are passionate about combatting perfectionism and helping SLPs create stronger and healthier relationships with their work worlds, and to have more fun and calm at home. On the podcast, Sarah and Sarie talk about happiness, SLP lesson fails, easy (lazy) lessons, new habits we are trying to create, and tips and tricks for maintaining more SLP calm.

Swallow Your Pride

https://itunes.apple.com/us/podcast/swallow-your-pride/id1257987923?mt=2

The Swallow Your Pride Podcast was created with the purpose of diving deeper into the issues that speech-language pathologists face when working with patients with swallowing disorders. Theresa Richard discusses many controversial topics in order to provide the LATEST evidence-based treatment strategies, and create a community of dysphagia clinicians who want to consume incredibly valuable insight and information.

SLP Trivia Fun

https://itunes.apple.com/us/podcast/slp-trivia-fun/id1307606294?mt=2

Hosted by Erik X. Raj, “SLP Trivia Fun” is the ONLY game show podcast on the planet where each and every contestant is a speech-language pathologist.

True Confessions with Lisa & Sarah (SLP Toolkit)

https://itunes.apple.com/us/podcast/true-confessions-with-lisa-sarah/id1362306767?mt=2

A true story of two school-based SLPs who decided to start a business and record their adventures. Find out what happens when Lisa and Sarah stop being polite and start getting real.

SLPs Wine & Cheese

https://itunes.apple.com/us/podcast/slps-wine-and-cheeses-podcast/id1384334799?mt=2

Deborah Brooks, MS, CCC-SLP, TSSLD and Maria Kotsonis, MA CCC-SLP, TSSLD host an entertaining podcast for the realistic SLP. They provide practical speech therapy tips and tricks while enjoying wine and cheese.

Conversations in Speech Pathology

https://itunes.apple.com/us/podcast/conversations-in-speech-pathology/id791327219?i=348328662&mt=2

Join speech-language pathologist, Jeff Stepen, as he interviews a variety of professionals, parents, and other assorted characters about topics related to the practice of speech pathology/therapy.

The A.T.Tipscast

https://itunes.apple.com/us/podcast/the-a-t-tipscast/id272223032?mt=2

Chris Bugaj’s podcast is about using free or low-cost technology to help students meet their educational goals and to help you design awesome educational experiences for all!

Speechie Side Up

https://itunes.apple.com/us/podcast/speechie-side-up/id1409431028?mt=2

Hosts, Kim and Venita, serve up their tips and tricks and interview other SLPs so you can get inspired and learn from experts in the field. They are serving up some informative and fun topics in “Speechie Side Up”.

Strength in Words

https://itunes.apple.com/us/podcast/strength-in-words/id1085976366?mt=2

Join Ayelet Marinovich, M.A., CCC-SLP, author, singer, mother of two and pediatric speech-language pathologist, for a podcast for parents, caregivers, and educators of infants and toddlers. “Strength In Words” is the place for families with infants and toddlers to engage in a high quality, evidence-based conversation about all things early childhood and early parenthood.

The Speech Space

https://itunes.apple.com/us/podcast/the-speech-space-podcast/id1223794927?mt=2

Looking for some fresh ideas for your speech therapy sessions? Jessica Cassidy, M.S., CCC-SLP hosts a podcast full of tips and time-saving resources for busy speech-language pathologists working in the schools or private practice.

Private Practice Success Stories

https://itunes.apple.com/us/podcast/private-practice-success-stories/id1374716199?mt=2

There is no such thing as a "perfect" private practice; only one that's perfect for you. Listen to Jena Castro-Casbon, MS CCC-SLP interview successful private practitioners from around the US (and world!) as they share their journey, lessons, information and inspiration with SLPs interested in starting or growing a successful private practice.

Xceptional Leaders

https://itunes.apple.com/us/podcast/xceptional-leaders-with-mai-ling-chan/id1435433350?mt=2

Hosted by May Ling Chan, “Xceptional Leaders” highlights amazing people who are dedicated to helping people with disabilities. Learn priceless tips and first hand experience stories from weekly podcast interviews of successful entrepreneurs who focus their efforts on helping people with disabilities.

Speech Science Podcast

https://itunes.apple.com/us/podcast/speech-science/id1224862476?mt=2

Hosted by Matt Hott, Michael McLeoud, and Michelle Wintering, “Speech Science” interviews leaders in the field of speech and language therapy, individuals who are making a difference in the lives of others with disabilities, and interviewing individuals who have overcome deficits in their own lives. Weekly they offer news stories related to the field and critical reviews of literature, tools, and ideas related to speech and language therapy and audiology. New episodes are released every Tuesday.

Talking With Tech

https://itunes.apple.com/us/podcast/talking-with-tech-aac-podcast/id1300126888?mt=2

Shameless plug! This one is my podcast… but I had to include it on the list! How do people with complex communication needs learn to use augmentative and alternative communication (AAC)? Join speech-language pathologists Rachel Madel (that’s me!!) and Chris Bugaj as they answer your questions, discuss relevant research and give you updates on the latest and greatest developments in the field of AAC! Interviews with industry thought-leaders, clinicians, parents, researchers, users, and app developers help you stay up-to-date on the latest devices and apps, best practices for device selection and implementation, ideas for working with communication partners, and more!

Night Light Stories

https://itunes.apple.com/us/podcast/night-light-stories/id299352561?mt=2

“Night Light Stories” is a podcast featuring original children's stories. Written by a husband and wife team, these narrations were brought to life while sitting by the friendly glow of a child's night light. Chris and Melissa Bugaj invite you now to share these stories with your own family, at night, in the morning, or anytime... anywhere.

Over to you

Have you listened to any of these podcasts? I’d love to hear about your thoughts in the comments below!

In my last post, I described the difference between core words and fringe words, and talked about the benefits of teaching core vocabulary. This is the fastest way to help a child start communicating more effectively. 

If you’re new to the concept of core words then you might be feeling a little overwhelmed and not sure where to get started. 

Rest assured: This post will break it down step by step for you. 

1) Download my board

I use this communication board every day in my practice because it's such a great visual support to teach language.

I’ve kept the “Lite” version of the board really simple, with only 10 core words, so it’s a really good place to start, and a great way to encourage communication without needing to purchase an expensive device.

2) Focus on one word

Choose a core word of the week, or of the month. This will make things more manageable.

The words “Eat”, “play” or "go" are all a good place to start, so choose the one that might be the most motivating for your child. Then every couple weeks you can add a new word to the mix. 

I started working with a 4-year-old little boy with autism who is OBSESSED with a toy piggy bank that lights up and makes noises. 

He doesn’t have the dexterity to slide the button to turn the pig on and he was REALLY motivated by this. So that's why we decided to focus on the word "on". For the entire month,  I helped Mom find as many opportunities as she could think of to help him say “on”. 

After the first week Mom reported back that he was able to say “on” to turn the television on. And then the next week he told her that he wanted to turn the lights "on" and the water "on" to take a bath. The following week, he said he wanted to put a hat "on" and told Dad he wanted to sit "on" his lap.

Every week when I came back, Mom would be excited to tell me all of the new situations she discovered.

When you focus on one core word for an entire month it gives children lots of practice with one concept and it also gives parents a very specific and easy to achieve goal. 

3) Get your child to point, not imitate

Some children with autism are master imitators, but they have a hard time creating spontaneous communication. By pointing to a picture instead of telling them what to say, you are helping your child’s brain actively find a word on their own. 

Let me give you an example of how I  might do this at snack time.

You can start by modeling the word "eat" for your child to say (e.g. “Tell me what you want to ‘EAT’”) and  pointing to the word "eat" on the communication board. 

You keep saying "eat" and pointing to the communication board to help them ask for the snack.  

Then after you've done this several times, you pause. If they don't respond then you can point to the icon "eat" without saying anything.  Sometimes the child will point to the board after you and other times they might even say the word "eat".

The key is to reinforce every attempt they make at communication. 

4) Model core words constantly

Core words can be very abstract, so they take lots of exposure and repetition in order for children to start understanding their meanings. A great way to demonstrate the use of these core words is through fun and engaging activities.

When modeling, be sure to use your voice to emphasize the core word you’re working on: “Oh, do you want to EAT?”.

Focus on modeling core words all day long with the visual support of the communication board and be sure to create lots of opportunities for them to use the words you’re trying to teach. 

Remember my principle: “Inspire, don’t Require.”

Inspire your child to communicate by finding motivating activities but never force them to say a word or point to a picture. With enough practice and a highly motivating activity, children will start responding on their own!

Over to you

After you download my communication board, I’d love to know how it goes! Does it make it easier for you to work with your child and get started with core words? Let me know in the comments below!

We’re living in a digital age and children amaze me at how tech-savvy they are. Sometimes it can be overwhelming finding the right apps that both motivate children and also facilitate learning and communication.  

We often think of screen time as a passive experience, but when we implement the right strategies, we can harness a child’s motivation for technology and create a dynamic language-learning experience. It’s important to remember that any time you’re using apps to support communication development, it is essential that adults maintain control of the device. If children are busy pressing, tapping and swiping, then they are less likely to communicate. I typically hold the device in front of the child and encourage them to tell me what to do. This slight shift in control allows kids to explore new apps using the power of their words to make exciting things happen on the screen.  

However, with thousands of apps on the market, it’s sometimes challenging to weed through the noise. Below are five questions to keep in mind when determining if an app might be helpful in supporting communication development. 

If you want to jump straight to my favorite apps for children, download my free App Guide. 

1.)  Is the child excited about it?  

In order to communicate, we must have a high level of motivation. This is especially true when you’re using apps to support communication. I find myself downloading new apps and getting really excited, but then presenting them to a child during a session only to find the child is not interested. If an app doesn’t spark excitement, then chances are a child will not be motivated to communicate. A caveat, however, is that children sometimes it takes a few trials of an app before a child realizes they enjoy it. I tend to leave new apps open and allow a child to explore on their own to see if they might like it.

The moment where a child begins to seem intrigued or excited is when I then make the shift to holding the device and attempting to elicit communication. 

2.) Are there a variety of action words?   

Children tend to have a wide variety of nouns in their vocabulary but sometimes struggle with more abstract language concepts like verbs. The best apps for communicating are games where a variety of actions take place on screen. One of my favorites to work on action words is Pogg, featuring an alien who does a variety of actions on command. I also like Verbs with Milo, which was developed by a speech-language pathologist, and includes more than 100 action words that Milo the Mouse performs. 

For children who are just emerging in their ability to understand verbs, you can try using the words “stop” and “go” during a variety of apps to solidify the concept of making characters and/or vehicles move on the screen.

3.) Do the apps mimic real-world experiences?  

Our ultimate goal is having a child’s experience using technology translate into skills in their real-world experience. Therefore I like to focus on apps that can help children practice daily routines. One of my favorites is Pepi Bath, where the main character, Pepi, is really dirty and needs to do a variety of self-care activities, such as wash her hands, blow her nose, brush her teeth and take a bath. I also love all of the My PlayHome apps, because it’s a virtual dollhouse that allows characters to visit different rooms in the house and participate in activities like cooking, cleaning up and getting dressed. On the app you can easily teach a skill, like hand-washing, and then go to the sink and have the child practice in real time. If a child is having a hard time completing the task, I’ll use the app as a motivator by saying something like, “First, you wash your hands, and then we can help Pepi wash her hands, too!” 

4.) Are there predictable routines? 

We know that establishing a predictable routine helps children quickly learn concepts, and it’s no different during app play. Many of my favorite apps like Road Trip and Toca Kitchen are fantastic at setting up an established routine. Once the child understands and begins anticipating the routine, I will often pause and wait for a child to communicate what they want to see happen. For example, if we put food in the oven during Toca Kitchen, we eventually have to “take it out.” Once a child is primed for this routine I will simply pause to see if the child can attempt to say this on their own. Even for apps where the routine is not definitive, you can still try to present actions and vocabulary in the same way every time to build a predictable routine.

Children are also highly motivated to communicate when I sabotage established routines by doing something different. That way we can work on language like “Not that one” or “First ____, then _____.” 

5.) Is there room for creativity? 

Children are really empowered when they are able to create something like a story or a piece of artwork, and there are a lot of amazing apps that can help foster a child’s creative side. I use story creation apps like MyStory and Draw&Tell HD, which allow children to add stickers and even personal photos into various scenes to make their own stories. An added bonus is apps that have a record feature so children can record their voice and then listen back to the story they created. Storytelling apps are perfect for all ages and many can be personalized so that a child and his/her family members can also be part of the story. I also love the apps by Tiny Twiga Studios, like Robot Maker and Fairy Maker, which help kids make their own version of a fairy princess or robot. These are the perfect activities to help kids learn how to specify and describe using adjectives to get exactly what they want to build their masterpiece.  

If you’re interested in learning more about my favorite apps to support various domains of communication development you can download my free app guide here.

If you are interested in learning more about the top 5 apps I LOVE to use for speech therapy, click here.

OVER TO YOU

What are your favorite apps to use in speech therapy? I’d love to hear your thoughts in the comments below!

So honored to get some gems of wisdom from early intervention expert, Stacey Landberg. Stacey is an LA-based speech-language pathologist who has developed a particular interest in the effects of screen-time and early childhood development.

Tell us a little bit about yourself and how you became interested in screen time and its effects on speech & language and development. 

I am an SLP who has been working in home-based early intervention for 13 years. Throughout my career, I have worked with very young kids who are diagnosed with autism spectrum disorder (ASD) or go on to be later diagnosed with ASD. I first started down this path when I became a mom in 2012 and had many questions. I discovered it was difficult for me to adhere to the current AAP recommendations regarding screen time. I wanted to know exactly why kids had to wait until 24 months to watch TV. What happens in the brain exactly? How much (screen time) is too much? How do we know? Are we sure? And yes – I was so curious to learn whether or not all this screen time affected kids’ language development and especially curious about any possible impact on their social communication. Since then, I’ve been following this research closely and since 2015, I've been fortunate to present on this topic to thousands of therapists from many disciplines across the US.

Does screen time affect speech and language development?

Speech – probably not. Language - quite possibly.  I’m not a researcher myself, but from what I know from based on an exhaustive review of the literature myself and communicating directly with researchers, we don’t really have enough studies yet to do a systematic review on this question. We also can’t conduct strong randomized control trials to prove whether or not screen-time is a direct cause of language impairment delays because of the ethics involved.  For example, we can’t take group A and give them 5 hours of screen time per day vs. Group B who gets zero screen time (similar issue with showing violent content vs. educational content to two groups). Therefore it’s hard to make a direct correlation between screen time and any area of child development since it’s impossible to control for every possible factor: like parent education level, SES, language used in the home, gender, screen content, time spent watching, etc. 

Is there any research proving that screen time is detrimental to how children learn language?  

So far the research I’ve seen isn’t incredibly compelling as I mentioned before. There are some studies that make some convincing arguments about the relationship between screen time and language development. I think as a field in general, we are right justified to have concerns about the effects of very early screen exposure and language development. Research has recently started to shift, by looking closer at adults' screen-time and screen behaviors and how that may also impact child development. Some recent research (2017, Jessa Reed, Kathy Hirsh-Pasek, and Roberta Golinkoff) has looked at word learning and showed that 2-year-olds did not learn a new word (receptively) when their parents were interrupted by a cell phone. I do worry about a possible negative correlation between distracted parenting and communication development. I don't think we have enough research to prove much yet, but we certainly have enough research to support parent education about the critical importance of face-to-face, uninterrupted, frequent, and ongoing interactions with their children. 

What are your top recommendations for managing screen time for kids? 

1. Introduce rules when you introduce screens – and stick to them. Don’t just hand kids an iPad. Give them an explanation. Who does this belong to? How does it work? When do we use it? What do we use it for? When do we put it away? 

2. Children learn by example – Parents can manage their kids’ screen time by managing their own. I’m a big fan of talking aloud. My kids hear me say things like “my phone is vibrating because nana is texting me. But I’m not going to text her back until after dinner because we don’t use screens at the dinner table.”

3. For infants, hold off on introducing screens - consider the YouTube algorithm. There’s something much more addictive about having access, unlimited options, and total independence. If you can, try to wait to introduce screens. It’s harder to take it away later than it is to avoid it altogether. 

4. Guided Access and setting limits - there are useful tools within devices that can help parents manage screens. 

5. Don’t isolate screen users – have kids share. Some studies have found that kids who share an iPad tend to learn more than those who are plugged in independently.

Anything else that we haven’t covered that you’d like to mention? 

We ALL learn best and retain more from real life vs. screens, especially very young children under age 3. The exception appears to be video chat from the studies we have so far. So, a Spanish speaking 2-year-old might learn some English words from TV, but they would probably learn many more words if they were being taught in real life, or exposed to real-life English speaking conversations. This is a good thing to keep in mind for helping children retain new words and information.

Interested in more?

Find out more about Stacey at speechtheraping.com

Check out her FB Page Media Mentorship for 0-36 month olds

Listen to her on the Talking with Tech Podcast

OVER TO YOU

What are your thoughts about screen time? I’d love to hear your thoughts in the comments below!

As a speech therapist and technology specialist, I get asked all the time about my favorite apps I use in my practice. It can be overwhelming finding the right apps for children that are practical, but that also facilitate learning and communication, and aren’t just for playing games. So in my latest blog post I’m sharing a few of my favorite apps.

Peekaboo Barn

Peekaboo Barn is a great app for early learners just starting to understand cause-and-effect relationships. If impulse control is one of the biggest challenges for your child,Peekaboo Barn is the perfect tool to help work on this. Peakaboo Barn helps address that frequent act of children wanting to immediately start touching the screen. With this app, kids practice waiting and listening to the animals inside. Then they can say things like “open” or “go” to open the barn door and reveal the animals. For older kids, this app is great for learning how to make inferences by  listening to the animal noises and making guesses about who is hiding behind the door.

Toca Kitchen

Toca Boca, a game developer of child-friendly apps, makes a wide variety of products for kids. However, Toca Kitchen is one of my favorite apps because of how many different words you can practice. Children begin by choosing a character (little boys love the monster!) and then start preparing food for their character. I start by showing all of the food options and then help kids choose what they want. It’s perfect for the core words “eat,” “more” and “on” when starting to cook. For older children, Toca Kitchen is a great way to work on social skills. Children can observe their character’s body language and facial expressions to decide what they “like” and “don’t like” and then we can talk about it!

My PlayHome

My PlayHome is one of my favorite apps for children because of how many different things children can learn. Children first pick a character, and then can begin doing activities throughout the house. Kids can tell their character to sit on the chair, open the refrigerator or drink some milk. Additionally, a child can practice different routines with their character that that child may be struggling with at home such as getting dressed or brushing their teeth. I love working on more abstract language concepts like "on” and “off,” by turning the lights or television on or off.

Road Trip

Road Trip, developed by Sago Mini, is an all-time party favorite! Road Trip is especially popular because I work with a lot of little boys who LOVE cars and trucks. Road Trip begins with kids putting clothes in a suitcase, which is the perfect opportunity to target the core word "in." Then they get to choose a car, where we can focus on core words "like" or  "don't like." Next we put the suitcases (and the cat) in our car, and hit the road. With this app for children it’s easy to target words like "go" and "stop." My biggest recommendation with Road Trip (and any app for children for that matter) is to always be in control of the iPad. If you let your child drive the car your child might be more focused on playing than communicating!

Interested in seeing these apps in action? You can check out my video here.

Pogg

This app features a green alien named Pogg who does lots of different actions and I use it all of the time to help kids learn verbs. Children can often label lots of THINGS in their environment but they may not be using any action words- you can't really get far by building sentences without verbs. 

In more traditional speech therapy, we might use photo cards or still frame images to try and teach these concepts, but this app makes the actions come to life through animation. 

Once kids realize they can tell Pogg what to do (either by saying the action or activating it on their device) they get really excited to see what he comes up with. You can make him sing, drive a car, eat, throw a ball, fly.  

Over to you

Have you tried any of these apps for children? I’d love to hear about it in the comments below!

“You were a late talker too,” your mom says as she sips her latte. “I wouldn’t worry about it. Look at you. You turned out fine. Just give him time. He’ll talk when he’s good and ready.”

You want to listen to your mom. She’s your mom! She’s been the cornerstone of wisdom your entire life and she’s never steered you wrong. She was right about that jerk you dated back in 11th grade. She was right when she told you to eat your vegetables. She was right about a lot of things. So, she’s likely right about this too, right?

Maybe. 

Your well intentioned, reassuring mother might be absolutely right. Your child might begin talking (or talking more) any day now. But what if she’s not right? What if speech doesn’t develop like you hoped it would? While you wait to find out, might valuable time be slipping by when your child could be learning tools that could help him to communicate? 

How do you know when a child needs a device to help communicate?

Tools which help people communicate are called Augmentative/Alternative Communication (AAC) and can range from simply utilizing pictures to using a high tech device such as a tablet, iPad, or computer. Here are some guidelines that can help anyone decide when to consider AAC:  

Child isn’t talking at all

According to development research, typically developing children start saying words by the time they are between 12 to 18 months old and are beginning to combine 3 to 5 words together into sentences by the time they reach preschool. Ask yourself: what is the child’s primary way of communicating? If a child is over two years old and primarily relying on gestures (i.e. pointing, grabbing your hand, etc.) then starting AAC is essential in helping that child expand his/her communication skills. 

Child isn’t talking much

Sometimes children are using words but they aren’t using enough of them. This is especially relevant when thinking about preschool and early elementary school children. You may encounter a child who can piece together thoughts into simple sentences but are missing essential conjunctions (like “and” or “but”), prepositions (like “in” and “under”), and other grammatical markers (“run” vs “ran” or “mouse” vs. “mice”). For some children formulating complex sentences is taxing.  Utilizing technology can help make the process of putting words together in the right order more visual and more memorable which allows them to start creating longer and more sophisticated sentences. 

Child is talking, but isn’t intelligible

Often parents and teachers get accustomed to the way a child is speaking and become master translators. Parents often recognize when their child is not being understood and, in turn, begin to learn to understand what their child is trying to communicate. A true test of a child’s intelligibility is whether or not listeners who are less accustomed to the child’s speech, such as extended family and friends, understand what the child is attempting to say. Making speech sound errors is a typical developmental process that begins to subside as children develop appropriate musculature and coordination in their lips, tongues and jaw. By 3 years of age, an unfamiliar listener should be able to understand 75% of what your child has to say. If a child is having a hard time being understood, AAC can be used as a tool to help a child clarify his/her message. 

Child is scripting or only saying nouns

This is especially relevant when you’re thinking about children that have complex communication needs. Children with complex communication needs may have a large and detailed vocabulary of nouns, but lack relevant verbs, adjectives and prepositions. These parts of speech are essential in the creation of sentences. Students with complex communication needs might also have the capacity to memorize long scripts from past experiences and tend to use these scripts in a variety of situations. Sometimes these scripts can even be used in context but it is difficult to have a memorized script for everything someone might ever want to say. Sometimes students who are using scripts do not understand the meaning of the individual words  that allow them to create novel sentences that they haven’t heard before. Using AAC creates a visual representation of these abstract language concepts. With practice, instruction, and when others model using these words on a device, children with complex communication needs can expand their vocabularies and develop the ability to create novel sentences. 

You, or anyone, thinks your child needs AAC

If you are asking the question, then your child needs AAC. If any educator, doctor, family member, family friend, stranger you meet on the street, or anyone else even brings up AAC as an option, then your child needs AAC. Using technology to help someone communicate can never do harm. Copious research suggests that AAC can only ever help. Using a device to say a word provides another modality by which someone can learn what a word means. Most communication devices are designed to combine a visual representation of a word (symbol), with the orthography (text), and auditory output (sound). Put simply, communication devices allow students to simultaneously hear how a word sounds, see a picture of the word, and see how it is spelled. When these words are paired with experiences to help the child learn the meaning, he or she learns how and when to use the word. If a student is destined to use verbal speech as his or her primary form of expression, then a device only works to make those connections faster. Communication devices do not restrict verbal speech. They only work to enhance and improve the experience of communicating with others.

Once an idea of using a communication device has been broached, the real work begins. Families collaborate with professionals to begin selecting what the system should be. Stakeholders in the child’s life meet to brainstorm specific needs and then use that list to find a system that meets those needs. Once a system is put in place, everyone can begin to use that system to model how and when words are used. Given enough time, with enough of the right instruction, and access to the right tools, the child can and will learn language. 

It might be cliche, but the old adage holds true. Every journey starts with a single step. The sooner you take that first step, the sooner you get to your destination. In the case of a child’s ability to communicate, it’s never too early to start. 

This blog post was co-authored by Christopher R. Bugaj, MA CCC‐SLP. Chris is an assistive technology specialist and Rachel’s co-host on the Talking With Tech podcast.

I was really honored to be featured this month in the SpeakUp Blog hosted by USSAAC which is the American chapter of the International Society for Augmentative and Alternative Communication (ISAAC).  The SpeakUp blog highlights stories of Augmentative and Alternative Communication (AAC) users, helpful resources and strategies from all-star AAC clinicians and timely information on AAC research and advocacy. In this month's feature I wrote about a catch phrase that I've been using for years to help coach communication partners working with children with complex communication needs: "Inspire, don't require"

Here's a sneak peek from the article... 

We don’t have the capacity to force verbal children to talk… so why, then, would it be acceptable to take a child’s hand and activate their words on their device or tell them what to say in any given situation? 

And more importantly... how does requiring a child to say specific words actually translate into autonomous communication? Spolier alert: it doesn’t. 

 That’s where the “Inspire” piece of this catch phrase comes into play. 

 As the adults who are responsible for teaching children how to communicate, it’s our responsibility to INSPIRE. This often requires us to put aside our own agenda and approach a child with genuine curiosity. It means focusing on having fun, before we even begin to think about specific language targets. 

In my own practice, I’m on an endless pursuit for the novel, the interesting, the weird, the surprising and the silly because those are the types of activities that inspire a child to communicate in an authentic way that’s neither coerced, nor forced. 

Click HERE to read the full article. 

What are your thoughts on "Inspire, Don't Require"?  What are your favorite ways to inspire your children to communicate? Leave a comment below--- I would LOVE to hear from you! 

OVER TO YOU

How do you inspire your child in practice? I’d love to hear your thoughts in the comments below!

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]]>ResourcesRachel MadelThu, 16 Dec 2021 01:00:00 +0000https://www.rachelmadel.com/blog/nonverbal-autism-resources-top-5-parent-friendly-podcast-episodes54144566e4b03a1356f912f4:542b3958e4b01d8f6abe5133:5b7340106d2a730222aeb98b

Hi my name is Rachel and I’m a podcast junkie. Every day I hop in my car, hit play and start flooding my brain with life hacks, compelling stories, news headlines and daily inspo all while I sit in L.A. traffic (YES, L.A. traffic is as bad as everyone says it is!).

My podcast addiction peaked last October when I was asked to co-host a new speech therapy podcast called “Talking with Tech”. Talking with Tech combines two things that I love most: speech therapy and technology. Not sure what kind of technology I’m talking about? Well there’s an earlier blog post in which I talk all about AAC and how it can transform your child's communication.

Our podcast was originally created to help guide speech therapists working with children who are minimally verbal, but we quickly realized the information was applicable well beyond the scope of speech-language pathologists. Now with 60,000 monthly downloads across 54 countries, we’ve gained a following of dedicated parents interested in helping their child start communicating more effectively.

But I’m not going to lie, sometimes we geek out hard and the discussions get pretty technical. So I’ve included my top 5 favorite parent-friendly podcast episodes below, even explaining (in 30 seconds or less) why you should listen.

1.)   Karen Owens

Looking for a super mom to inspire you? Look no further than Karen Owens. She’s the mom to 4 adopted children with complex communication needs, all who are nonverbal and using technology to communicate. In this episode we talk about communication being a basic human right and that simply believing in your child is often the catalyst to inspire communication you might have never thought was possible.

https://itunes.apple.com/us/podcast/karen-owens-of-we-speak-podd/id1300126888?i=1000399955106&mt=2

2.)   Round Table: When Should We Start Using AAC

Think that technology might prevent your child from talking? Well then watch this video first and foremost. Often, the next question I get from parents: “How young is too young to get started?”. In this episode we talk about the pros and cons of starting AAC with you child (SPOILER ALERT: the earlier you start, the better.), plus specifics on which systems (i.e. pictures, sign language, iPad app) to get started with.

https://itunes.apple.com/us/podcast/roundtable-when-should-we-start-using-aac/id1300126888?i=1000412080561&mt=2

3.)   AAC Agreements

I love this episode because it talks about fundamental concepts you need to know when implementing any type of AAC technology with your child. No matter which system your child is using, there are guidelines both you and your speech therapist should be following to ensure your child learns how to become a successful communicator.

https://itunes.apple.com/us/podcast/aac-agreements-universal-principles-for-aac-intervention/id1300126888?i=1000410924446&mt=2

4.)   Round Table: Modeling

Is your child currently using an iPad or speech-generating device for communication? We can’t simply put a device in front of children and expect them to miraculously start communicating. You may have seen this on an episode of 20/20, but I’m going to give it to you straight: No matter how great your child is at navigating technology, we still need to show them how to use language.

For example, if you want your child to adopt a phrase like “that’s funny,” then they have to first watch adults and peers use the word “funny” in a variety of different contexts before they can start understanding what it means. How do we teach this? We do it through modeling on their device. I’d argue this is the single most important predictor of how well your child will be able to communicate using an AAC device.  We’ve dedicated an entire episode to modeling; what it is, how to do it and why it’s so important.

https://itunes.apple.com/us/podcast/roundtable-modeling/id1300126888?i=1000410237803&mt=2

5.)   Round Table: Core Words

One of the biggest pitfalls I see speech therapists making is placing far too much emphasis on nouns and not enough on core words. Core words are those words that will break your child out of simply saying “I want” and truly give them the capacity to start combining words into sentences on their own. In this episode we review the definition of core words and explain why focusing on these types of vocabulary words will help your child start speaking in sentences.

https://itunes.apple.com/us/podcast/roundtable-core-words/id1300126888?i=1000404886659&mt=2

Over to you

Have you listened to the podcast? I’d love for you to send us some love on iTunes. When I’m feeling like a pick-me-up I go and read all of our reviews. It’s also the quickest way for us to reach brand new listeners that can also benefit from the information we share!

In the special needs community we LOVE a good acronym, but if you don’t know exactly what each one means they can feel overwhelming and unintelligible.

You might be asked:

Does your child get ABA?

Is it included in your IEP?

Do you have a good SLP?

Argh!

I sympathize; in grad school an entire portion of one of our exams was dedicated to acronyms!

However, I do have a favorite.

AAC.

It stands for Augmentative and Alternative Communication, and it basically refers to any kind of communication system that helps kids (or anyone, for that matter) express their needs to you if they can’t use verbal speech.

And, what’s more, it’s not all high tech.

One of the biggest misconceptions I see in my practice is that people think that AAC only refers to sleek gadgets activated by fancy buttons.

In fact, some of the most effective AAC supports I use every day are quite simple, and considered “no tech” or “paper based”.

NO TECH= NO EQUIPMENT

No tech AAC means that you don’t need any equipment at all!

It amazes me how savvy children can be to get what they want, especially children with limited verbal communication!

They are looking with their eyes, pointing with their fingers and making facial expressions to communicate to us how they are feeling.

Sometimes we get so caught up in technology that we forget the power of teaching a simple head shake for “no” or pointing to something that is desired. Those gestures are universally understood, even by grandma and grandpa.

PAPER BASED= NO BATTERY/ MADE OF PAPER

Paper based AAC essentially means there’s no battery.

I love low-tech AAC because it really helps students who are visual learners. Visual aids such as pictures or cues cards can help ease that burden.

One of my favorite tools to use is a communication board.

Make sure to get my free communication board to help your child get beyond single words. 

Something else we need to remember is that sometimes high tech AAC fails us. Screens smash, batteries die, iOS updates take way longer than you expected.

TALKING TIP: You always want to have a solid low tech backup so that your child isn’t stuck without the means to communicate with you.

HIGH TECH= REQUIRES A BATTERY

High tech AAC is extremely useful, when used well.

Technology advances have been a serious game-changer in helping children with complex communication needs.

Communicate with the world using just the tap of a button!

And if your child doesn’t have access or mobility to tap a button, rest assured, we can now use eye-gaze technology to track the movements of their eyes. For children who are non-verbal, a high tech speech-generating device affords a child the opportunity to speak when they might otherwise have no means of verbal communication.

With so many apps and systems out there, however, it’s challenging to know which one has the features that are optimal for your child’s specific needs.

My best piece of advice? Focus on core word vocabulary to help support a child’s ability to generate novel language.

Over to you

Have you tried AAC with your child? What’s been your experience with AAC? Have you and your child had any success with no, low or high tech? Let me know in the comments below - I’d love to hear from you!