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The Autism Little Learners Podcast
#154 Is PECS Still the Best Option? Rethinking AAC for Autistic Communicators
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- [00:00]
A
Welcome back to the Autism Little Learners Podcast. Today we're diving into a hot topic in the world of autism and communication, the Picture Exchange Communication System, or pecs. Over the years, PECS has been widely used as a way for autistic children to communicate. But as new research and insights have emerged, there's been a lot of conversation, some of it controversial, around its effectiveness and limitations. In this episode, I'm thrilled to be joined by two speech language pathologists, Paulina Elias and Amanda Blackwell from Natural Communication who share their invaluable expertise on PECS and the bigger picture of AAC for autistic children. We explore how PECS started, what it offers and why more and more professionals are moving toward more flexible child led communication methods that honor autonomy. You'll hear us discuss everything from the importance of giving kids the freedom to say no to strategies that empower communication beyond request. Plus, we talk about the pitfalls of hand over hand prompting and the emerging preference for tools that grow with a child's communication needs. If you're an educator, parent or anyone working with autistic children, this episode will give you new perspectives on PECs, AAC and the role of true connection in supporting autistic communication. Get ready for a thought provoking discussion that might change the way you think about communication support. Hi, I'm Tara and this is the Autism Little Learners Podcast. I am a speech language pathologist with a twist. I run my own communication based classroom for over two decades and I'm so excited to share actionable tips and strategies for supporting young autistic children. My goal is to help you feel more confident and successful when teaching your autistic child or students at the early childhood level. If you are ready to learn some tried and true strategies that really work, this is the podcast for you. Let's get started. First, I want to introduce our guests. Paulina Elias is a speech language pathologist and she's multilingual. She lives in Canada and and although she works with people of different ages and communication needs, she has a special interest in the areas of multilingualism, gestalt language development and autism. Paulina enjoys collaborating directly with families and interdisciplinary teams in each person's native language. At this time, Paulina offers international consults virtually and evaluation and intervention services in Ontario, Canada. She regularly presents internationally on the topics of multilingualism, gestalt language development and AAC. Our other guest is Dr. Amanda Blackwell. She's also a speech language pathologist. She is passionate about communication in all forms. She has had the opportunity to Learn from a variety of people from diverse cultural backgrounds. As she has lived and worked full time as a bilingual English Spanish SLP in Guatemala since 2013, Dr. Blackwell teaches postgraduate courses in Autism and AAC at Minot State University and St. Mary's College and mentors SLPD students in their capstone research projects through the MGH Institute of Health Professions and Rocky Mountain University. She loves to travel around the world with recent trips to Spain, Argentina, Ecuador, Mexico, Paraguay, Honduras and Sri Lanka to collaborate with professionals in presentations, workshops, research, and autism identification by using the ADOS 2. Let's get started with Paulina and Amanda. Hello. I am so excited to welcome two guests to the podcast today. The three of us are going to be talking all about PECs and AAC and how things have changed. And so I want to welcome Paulina and Amanda from Natural Communication.
- [04:05]
B
It's so exciting to be here. Thank you so much for the invitation. This is Paulina speaking. And yeah, I'm really happy to be here with Amanda.
- [04:15]
C
Hello. Greetings from Guatemala. I'm finally at home for a couple of days, which is rare, but I'm excited to be here too. Glad we could connect.
- [04:23]
A
Yeah. And I'd love for you to each, one by one, tell a little bit about yourselves.
- [04:28]
C
Perfect.
- [04:29]
B
So I am Paulina Elias, and I am a speech language pathologist who, I would say one of the key characteristics of my identity is that I'm multilingual. I really, really love languages. I have loved languages since I can remember. I was originally born in Guatemala, so my first language is actually Spanish. And then when I went to school, for some reason, this is like a very random fact, but my parents decided to enroll me in a German immersion school. There's no real German background in my family, so it was just kind of this decision. Well, we kind of like that system and we would love for. For our kids to learn another language. And yeah, so it ended up being German. And so I went to an Austrian. It was actually the Austrian school in Guatemala. So my second language is German. We had all of our classes in German except for Spanish, of course. So that's how I learned German. And then once I moved to Canada, which was around 14 years old, like right at the beginning of high school, that's when I started really learning English. So high school was a little bit tough because I didn't really know English very well. And so, yes, English was my third language. And then when I went to university, I really wanted to learn French. And so I decided to go to McGill University for my undergrad and McGill is in Montreal, which is in the French province of Canada. So I really, really focused on practicing my French when I was out and about. And I did a French minor in university so that I could really. Yeah. Learn the grammar, but also have that conversational skill in French. So that is my language summary right there and kind of why I love what I do as well, which is being a speech pathologist, but actually being able to support basically lots of clients in their native language as well. And so that, yeah, intersection of speech pathology and multilingualism is my, my main interest.
- [06:50]
A
I would say, wow, what a story. And, you know, not just living in different countries, but being immersed in different languages as a young child. I mean, not many people can say that they have that background. So I think it's really neat. And now as a speech language pathologist, you'll. You're able to provide such an important service because I know with all of the things I create, there's, especially here in the United States, a huge demand for. Do you have that in Spanish? Do you have that in Spanish? And know it's. It's a, A huge need. So really neat that you can combine all of that.
- [07:30]
C
Thank you.
- [07:31]
B
Yes. Well, and keep me in mind too. Well, both of us, since we're both bilingual, for anything that you need, translation wise or anything like that too, we, we love doing that and making sure that the information that we're. I think that's a really big part of any translation work, that it's adapted, not just translated.
- [07:48]
C
Right.
- [07:49]
B
Because if we just translate, a lot of times the information will change and it might not even be applied the same way in another diff. In another language, I mean, or in another culture. So it's something also that Amanda and I really, really emphasize when we're doing our, our translation.
- [08:07]
A
Wow, I love that. And I think that's one of the reasons that I've been a little hesitant to go the route of translation or like you said, adapting it because, you know, you do. You have one person do it. I had some free social stories and during the pandemic and I had some people that said, I'll translate. And it didn't matter if they were their first language was Spanish or if it was their second language. Someone else was always like, well, that's not quite right. And that's not quite right. It kind of scared me away, like, okay, I have no idea how to quality control this. So anyway, so that's really great to know. And I saw that you two, in your natural communication Social media, you have an English and a Spanish account, which I think is so cool. And I didn't know that till I was researching you more.
- [09:01]
C
That's actually our biggest focus is our Spanish account. Like wow, we neglect our English account a lot. We are so passionate about making information accessible to everyone. And I live in Guatemala now and I'm super active in our association of Speech Therapists here that we started a few years ago. And we just realize that there's no lack of wanting more information or wanting to learn more, wanting to advance their skills and their knowledge. It's just purely a lack of access to it. And so if you don't speak English or you don't read English, you're so limited on what you have access to. And the latest and greatest evidence based practice information, all the new articles, it's all in English. And so that's what we're most passionate about. And we're actually expanding to French and to Portuguese now too because this, this is what has to happen. I mean if we want the world to advance and not just the United States and Canada or English speaking countries, then we really have to work hard to, to like Paul said, not just translate, but adapt and make it ecologically valid in all of these different places. So we're really super passionate about that.
- [10:13]
A
Wow, I'm just kind of at a loss for words because this is stuff I've never really talked about before. And you two are both bringing up such good points and I can see your passion and you know, when, when we have here in the United States or English speaking areas a lot of new information up to date, information that can help kids. That barrier of language is so hard because there's so many more people that could help their own children or clients that they're working with if they have that information. So thank you for what you do. And that was Amanda who was talking that she lived in Guatemala or lives in Guatemala. So why don't you introduce yourself? Amanda? Yes.
- [10:57]
C
So I'm Amanda Blackwell, I must speech language pathologist from the United States. But I've lived in Guatemala for the last 11 years and since I've lived here, like I said, I've been become really passionate about, I'm still passionate about learning but now about sharing and about learning more and about teaching. And so, so I went back to school, I did a clinical doctorate in speech language pathology, so an SLPD and then I did a doctorate in education, so an EDD with the goal of creating a postgraduate program here in Guatemala or Central America for Speech language pathologists. So we started the association here. We're almost at 80 members now, and we do constant workshops with bilingual SLPs around the world who are helping us get up to date and really improving the quality of services here. And thankfully I have the ability to travel a lot and I get invitations to a lot of places. So I'm really a nomad lately. I spent a full month total in my house this year. Yesterday I was in Mexico. On Thursday, I'm flying to Paraguay and then Argentina. And what I do is share information. That's really what I do. I'm super passionate about autism. My research interests are in autism and in aac and with Paulina, we've had the opportunity to collaborate with professionals around the world. We were just in Belgium last month and we participated in the UK and yeah, so. So we love to just learn and share and study and keep growing and connecting with families and professionals literally around the world. I mean, this is what we do. So I also teach at a few universities in the us. I teach in the master's programs at Minot State University. I supervise graduate or doctoral students at Rocky Mountain University, at Moravian, at, oh my goodness, MGH in Boston. So I love doing research and just staying super active and, and current on all the research. Yeah, so that's what we do.
- [13:04]
A
Wow. Again, beautiful and so impressive. You too. Ah, there's so many things I could talk to you about and today our focus is on PECs and AAC, but I'll have to have you back to talk about just some of these issues and barriers when it comes to langu like that. It. Yeah, I have so many questions, but they're not on topic, so I should probably keep going. But thank you so much for introducing yourselves. And so both, I'm impressed by both of you so much, but I'm excited to talk to you both today about this huge change that we've seen in the autism world over the past 25 years. You know, when I started, there wasn't a lot of information for us in English. You know, it was very grassroots still at that time. And, you know, there were a few trainings that I went to, but a lot of it was trial by fire and learning by what felt right. And throughout the years, I've always been a relationship based kind of speech language pathologist. Like that's at the forefront. And I still have several students, former students, that were my very first kids in the public school, and we stay in touch. One of them is 31 and he just came trick or treating at my house the other night. So he still does it every year. And anyway, relationships are key. But when I started out as a brand new slp, the gold standard for AAC or augmentative alternative communication was the Picture Exchange Communication System or pecs. And I think a lot of people now, if they're following on social media, following people talking about AAC and Gestalt, Language processing and so many other kind of newer cutting edge topics, they're going to notice that pacs is getting backlash now. It's not the gold standard anymore and oftentimes people are saying get rid of it. So can you talk a little bit about what PECS is before we chat about why it's a form of AAC that's not really recommended anymore for autistic kids.
- [15:18]
B
So we wanted, both of us wanted to be very careful when we answered this question because we have had conversations about PECS in the past. And one of the questions that often pops up after the, the conversation is, well, how does that differ from something else? So what I wanted to do, being very responsible, was actually open up the definition straight from their website so that everyone who's listening today knows what PECS is as they define it themselves. And this is, they, this is Pyramid Education Consultants. Pyramid Educational Consultants. So that's the company that has created the PECS protocol. And PECS stands for Picture Exchange Communication System. So what they have on their website as the definition, again thinking more objectively, is a unique, unique alternative augmentative communication system that was developed in the USA in 1985 by Andy Bondi and Lori Frost. There's obviously more information than that, but the second paragraph really talks about what it is. So it's a teaching protocol that is based on B.F. skinner's book verbal Behavior and Broad Spectrum Applied Behavior Analysis. So that's very. All technical, but really what we are referring to when we talk about PECS is this very, very structured system where a person is taught or trained to exchange a picture. A little, yeah, printed. It could be, you know, an illustration, it could be a symbol, or it could be an actual picture that has been printed out for something that they want or something that they want to communicate. And so that's really what we refer to when we're talking about pecs. And it's not the same as using printed pictures or symbols to further someone's communication development or to contribute to someone's language development. There's so many kinds of, you know, alternative communication systems that include printed out pictures and images and symbols. And so there are Lots of really, really positive ways of using these kinds of symbols as well. But when we think about pecs, it really is this structured protocol that involves six phases of training. So that's kind of what. It's a long response. Sorry, but I wanted to get all the.
- [17:58]
A
No, I think this is perfect because clarifying in their own words, the creator's own words, kind of the methodology that's used, I think that is one of the key pieces to why it's fallen out of favor is that the behavioral methodology, they say themselves, it's based in ABA off of Skinner's work. So I think that's a really great delineation.
- [18:25]
C
Yeah.
- [18:25]
A
And go ahead, go ahead, Amanda.
- [18:27]
C
Well, we're just thinking about, we want to stay super objective in that sense and differentiate between what is light tech aac, which is so valuable and so useful, especially in our context where we're working with families who are, have limited resources. And so we definitely are not discarding all light tech aac like Paulina said. We want to make sure that we differentiate between this behavior based exchange system and using visual supports, which we know is a great, great, great strategy.
- [18:58]
A
Yeah, I think that is a great distinction because I just think back to my experience, 25 years of working with young autistic kids. That's the first training I ever went to about AAC was PECS training. And it was through that system, through Pyramid. And I remember leaving there going, how am I going to do this with, in my class with like me and a couple of paraprofessionals and like eight students? Okay. So honestly, I think those of us in the classroom were never able to do it with fidelity like they taught us. Right. However, you know, that's all we had for someone guiding and leading us on how to help with communication. And so I think so many people that used to use it or are still using it, it's maybe because they don't have accessibility yet. Whether it's their school that's not going to provide AAC, robust AAC devices to kids, they don't have the money or they, I mean, I was in a wealthy district at the last 10 years and our district did not provide AAC devices to kids. I would help them get, get them through their family. But in the meantime, what are you going to do? You know, you're going to use a variety of visuals, but it's how you use it. Right. And that's why now with the, the phrase model without expectation, that is such an important phrase to remember as you're moving Away from something like the PECS method methodology where they're encouraging hand over hand prompting, making a child do this. And Polina, you said too, it often was for something they want, which automatically makes it a request. And this I have seen over the years. So it's almost like that motor planning. Kids get used to I want whatever and then the verbal that starts coming out of their mouth whenever they're trying to communicate something is I want because it's just automatic. And then they're maybe not even trying to request something. It's just this. It's an automatic. And especially for our Gestalt language processors, you know, that delayed echolalia or echolalia can be more prominent. And anyway, I think that's a huge piece that hand over hand prompting is one of those methods that's become outdated when it comes to teaching autistic kids. Can you explain why?
- [21:33]
B
I think that. Amanda, jump in as well if you want to add anything. But I think the hand over hand prompting is something that often comes up because even parents often doubt whether they feel good doing this. Kind of like taking their child's hand and pointing, I don't know, towards something or helping them grab something else. And I've had so many conversations recently with parents who have had some kind of, yeah, I would say behavioral approach in, to, to their child's development or that child has been in, you know, ABA in the past. And so they get to a point where even their kiddos are always looking for someone else's hand to communicate something, to request something. And that's, I think, a moment that is like a key, I don't know, realization for a lot of parents or I have realized in speaking with lots of parents that makes them think, oh, this, this is, this isn't great, you know, that this has been kind of the result of that consistent hand over hand prompting. And something that has come up as well is that if we're really, really just focusing on the requests, which is really that initial phase of again, thinking of PECS as a, as a system, the focus is solely on requests. And now we know that there are, you know, communication is about so much more than that. And there sometimes I would even argue that something like a protest or being able to reject something, you know, is even more important, being able to request something specific. And that's also something that, again, thinking of this specific system, communication system, it's not present. There is no protocol, no approach to this idea of rejecting or protesting. So going back to the hand over hand prompting, we've talked a lot with families and also with autistic individuals who have commented on how a hand underhand approach is a really valid, reasonable replacement or way to avoid a hand over hand prompting. That still kind of puts the motivation and the respect on the person who is wanting to or trying to communicate something. So one just kind of being there for support if needed, but not being the one who initiates that physical prompt.
- [24:25]
C
Right.
- [24:25]
B
And not putting our hand on top of someone else's, because that could even sometimes or in some cases even lead to this, you know, violation of someone else's bodily autonomy. And instead kind of just being there for support. And if they look for our hand, of course we can kind of offer it up in this hand under hand approach, which is literally what it sounds like, just putting our hand under the person's hand. But they are still the ones that are in control. So they can remove their hand from ours whenever they want to, as opposed to when we are taking theirs and guiding it.
- [25:02]
A
Yeah, that's a great point. I had. I don't know if you're familiar with Dr. Diamond Rashad. She's an occupational therapist and she talks a lot about in general getting why to get rid of hand over hand prompting. And she talked about just that every one replacement could be the hand underhand. And she said, just like you did, when you're going hand over hand with somebody, you have control of their hand, right. And if they tried to lift up your hand, is there blocking it essentially. But if you are under, they can break away easily when it doesn't feel comfortable to them. And you know, before we had terms for this like, you know, hand over hand underhand, and we're thinking about bodily autonomy and stuff, we just kind of had a saying. The teacher that I work with, worked with for 10 years, we would say if it feels yucky, don't do it. You know, if, you know, you can picture in your head the children that you've worked with before who don't like to be touched, don't like to be moved, controlled. You know, this. So even if by accident, just out of habit, you grab their hand to help them with something, they pull away. Those are the kids that are not going to respond well at all. And then what are you teaching them, whether it's with pecs or something else, if I'm taking control of their hand and forcing them to do it, causing a meltdown and dysregulation. And what is being learned in that moment other than I am in control of you and so Looking back over the years and seeing this play out, I'm just so glad things have changed or are attempting to change when it comes to this.
- [26:47]
C
Yeah, and it first came out in 1985. And so that's 40 years ago already. And we're learning. Like, think about how much we've learned about autism in 40 years. And so we have to evolve. Like, we can't just stick with one system. Especially now, learning so much directly from autistic people and their lived experiences. And the data is really there. That does make us question. If you read the articles carefully, it's not like these amazing gains in overall communication with these PECS articles. There's one in particular that I always send out to people when they ask me about information that's from 2010, so it's not really recent either. And they talk about these small, like minimal gains, small to negative gains are actually what they say. And they raise real concerns about the maintenance and the generalization of what these kids are learning. So yeah, they're learning to request, but nobody got to the final stage of commenting, which is, according to this model is the end point. We go from requesting to commenting, and that's it. But communication is so much more than those two reasons why. But, but we didn't see generalization. We haven't seen generalization that is using those skills in other uncontrolled environments on their own, spontaneously, just because they want to communicate. They, they become prompt dependent a lot of times and, and they get stuck at just requesting and who wants to hang out with somebody who's just asking for things all day long.
- [28:20]
A
Right, right, right. And situation dependent too. You know, we use it at snack time. They know to go get it when it's time to get something to eat. But during playtime, they're not going and grabbing their pecs book. You know, I think it's, it's one of those things too where I've seen people bring this up. I think autistic adults have brought this up. Have you ever seen an autistic adult using a pecsbook out in the community? Zero. For me, never. And I have lots of, you know, anecdotal evidence. All of my former students who we used PECS with used a communication book of some type. None of them as adults, whether they're minimally speaking or. Or non speaking, none of them are using PECS as an adult. And it kind of shows you that it's, it's not sustainable. I think one of the other huge things with PECS that really made sense to me as a speech language pathologist as to why it maybe isn't the best choice. And it beyond the hand over hand prompting and the behavioral method is the fact that you're encouraged to move pictures around so that kids have to look and find it. And I've heard it equated. And whenever I talk about this with my members, they're like, oh, this makes total sense. When you have your phone and you accidentally lean on it and you lose one of your apps and then it jumbles everything up and you don't have that muscle memory anymore to be like, I just have to put my thumb up and I know I'm in my text messages or scroll Facebook. And the distress you have when you're like, oh no, which one's gone? Okay, okay, I found which one's gone. But where do I put it back? And you move it around and you're like, I don't know where it goes anymore. I just know my fingers not going to the right spot for the one thing I use the most. And that is a problem with the pecsbook setup. And when you can make, like you said, a different format, a communication book where maybe you have these different pages for it could be things they request, like foods, but it could be commenting all these other things, but keeping that order the same. So you might have a printed out page with all of the favorite foods activities and then you have a picture on top of that so that everyone knows it goes back. You know, if you have a student that maybe isn't pointing, but they do better grabbing a picture and giving it to you. Just keeping in mind that that muscle memory that helps kids and adults be efficient with whatever they're using. Okay, so speaking about pecs and communication books, would one of you want to take this on? Are all communication books bad? And I know we already touched on this a little bit, and if not, how can they be modified? I think I touched on it just a little bit so that they're not being used in that same way that pecsbooks are.
- [31:24]
C
Okay, I'll start. And I know Paulina is going to say more. We talk a lot about the difference between autonomous communication and independent communication. And what we're referring to there is, is someone able to say what they want, when they want and how they want. That's autonomous communication. That whatever's in their brain, whatever they want to say, they have the ability to say that in some way. But it could be that you're holding up the book for them and they're still choosing. Or they might need some kind of physical support with that. So it might not always be independent that they're doing it. So when we have a communication book, I think the, the danger is always the fact that we could be like not allowing them to be fully autonomous because if we've created the materials for them, we still have control of what they can say. Right? Because we could not print out a no symbol for them and then they don't have a way to say no if we do that. So we're trying to help them be independent in that way. We're trying to give them access to lots of different words or different symbols in a communication book. But we have to be very aware of the fact that it's still limiting their autonomy in some way because there's, it's very likely that the child is. Or the person is thinking something that's not available to them in the, in the book that you've given them. And so, so no, communication books are not bad across the board, but you just have to be very aware of the fact that you are still controlling their communication, that you are the one deciding what they're able to say and what they're not able to say through their communication books. So we want to just give them access to a huge quantity of words and symbols and phrases and all kinds of things that reflect as much as possible as what they could want to say, possibly some at some point in their lives, which is really like an impossible task to do. But that's why we lean a lot on high tech aac, because they have access to literally tens of thousands of words and phrases and they're personalizable. Is that a word in English? Struggle with English.
- [33:36]
B
Sorry.
- [33:37]
C
But anyway, so. So if we're using communication books, we just have to just try not to limit them as much as we can because we don't want to take away their autonomous communication.
- [33:49]
A
I think that's a great point because I think a lot of people are guilty of this. We don't want them to tell me no or I don't think it's even as conscious as that, honestly, I think it doesn't occur to people we should give them a way to protest. And you know, we've. With the whole idea of multimodal communication coming to the forefront, which I think is such a huge breakthrough in how we think about things. I try to teach people, like if I have a student that they come and I have this activity and they push it away, that is communication, that is them protesting. And we Want to be able to honor or at least acknowledge the protest. Right? And I think that's really hard for a lot of people. But if you think of it safety wise for individuals who, you know, if they're taught or never given the option to protest, it can put them at risk as they grow up. There's just so many things that kind of go into that, but honoring or acknowledging. So I would say, okay, my student pushed it away. I would say, oh, I don't want that. You know, I'll kind of model it. Even if you don't have any pictures there for that or a device modeling it and acknowledging it from their perspective, like, I don't want that, no thanks. And then put your pride to the side and say, okay, I'm going to pivot here. I don't have to push through with the activity. People say, well, he's just trying to get out of blah, blah, blah, maybe, but guess what? We can pivot. And this is an individualized education and we get to do what we want. And I think just assuming positivity and instead of that super negative place like, well, if I don't follow through, it's going to teach them this and this and this. And I just think like, you're looking way too far into it at that point, but offering a couple choices or taking a break and doing something else and coming back to a different activity. And in two days they might be fine doing the original activity that you had there, but just that day it didn't work. But that's work we have to do on our end as adults instead of something they have to do. I think the other thing with pecs that I'm guilty of because we were taught to do it this way is let's say a child was using multimodal communication. We didn't have that word for it back then, but they took my hand and they brought me to the counter and then they reached up, reached my hand up to the cabinet and I knew, oh, they want a snack or they want goldfish crackers. I probably knew exactly what that child wanted because they all had real specific foods that they loved. And they kind of teach you to play dumb and be like, oh, tell me with your book. And it's like, that's where a meltdown, distress dysregulation can happen. Imagine if you were talking to someone and they're like, nah, can you just text it to me instead? Like, I didn't. I don't understand your words. So I think with that, that's a Shift anyone can make really easy instead of tell me on your talker or tell me with your book accepting that communication. And then you can just model what they could say using their AAC but not requiring them to do it.
- [37:27]
C
And you talked early on about the connection and the importance of connecting with your clients, your students. And I, there's an activity I do all the time with my students in my AAC graduate class. We use light tech boards for an entire class period one day. And I throw like random scenarios at them and I say, okay, talk about that with your boards that you guys made. And they're all like, I don't like, there's no nowhere to start with their boards because they realize like oh my gosh, I don't even have a single question on here or I don't have a way to respond to that person's question to me or I can't comment about if I like that or not or if I think that's gross, I want to say or you know, something like that where they realize like oh my gosh, I've liven it myself. And they've created these boards for themselves. I said like put all the things that are important to you on this board. And even then they were so limited by what they could say themselves. And that wasn't someone controlling them, that was them controlling what they had access to. But when they don't have access to their mouth words, they realize like, oh my goodness, I can't be authentically me if I don't have access to all of this vocabulary.
- [38:38]
A
Wow, that is a powerful activity. And I think that would be an amazing activity to do with paraprofessionals as a team sometime even just having a staff meeting and doing that, that would be so powerful. And you know, it makes me think of students that I've had where the very first student that was only three years old and his parents got him a robust AAC device, this is probably six, seven years ago. And he came in with this device and it was through a company, they were really great about coming in and providing training to home school everywhere. And I think he was a kid where people thought he's 3, he's non speaking. You know, if you had this old school list of like you need these prerequisites to have an AAC device to qualify, he wouldn't have met any of them. Right. Thankfully that's not the way it's looked at anymore mostly. But you wouldn't think he'd be poking around in there, exploring and then coming up with something. Totally. Right on. So we were sitting there and I was about to work with them, and all of a sudden he's poking around. And I just thought, well, he's exploring. And all of a sudden he clicks the entire sentence. This is boring. And I was like, oh, my gosh. I'm like, I don't know if that was on purpose or not, but I'm gonna act as if it is and change the activity up. Did something more fun. And I was like, dude, thanks for telling me.
- [40:17]
B
I think that idea also of just. We often focus on our own goals and agenda and with the best of intentions. But when we do that, which is most of the time, we get frustrated really quickly because, number one, we are already placing expectations, expectations and demands. And number two, we already have an idea of how we're going to do what we're going to do. And it's kind of like we lose sight of the fact that the person we are supporting, they should be the ones that are taking the lead. And so I find that often when we start, we spend so much time, even, like Amanda said, this exercise, creating low tech, I don't know, versions of a communication board or something like that. And instead we could really just be taking some time, taking a moment to just observe and listen. Like, how is this person communicating already? What are the things that they are interested in? What are the things or the reasons they're they are communicating? And what are some areas maybe where there is still no visible, at least communication to me as a communication partner. And then we start there, like, we start with the things that they are interested in because we know that there won't be as much time or effort needed on either part to really build a connection in a relationship there. If we're focusing primarily on what they are focusing on and just creating that little bond at the beginning, I find then it's like they know that we've got them. They know that we can, you know, they can trust us and we are really paying attention as opposed to just, I don't know, imposing and kind of.
- [42:34]
C
Yeah.
- [42:35]
B
Transferring our expectations and our demands onto them. So I think that's kind of the number one thing that I always think about when we're starting with aac. Okay, so this is all of the stuff that I am thinking that is happening through my brain, but what is happening in this person's world? What are they noticing? Why are they kind of looking for other people or what are they enjoying or not enjoying? Because I had, as I mentioned at the beginning I think being able to say, I love this, I want this, is important. But being able to say no, I don't like that. Stop. It is so important too.
- [43:19]
A
When you think of toddlers, when you think of 2 year olds and 3 year olds, neurotypical toddlers. What, why, what do they call it? Like the phase of no, everything's no. It. It's a developmental kind of rite of passage kids go through and our kids aren't allowed to say no in that way. And I think if you, if people have one big takeaway from today is make sure your students, your clients have some way to protest. And if it's, if it starts out with them just pushing something away, model it. Whether it's with a picture saying no or with the AAC device, that would be one huge gift that you could give them.
- [44:02]
B
And I also wanted to mention, because I know that there is a lot of talk of, you know, robust systems and high tech aac, and that's what we have seen works so well for so many people. But as Amanda mentioned, we both have so much experience and we have so much background when it comes to these, I would say community societies where that is simply not an option. Like a high tech AAC system is just not an option because you might get your iPad stolen as you're walking on the street. Because, yeah, like for any obk you can have for it, that's the other big one. So one of the things that I thought could also be helpful was just mentioning a few of them because there are so many of them now, but a few of the companies or application companies that also have low tech versions of their apps, like a communication board. I think we're all super familiar with the assistiveware communication board. It's in so many classrooms, some now even in parks, which is so exciting. I've seen it around parks. So, but that one is just an example like assistiveware, right? Has that communication board that people can just print out. And I think that even though it's still not, you know, it doesn't do this perfect job of being a robust communication system because you might still need so many other words that you're adding to that. It really does serve as a really good starting point for this idea of modeling without expectation. The idea of also providing our kids with, well, access to a keyboard, like access to the Alphabet, which is the other big part of a robust communication system. And so there's assistiveware. And we'll add a few links. Amanda has kind of put together a list of links with some of these companies that have the printable free printable communication boards. And then maybe you can include them in the. I don't know how it works with the podcast.
- [46:17]
A
Absolutely. Yeah. Yep. I'll include everything in the show notes, so definitely.
- [46:22]
C
Yeah.
- [46:23]
B
Perfect. Because I think for me, Assistive War is the one that I always think about. But PRC SALT do Core has one grid as the project core as well. Smarty Symbol Score. And then there is arisac as well. I just like bombarded you with lots of different things, but we will include this so that you can kind of access those too, as a starting point because I also know that the beginning can be so overwhelming when we're starting with alternative and augmentative communication. So. Yeah. And a lot of these also have different languages, which for both Amanda and and myself is obviously key with the families that we support.
- [47:08]
A
Yeah, that's a really great point. And tip. There are so many things out there for free, but to have your guidance in kind of narrowing them down to this list that you gave me that we can put in the show notes where people can start. Because, you know, you hop on Google and you're going to have so many different choices and then you hit overwhelm. And parents and educators are like, I don't know, I'll just go back to what I was using because I just don't even know where to start. So thank you for that list. That'll be really helpful. And you also had mentioned, I just want to back up real quick relationships and taking the time. And I think that's a gift that whether you're a parent, paraprofessional, special educator, an slp, giving yourself permission to sit back, get down on the floor with the child and just get to know them and get to know what they love. And send home a survey to parents asking, what are their favorite songs on YouTube? What are their favorite toys that they play with? Even if they play with them repetitively over and over, like, let's use those. Get in their world. Because once you have that connection, you have everything. They'll follow you. They will. I've had students where I've connected with and literally follow me around the classroom. A student that, you know, a lot of our autistic young students are not using gestures yet. And one day he went down and he sat at the snack table. He was hungry and he sat down and then he pulled a chair over next to him and he patted on it and looked at me and I was just like, okay, that's the Biggest piece of progress that I could ever hope for because it was not just communicating through a gesture, but he also was connecting with me, saying like, I like you, I want you to come hang out with me. I feel comfortable with you. And that's the piece. I think when you look back at your teachers, you don't remember what every teacher taught you. You don't remember the lessons, but you remember the ones that made you feel really good. And I think that is one of the biggest takeaways.
- [49:20]
C
Yeah, absolutely. And we wrote an article last year with Marge Blanc about gestalt language development. And we included, of course, the lived experiences of some autistic individuals who have experienced this way of developing language and their language style is, is gestalt. And what we heard by and large was, was that need for trust and connection. And so that's why in the conclusions of that article, that's what's first is, is the need to establish that connection and the trust. And it goes for all people, I think, not just our autistic clients, but, but especially them who, who need to feel safe with the person that they're with. And then that's how we can create a genuine connection that's not based on a transaction, that's really just based on wanting to be near each other. And that's what it's all about.
- [50:14]
A
Yep, that's beautifully said. I. That is, it speaks to me so much because I think as I've been teaching over the last 25 years, and especially as a new teacher, I always say teacher because I ran a communication based classroom. I am an slp, but I kind of wore all the hats. I was doing the reading and writing and all of that too. But without a lot of guidance at that time, you have to go with your gut. And all I knew was how to. I want to connect with the child, I want to understand them. And I think if we give ourselves grace and we give ourselves time to sit back and really get to know kids, a lot of things, whether it's in your classroom or a therapy setting, are going to improve. Especially when it comes to behavior or things that maybe look like, like a child that might seem uncooperative. I think a lot of it, when you come back to relationship, that can fix a lot of that and honoring who they are finding. You know, there's just so many things that, that go into that. But now we already talked about that. You offer both English and Spanish and where can everybody find that and where can they find you?
- [51:32]
C
So we have everything. We have is in English and Spanish. So we have naturalcommunication.com is our website and then in Spanish it's Communicacion Natural for the people who speak Spanish out there. We have the, the introduction to Gestalt language development on our website in English, Spanish, Italian and French is coming Friday.
- [51:56]
B
Oh my God.
- [51:58]
C
Portuguese is in the works right now with our colleagues in Brazil. So. So yeah, so I think for the English people. But even if you speak Spanish, you can go through naturalcommunication.com and it's just you change the language on there.
- [52:11]
A
Okay.
- [52:12]
B
Our introduction, I was just going to mention particular it we also have that one out in Italian, like the one hour crash course about gestural language development, the three languages it already is available in. So Spanish, English and Italian and then yes, hopefully French and Portuguese coming very soon as well.
- [52:32]
C
And we're working on lots of things. I mean we're involved in research projects right now. If people are going to ashra. I'll be presenting with Carolan Gatti about AAC and Gelat Language Processing. And I have a poster there too about aac, a camp that we're doing in Spain. So lots of things happening and you'll be hopefully seeing in 2025 some more publications coming out because right now we can't really report about research until we write it up and get it peer reviewed before it comes out.
- [53:02]
A
Yeah. This is so exciting and I'm so glad that I stumbled across you, both of you, because I'm just going to dig in even more and your, your crash course, the Angelsta Language processing in those other languages. I'm going to share about that because that is so valuable and needed. So kudos to both of you and thank you for what you do and thank you for coming on the show.
- [53:30]
B
Thank you for having us. It was so nice to chat.
- [53:34]
A
I'm sending a big virtual hug your way because you just finished another episode of the Autism Little Learners podcast. Thank you so much for listening. If you enjoyed this episode and you'd like to help support the podcast, please share it with others, post about it on social media or leave a rating and review. If you have had success with any of the strategies that you learned about in this podcast, I would love to hear from you. Send me a DM on Instagram or Facebook. Autismlittlelearners. Don't forget to grab your free visual support starter set by going to autismlittlelearners.com visuals and always remember to find the good in every day.