“I Don’t Want To”: 5 Ways to Encourage Refusal for Students With Complex Communication Needs (CCN)

Message window of Smarty Symbols from the Speak for Yourself app with the words and symbols saying “I don’t want to.”

This is important. It’s important if you know and love any child. But it’s crucial if you know and love a child with complex communication needs (CCN). If you’re looking for a summer goal for your children or students who are using augmentative and alternative communication (AAC), this would be a good one.

A couple of weeks ago, I was working with a student in her home. We had been working on a Father’s Day project for a portion of a few sessions.

We used predictable chart writing with the stem “I like when my dad…” Then I found pictures based on her answers so that we could put them together in a book. On this day, it was time to put the book together. It was the last time I was going to see her before Father’s Day.

BUT…and this is the important part:

When I said, “Let’s put the book together for Daddy!” my 4-year-old medically complex student with emerging verbal skills said, “No. I don’t want to.” Calmly and as clear as could be. With direct eye contact. Like she said it all the time.

But she doesn’t say it all the time. 

I tried to stay cool and casually said, “Oh. Okay.” But her nurse’s eyes were wide with amazement and excitement, and I felt it too. So I said, “I’m so glad you told me that!” She looked up and smiled.

My little student was playing with orbeez (the tiny balls that you put in water and they grow and feel kind of slimy, smooth, wet, and cold). She didn’t want to stop what she was doing. My agenda and impending Father’s Day wasn’t her priority.

So I asked her slightly older sister to put it together for their dad. And she happily obliged.

We played with orbeez.

Child sitting on the floor with her back to the camera, books spread out in front of her and a baby doll by her side.

One of the most important things you can teach a child with complex communication needs is refusal. I’d been modeling it for months. Every time it looked like she wasn’t excited about my plans for the session, I’d model some variation of “No.” “No. Not that.” “No thanks.” “No, I don’t want to.”

The week before that, she turned her head away from me, and I modeled “go away!” and moved about 5 feet away from her. She looked at me with amusement then said it again, and I moved farther away.

Last week, as soon as I walked in, her smiled beaming, she pointed her finger and said, “Go away!” I immediately ducked out of her sight. Her mom looked shocked and said, “Be nice to Heidi!” until I said, “We’ve been working on it. She’s controlling her space.”

There are so many times when a child with complex medical needs doesn’t have a choice. Necessary procedures and tests are often uncomfortable or scary. Dietary restrictions remove food options. Medicine has to be taken. It all HAS to be done or there are potentially fatal medical consequences. There is no room for negotiation.

But she doesn’t have to glue pictures in a book.

When we give our children with CCN the right to refuse the little things, we build the foundation for them to refuse the more serious things. We protect them from compliance. Here are some suggestions to foster your child/client’s refusal skills:

Model refusal even if you don’t think they’re “ready.” 

We talk a lot about the importance of core vocabulary and having a robust language system. We talk about teaching our children/students various functions of communication. But the communication functions don’t have to be introduced in order from requesting to labeling to commenting…They can overlap. When a student requests chips, you can give them the chips and model, “you WANT CHIPS NOT PRETZELS.”

Make sure they have a way to express refusal.

If they’re using AAC, be sure they have access to refusal vocabulary (stop, don’t, no, not, go away). Model the nonverbal communication as well. Push the pretzels away. Shake your head “no.”

This is a good opportunity to add and model some pre-programmed phrases or sentences as well. Give them an assertive way to quickly refuse something with some polite options…and some stronger options. Sure you can say, “No, thank you,” when someone offers you something you don’t want. However, for situations that call for something stronger, “I said no!” or “Get away from me!” may be necessary. Give them a way to be strong and assertive and then work on teaching social etiquette.

We want our children to be sweet and polite, but more importantly, we want them to be strong and safe.

Reinforce refusal

Don’t expect a performance without practice. When children are going to perform, we give them a chance to rehearse on stage and practice their lines. There are dress rehearsals so that the performance feels familiar. Give your AAC learners a safe time and place to practice their “lines” so that when they need them in real life, they’re prepared. Make sure they know what’s supposed to happen when they say “no.”

When a child refuses something that isn’t crucial to his/her survival or safety, reinforce it. Missing an art project won’t make or break a child’s educational experience.

Validate refusal, even when it’s not an option. 

When an activity has to be done, acknowledge that they don’t want to do it and give choices when you can. For example, “I know you don’t want to work. We have to do counting or reading and then we can play. Do you want to do counting or reading?”

If your child/student gets upset, and you think they may be having comprehension issues, modeling and/or First/Then visuals may be helpful along with your explanation.

Be vigilant

Teaching refusal may take a lot of modeling, reinforcing, and explaining. Do it anyway. Once your children get it, they’ll really get it. They may even overuse it. But when they need to be able to say, “I don’t want to,” you won’t regret that you taught them to be assertive.

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The Results: Augmentative and Alternative Communication (AAC) Modeling Implementation Intention “Experiment”

Last month, for Better Hearing and Speech Month (#BHSM), we challenged you to participate in an “experiment.” We wanted to know if the body of research that exists for Implementation Intentions would work to increase AAC modeling/aided language input. **If you don’t need the background, skip to the Participants or Results section.**

We asked you to make room for AAC modeling within your week. Research shows that if you carve out a specific time and place for an important activity, you’re significantly more likely to do it! It’s true of exercise, doctor appointments, and writing. Inherently, we know this. We put reminders in our calendar to put Frontline on the dog, change the air filter in the heater, or get our teeth cleaned.

So, for the first two weeks of May, we asked you to make an appointment to model AAC for the important AAC learners in your life.

Many of you participated, and twenty-four of you generously took the time to answer our survey questions after the two weeks. This post will share the results of those survey questions (except for the irrelevant t-shirt-related questions of course:).


Modeling for individuals learning to use AAC devices is critical. Immersing AAC learners in the language you are expecting them to speak is one area where AAC professionals are in agreement. Evidence based research also supports the use of aided language input as an intervention strategy. Actually, if you are working with an AAC professional or speech-language pathologist who does NOT include aided language input as part of their AAC  implementation plan with your child, you should probably seek a different professional. It’s that important: Speak AAC to teach AAC.

However, it’s not always easy. Life is busy, and children who have complex communication needs often have complex medical needs as well. Some days, it’s hard to find the time to add one more thing. So when I heard a podcast guest talking about implementation intentions (it’s number 52 on the list:Minisode Monday #43), I immediately thought it may be an effective way to plan to increase modeling for our students who are learning to use AAC. This post has the background about the implementation intentions research.

With this experiment, we were hoping to answer two questions:
1. Will scheduling time for aided language input at a specific time and location increase exposure of AAC for the students who use it?

2. Is scheduling implementation intentions for AAC modeling a helpful strategy for individuals who support AAC learning?


The methods for this “experiment” were not super scientific, but I’m sharing it in the format of a research article because, it could actually be replicated.

  1. Information about implementation intentions was shared in the form of a blog post and shared on social media. That post also contained an announcement that more details would follow and t-shirts would be given away for participating in the survey.
  2. A blog post detailing the “experiment” was published and shared on social media. The post invited anyone using AAC to participate regardless of the language program that was being used.
  3. Participants were given the following instructions/challenge:Give AAC modeling a place to live within your day. Carve out the time to show your child/student(s) that communication is a priority. Put it in your schedule. We’re asking you to plan to communicate and connect with your student(s)/child(ten) who are using AAC. If you’re already doing that, that’s wonderful!
    1. Commit to modeling for (at least) 15 minutes a day for the next two weeks.
    2. Decide on a time and place that *should* give you 15 minutes of modeling time with the AAC user(s) in your life.
    3. Decide on a contingency plan. Unexpected things happen all the time. Plan around them for success.
    4. Complete the form below. Write it on your dry erase board in your kitchen. Put it in your calendar. Put a sticky note near the place you plan to model. Whatever you decide,  publish your intention so that you will see it every day for the next two weeks.

    Modeling intention form to put your plan in writing.

We asked participants keep track for 2 weeks and complete a brief survey letting us know if it worked or not!

4. Each day for the two weeks, I published a “modeling motivation” on the Speak for Yourself Facebook page. Those modeling motivations were compiled in this blog post following the two week experiment.

5. At the end of the two weeks, a survey was published and shared in this post and participants were given five days to complete the survey. We gave t-shirts to participants for taking the time to complete the survey, regardless of their results.


Participants self-selected for this experiment. It’s likely that many more people in the AAC community actually participated, but 24 followed through with completion of the survey. Survey response rates are traditionally low, but the most accessible means of data collection for a social media driven experiment by an inexperienced researcher. Participants included 14 parents of AAC users, 9 professionals whose caseload mostly consists of people using AAC and 1 (one) non-parent family member.

Here is the data for the participants:

What best describes your current relationship with AAC?

Data_Q1_role (to view above as a PDF)

We also asked for the age of the AAC users that the parents, professionals, and family members are supporting. Here is that data:

How old is/are the AAC user(s) in your life?

Data_Q2_AACuserage (to view above as a PDF)


The two questions we were trying to answer were essentially an attempt to increase AAC language immersion for students who use AAC.  We wanted to know if the broad body of research on implementation intentions has beneficial applications for AAC modeling. It is also my general impression that a commitment to modeling increases familiarity with the language system, and that comfort level increases modeling. We all like to feel successful.

For that reason, one of our survey questions was: My knowledge of the app/device has improved over the past two weeks. Respondents could choose strongly agree, agree, I don’t know, disagree, or strongly disagree. Of the respondents, 19 of them (79%) chose strongly agree or agree, indicating that their knowledge had improved.

My knowledge of the app/device has improved over the past two weeks.

Data_Q7_deviceknowledge (to view as a PDF)

One of the survey questions asked about daily goal modeling times. Fifty (50%) percent of respondents set a goal to model 15 minutes a day. That was the amount of time I suggested in my post. Now I’m wondering if it would have made a difference if I suggested a longer amount of time. It may just be that 15 minutes seems like a manageable amount of time to make a daily commitment. Guess we’ll never know. Anyway, here are the results:

What was your daily time target for AAC modeling for the past two weeks?

Data_Q3_targettime (to view as PDF)

Then we asked if it worked. Did you stick to your plan and/or use your backup plan? Of the 24 respondents, 100% said they modeled more than they usually do. Pretty exciting, right? Of those, 54% said that they stuck to their plan or used their back up plan, but that they modeled the amount of time they planned.

Which statement best describes your AAC modeling over the past two weeks?

Data_Q4_diditwork (to view as a PDF)

We also asked about weekly time spent modeling prior to using an implementation intention approach. Eighty-eight (87.5%) of respondents said that they spent less than one hour modeling in a typical week prior to this challenge. Here are those results:

In a TYPICAL week, prior to using this AAC implementation intention strategy, how many total minutes did you spend modeling/using AAC in front of your AAC user(s)?

Data_Q5_PREminutesofmodeling (to view as a PDF)

Then we asked: How many total minutes were spent modeling during the two week experiment using implementation intentions? For comparison purposes, I changed those numbers into weekly totals. Here are the raw responses from the survey:

How many total minutes did you spend modeling or using AAC in front of you AAC user(s) over the past two weeks?

The system was not able to graph the open-ended question. I did it manually. Here are those results:

Weekly AAC modeling time with Implementation Intentions

Modeling with Implementation Intentions (to view as a PDF)


When participants used implementation intentions to schedule their AAC modeling time, 87.5% said that they modeled more than an hour per week. Prior to using implementation intentions, only 12.5% of the participants said they modeled more than an hour per week.

Prior to scheduling time to model, no one said they modeled more than two hours per week. However, after using implementation intentions, 45.83% of participants said they modeled more than two hours per week.


So, what does all of this mean? Scientifically, there probably are not enough participants to come to an actual conclusion about the impact of implementation intentions on aided language input. And that’s fine. My purpose was not to create evidence-based research.

The purpose was to see if scheduling time to model AAC helps those of you who support children who use AAC. For the people who participated and answered the survey, it did. Maybe it will for you too.

The purpose was to see if carving out a time and place to focus on using aided language input increased the children’s exposure to AAC.  For the people who participated and answered the survey, it did. Maybe it will for the children in your life too.

More than 24 children benefited from the increased AAC modeling for those first two weeks of May. Professionals shared the challenge with other professionals so that clients experienced increased modeling throughout their days. Entire families participated and “argued” over preferred AAC modeling times.

Regardless of the efficacy or validity of this “experiment,” there is a large body of evidence-based research for implementation intentions that sounds an awful lot like common sense: If something is important, schedule the time and place to do it. Aided language input is an evidence-based, valuable strategy for AAC learners.        

AAC modeling is important. Give it a place to live in your routine.

(Survey Monkey was used to create the survey and graphs.)

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Looking for Some Augmentative and Alternative Communication (AAC) Modeling Motivation?

How many times have you heard that using aided language input is a key strategy to teach the augmentative and alternative communication (AAC) learners in your life? If you follow AAC blogs and groups, participate in AAC professional development, or read AAC articles, the answer is probably “a lot.”

We ran an AAC modeling implementation intention “experiment” the first two weeks of May for Better Hearing and Speech Month (#BHSM). For more details, check out this link.  As part of the “Make Room for AAC Modeling ‘Experiment,” each day for the fourteen day challenge, we shared a #modelingmotivation on the Speak for Yourself Facebook page.  For those of you who weren’t able to participate in “real time,” I thought it might be helpful to have some modeling motivation any time you want it! SO here is the information that was shared over the two week “experiment.”


Today’s motivation is the Jane Korsten quote that many of you may have already seen. (I’m attaching the graphic that Rachael Langley created.)

If you’re reading this quote for the first time, many people (especially parents) say they feel overwhelmed…Like they’ve already lost years of language exposure for their child.

But instead, let it motivate you to start increasing their exposure to an expressive language system now. Your children have been listening. They hear language all day, every day. They know the words.

Based on Jane’s numbers, if you have a six year old, he has heard 17,520 hours of spoken language. That time hasn’t been wasted. He’s been listening.

Using aided language input on an AAC system makes expressive language accessible. It provides a way for someone using AAC to participate in the conversation happening around them.

Show them how it’s done…and start today!

Day 2

If you missed yesterday in the Make Room for AAC Modeling “Experiment,” start today! I’ve left a few days between the end of the experiment and the survey to allow for a back up plan. 😉

Today’s #ModelingMotivation is a post I wrote more than 3 years ago. It gives a detailed explanation about how to model one more word than your child/student is using independently.

You don’t have to be perfect, and it doesn’t have to be overwhelming. Have fun and enjoy the time talking with your child!

“One of the more common, and important, Augmentative and Alternative Communication (AAC) implementation strategies is Aided Language Input or modeling.  It would be overwhelming to use your child’s/client’s device to model EVERY word you are saying verbally…for you and the child!  Here’s the good news, you can successfully use Aided Language Input without overwhelming anyone!”

Day 3

How is everyone doing?

My time spent with students is generally already carved out for aided language input, but yesterday, I knew the class was going on a walk during the time I would be there. It’s not a walk around the school. It’s a walk through the town to a store. There are traffic lights, crosswalks, dogs, cars, and other people. There’s a lot going on and it’s usually a difficult time to model.

In the spirit of this challenge, I planned to do it anyway. Everyone else was talking as we walked down the street. The student’s 1:1 aide is excellent so the student’s safety was covered.

The “place” I planned to model was when we stopped. So I modeled things like “waiting,” “red light,” “go now,” “need stop,” “walk school.” The student vocalized and watched the cars and lights changing.  She didn’t seem to care about the modeling, but she also didn’t tell me to stop (which she does if she wants me to stop:).

She never used the device herself as we were walking, but she didn’t clear the message window either (which she does pretty vigilantly).

Occasionally, as she was walking she’d slide her hand down to the device hanging at her side. Without looking at it, she’d touch the message window, causing the device to speak the modeled words.

Something important to remember about AAC modeling is that you’re not always going to get immediate results. She didn’t use any of the words I modeled yesterday independently. BUT she seemed to enjoy walking and talking.

Using aided language input lays the groundwork that communication is a positive experience, and you can use AAC anywhere. Take the pressure off of yourself and the AAC learner. Know that when you use aided language input, you’re not only teaching words. You’re teaching them that you want to hear their voice…everywhere.

Day 4

Today’s #modelingmotivation is a throwback post from PrAACtical AAC. 

“Everyone can do it. This is not a strategy reserved for highly trained professionals. Some of the best implementers I’ve ever seen of this strategy were paraprofessionals and family members. Even peers can get in on the action. Learning from friends? Yes, please!”

Day 5

If you’ve been getting “stuck,” today’s #modelingmotivation might help you problem solve your aided language stimulation approach. This is a quick 2 page hand out from Assistive Technology Australia.

If you’re having a difficult time modeling or feel like you’re in a rut, consider changing something in one of the areas they mention. The more you do it, the easier it gets!

Day 6

Today, I’m sharing some phrases you can model. Today.

This post contains lists of two, three, and four word core word utterances that you can pretty easily apply at some point throughout every day. This is our most often pinned post on Pinterest. I hope it gives you the #modelingmotivation you need today!

Day 7

We’re halfway through the 2 week plan to carve out the time and place to model AAC for the people in your life who are using.

For those of you who are motivated by evidence-based research, here is a research article.

“The most important clinical implication of this study is that a 3-week intervention program in aided language stimulation was sufficient to facilitate the comprehension of at least 24 vocabulary items in 4 children with LNFS (little or no functional speech).”

Day 8

As we begin the second week, today’s #modelingmotivation is a post by Kate Ahern about the importance of language rich immersion in AAC.

“Even if they were adults with full receptive language, a lifetime of experience in the world and average cognitive abilities AND they spent ALL 30 hours a week at school fully engaged in AAC learning (including during transitions, meals and hygiene activities) it would take approximately six months to get to basic communication mastery.”

Day 9

Today’s #modelingmotivation is a research article looking at a naturalistic approach and modeling. 

Here are some of the key takeaways from the article (in case you don’t have time to look at the full study).

The third one is my favorite…even if the child doesn’t use the SGD, YOUR use of it can result in language gains!

* “using an SGD within an effective naturalistic developmental behavioral intervention may facilitate longer and more frequent reciprocal communication interactions, leading to gains in verbal and nonlinguistic communication skills” (p. 11) in 5-8 year-old children with autism.

* In the SGD group, significant differences were seen in spontaneous communicative utterances and initiating joint attention.

* “…the gains made by children… could be explained by the therapist modeling SGD use, with or without child SGD use” (p. 12).

Day 10

This article has a lot of great information for #modelingmotivation!

“The attitudes, beliefs and knowledge of the student’s communication partners are pivotal in the success story of any kind of Augmentative and Alternative Communication (AAC).”

Day 11

Today’s #modelingmotivation is a post that has a couple of videos of me using aided language input. Sometimes it helps to actually see it happening (and see the things I do imperfectly:).

This post also talks about the layers of modeling and how students sometimes need a lot of exposure before they decide to reach out and touch the device.

Feel free to link your favorite AAC modeling videos in the comments (it doesn’t have to be on the Speak for Yourself app).

Day 12

Here are some new ideas, as we’re winding down to the end of this 2 week challenge/experiment.

So, for today’s #modelingmotivation, this is an older aided language stimulation information sheet. It has some great suggestions and some more in-depth details about variation in modeling approaches.

If you’re feeling like your modeling has become a little stagnant, check it out!

Day 13

Today’s #modelingmotivation is this video by Christopher Bugaj that explains modeling and gives some good examples of phrases to model.

It’s also easy to understand if you’re trying to explain why aided language input is important to peers, siblings, and people who may not be familiar with AAC.

Day 14

For today’s #modelingmotivation this is a great summary handout that explains aided language input, gives some examples of how you can model, and cites research.

We made it! Today is the final day of the two week challenge/”experiment” about modeling implementation intentions!

Thanks to all of you who have participated and shared your experiences! Stay tuned for the results!

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Survey: Augmentative and Alternative Communication (AAC) Modeling Implementation Intentions

Predictable chart writing on a dry erase board went in a slightly different direction. Teaching anything requires flexibility.

Yesterday, we wrapped up our two-week Make Room for AAC Modeling Implementation Intentions “Experiment.” 

This post includes a link to the short survey to see if using the research on implementation intentions was helpful to increase the use of aided language input for our AAC learners. The survey also includes questions about your size and where to send the t-shirt being given for participation*. The survey will be open from 9:00 AM EST on Monday May 15th, 2017 until 11:59 PM EST on May 20th, 2017.

If you are reading this after May 20th, 2017, feel free to use the format of the “experiment” to plan for your AAC modeling. Choose two weeks and commit – with specifics – to using aided language input.

Thank you to all of you who have participated and shared your stories, either publicly or privately. It’s nice to know that you’re out there and find the information helpful!


*Shirts are only being sent within the United States to the first one hundred respondents. We apologize for any disappointment.

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Make Room for Augmentative and Alternative Communication (AAC) Modeling “Experiment”

Two children sitting in the field each looking at their own device in front of them.

Augmentative and Alternative Communication (AAC) modeling is important. Ask any AAC-knowledgeable speech-language pathologist, teacher, researcher, parent, or AAC app developer. Aided language input is common ground in the field of AAC, regardless of the language system you’re using. So if you support someone who uses AAC, this “experiment” applies to you.

If you use AAC, the aided language input piece may not be applicable, but feel free to choose something you’d like to improve within your AAC use and target it using this approach.

As I write this, I have that butterflies-in-my-stomach feeling. This is out of my comfort zone. I’m not a researcher, but I am a research fan and follower. I imagine it’s the feeling that a Garth Brooks fan would have if he/she were suddenly thrown onto stage at his concert and handed a microphone. Well, maybe not that extreme. Even if you sing “Friends in Low Places” really well on karaoke night, it doesn’t make you Garth Brooks.

Here’s my disclaimer: This isn’t a perfect scientific research experiment. If you’re an excellent researcher, there are going to be glaring things that are wrong with my design or my method, or the survey. Please forgive all of that because my goal in this is not to be a renowned researcher. All of that being said, I’m loosely using the words “research” and “experiment.”

My goal is for parents and professionals to find a way to support the people they know and love who use AAC. When I hear about strategies that work in other areas, I try to apply them to real life. Research in any field is only six degrees of separation* from AAC for me.

So it should come as no surprise that when I heard James Clear talking about implementation intentions on a podcast about social science, I immediately thought of AAC implementation intentions. (I wrote about the implementation intention research in this post in more detail earlier in the week.)

It sounded…easy. If this research works, AAC modeling will increase with a quick, minor change in your routine. Pretty exciting, right!?

Here’s the Plan!

May is Better Hearing and Speech Month (BHSM), and the theme this year is Communication: The Key to Connection. Let’s do a little research about modeling AAC using motivation and planned implementations.

Here’s what I’m asking of you

Give AAC modeling a place to live within your day. Carve out the time to show your child/student(s) that communication is a priority. Put it in your schedule. We’re asking you to plan to communicate and connect with your student(s)/child(ten) who are using AAC. If you’re already doing that, that’s wonderful!

  1. Commit to modeling for (at least) 15 minutes a day for the next two weeks.
  2. Decide on a time and place that *should* give you 15 minutes of modeling time with the AAC user(s) in your life.
  3. Decide on a contingency plan. Unexpected things happen all the time. Plan around them for success.
  4. Complete the form below. Write it on your dry erase board in your kitchen. Put it in your calendar. Put a sticky note near the place you plan to model. Whatever you decide,  publish your intention so that you will see it every day for the next two weeks.

Modeling intention form to put your plan in writing.

The second thing we’re asking is that you keep track for 2 weeks (May 1st-15th, 2017) and complete a brief survey letting us know if it worked or not! Once you complete the survey, you’ll get a free t-shirt** for your time! You can use this weekly calendar to check off if you modeled or not, or you can do it in a way that works best for you.

Modeling implementation intention weekly calendar.

Here’s what I’m going to do

  1. Every day, for the next two weeks, I’ll post a “modeling motivator” on the Speak for Yourself Facebook page. I’ll share a post about aided language input, a success story, or a research article that reminds you that modeling is important.
  2. On May 15th, I’ll post a survey asking for your results. When you complete the survey, we’ll send you this t-shirt.** (The survey will include size options and mailing address information for t-shirt sending purposes only. We won’t use your identifying information for any other reason.) The survey will close on May 20th, 2017 at 11:59pm EST.
  3. Write about the results and post them by the end of May!

Blue t-shirt that reads: I (heart) when we speak AAC.

Thank you all so much for your excitement and participation! I can’t wait to see how it goes!

*If you’re not familiar with it, six degrees of separation is the idea that everything in the world and all living things are only six or fewer steps from each other.

**T-shirts will be sent to the first 100 survey participants ONLY. Due to shipping costs, t-shirts will only be sent to participants within the United States. I apologize for any disappointment. The shirts are meant to add fun and incentive to the project.

T-shirts can be purchased (at the same price we’re paying) here. If you need children’s sizes, they can be purchased here.

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I Meant to Model Today: Augmentative and Alternative Communication (AAC) Implementation Intentions

Jess looking at me with high expectations of a good alternative to live theater.

It happens to the best of us. You have every intention of using some amazing and advanced aided language input. You imagine this wonderful interaction between you and a captive augmentative and alternative communication (AAC) user, soaking in the model of expressive language you fluently provide. But the day passes, and before you drift off to sleep, you realize that it didn’t happen. Life is busy. You got interrupted. Or maybe you were just having fun and enjoying the moments with your child. Whatever the reason, modeling intentions get pushed to the next day. You close your eyes and think, “I’ll do it tomorrow.”

Here’s the thing…tomorrow is going to be busy too. You’re going to get interrupted. And hopefully, you’re going to spend some time in everyday moments having fun and enjoying your child or student. What if the research about implementation intentions could make your aided language input intentions a more consistent reality?

As a field, professionals and researchers generally agree that aided language input is a crucial strategy in AAC implementation. Let’s see if we can use research in another area and apply it to increase the aided language input we provide!

I Meant to Model, but…

I recently spent some time hanging out with Jess, who you may know from her mom’s blog, You Don’t Say AAC. Jess is a twenty-five year old young woman who has Angelman Syndrome and uses Speak for Yourself. We had a fun day planned that was packed with her decisions. She initially wanted Burger King, but as we were driving, she decided on lobster for lunch. Sure! Ice cream? Why not?! Dried apples from the orchard market. Of course! (I had to veto Mamma Mia and Les Miserables because they weren’t playing near us.) She settled for Beauty and the Beast at the movie theater. Here’s a video of that conversation:

I intended to load her vocabulary data setting on my iPad and spend some focused time using aided language input, but two things happened. First, I picked her up in a whirlwind of excitement and ended up in the car without a wifi connection. Second, she was so talkative throughout the day that I didn’t feel like there was a good opportunity to take her device, connect it to my hot spot, and then email her user vocabulary to myself. I didn’t do it.

I modeled on her device while we sat in the car outside of the restaurant. We talked about what we could do in the hour between lunch and the movie. I modeled in the restaurant when we were figuring out the choice of sides. When her device battery died, I pulled out my iPad and modeled on the unpersonalized vocabulary in my app before handing it to Jess to use. But when the day ended, I thought, “I meant to model today.”

Implementation Intention Research

My modeling “failure” reminded me of something I had heard about research on implementation intentions. I had saved the research article, which talked about exercise. Part of the reason I saved this article was because it made me think of using the strategy in the article for implementing aided language input.

The researchers randomly divided people into 3 groups. The control group was asked how often they exercised. The second group (“motivated group”) was asked how often they exercised and also given motivational materials about the benefits of exercising. The third group was given the motivational materials and also asked to fill out a form with the “when, where, and how” of their exercise plan. After two weeks, the researchers found that there was not much difference between the control group (38% engaged in exercise) and the “motivated” (35% engaged in exercise) group. However, the third group with the clear intention plan, had 91% of the participants follow through on their exercise plan. This is not the only research about implementation intentions. This research supports an already strong body of evidence in this area.

I Tried It For This Blog Post

My MacBook screen with two sticky notes. The first (orange note) reads: “I will write uninterrupted on Thursday (4/20) from 9-11 am in the shedquarters.
The second (blue note) reads: “If I am interrupted, I’ll add that time after 11.”

…and it worked! I’ve been thinking about this blog post for at least a few weeks. I keep intending to write it and then something else takes my attention. Today, I made it a priority. I wrote it down and made a commitment to devote a couple of hours to actually doing it. And I did.

What’s the Possible Implication for AAC?

I don’t know, but let’s find out! May is Better Hearing and Speech Month (BHSM), and the theme this year is Communication: The Key to Connection. We’d like to do a little research about modeling AAC using motivation and planned implementations. It will be a better experiment with your help!

Here’s what I’m asking of you: Give AAC modeling a place to live within your day. Carve out the time to show your child/student(s) that communication is a priority. Put it in your schedule. We’re asking you to plan to communicate and connect with your student(s)/child(ten) who are using AAC. If you’re already doing that, that’s wonderful!

The second thing we’re asking is that you keep track for 2 weeks and complete a brief survey letting us know if it worked or not! Once you complete the survey, you’ll get a free t-shirt for your time! I’ll post a blog with all of the links and details on Friday April 28th, 2017, and we’ll officially get started on May 1st!

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The Aftermath: Emergent Literacy in Augmentative and Alternative Communication (AAC)

Avery sitting in a waiting room with books spread out in front of her and a baby doll by her side.

Just over two months ago, I walked into Avery’s house with an armful of books. I boldly told her and her mom that we were going to work on reading and writing. Avery had just turned four, and her mom unflinchingly said, “Sounds good to me.” Avery gasped with excitement as if I’d walked in with a new puppy or a bushel of balloons. We had been doing a lot of shared reading, but I had a fresh plan for literacy. Avery was completely on board.

I returned from the Assistive Technology Industry Association (ATIA) conference with renewed excitement. It is the kind of enthusiasm we hope to gain from professional development experiences. I attended a session called Using Core Vocabulary in Emergent Literacy Instructional Routines presented by the Project Core team. It resonated with me. I appreciated the framework for targeting and encouraging emergent literacy for users of augmentative and alternative communication (AAC). Their plan put the responsibility on the instructor rather than the student. It also fit well with the Speak for Yourself AAC app.

That hour and a half session inspired a six part series of blog posts addressing literacy using AAC and Project Core.

In case you missed it…

For those of you who have busy lives and haven’t been able to follow along every week, I thought it might be beneficial to round up links to all of the posts. So here they are:

Using Speak for Yourself with Project Core Non-Instructional Routines 

Shared Reading: Using AAC With Project Core

“I like” Predictable Chart Writing: Using AAC and Project Core

Independent Writing: Using AAC and Project Core 

Alphabet and Phonological Awareness: Using AAC and Project Core

Independent Reading: Using AAC and Project Core

I read a lot of research, but not just for the sake of reading it. The value of research is in the application of it. When I read research in any field, I think how does this apply to my life?, which generally ends up translating to how does this apply to AAC? So when there’s a framework that really smart researchers take the time to establish, it makes sense to listen.   It makes sense to try it.

The Aftermath

As clinicians, we know that what works for one child may not work for another. Even if it’s been researched. But what I will say about these emergent literacy strategies is that they were not difficult to try. They didn’t take long. And most importantly, they generalized seamlessly. It does help that Avery was already interested in books when we started. It helps that as soon as her occupational therapist knew about it, she jumped in with writing activities too. It also helps that her home is a “book rich” environment. However, none of those things are pre-requisites for literacy to emerge. You can start with one small act. Put books in your environment. Start reading out loud to your students using AAC. Model some of the words on their device. Like so many things, it starts with a first step.

Sometimes we implement things and we don’t get to know if they “worked” immediately. We don’t always get instant results and as clinicians we accept that. Our work is for the long term. But sometimes, we’re fortunate to see the impact right away. Avery’s mom texted me the picture in the beginning of this post and a short video last week (and graciously gave permission to share them). She had a doctor’s appointment, in an office full of toys (which she also used), but guess how Avery decided to spend her time…better yet, she can tell you herself! (Listen to her use of core vocabulary!)


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Speak for Yourself and VocaliD Bring Cutting-Edge Custom Voices to the iPad

Lemmy looking at his Speak for Yourself screen with excitement.

We just released version 2.7 of Speak for Yourself! This version is very exciting for some of you, and for others, there will be no difference in the app.

For us, it’s pivotal! This update allows VocaliD voices to be used in the Speak for Yourself AAC app! I know we’re not the first augmentative and alternative communication (AAC) system to offer access to VocaliD voices. However, we are the first – and as I write this, the only – AAC app that has this option.

Lemmy (in the adorable pictures) and a few other individuals who chose to purchase VocaliD voices will be receiving those voices shortly.

We announced that we would be incorporating VocaliD technology in this post when we first decided to work with Rupal Patel and the VocaliD team. This was in May 2015, almost two years ago. Shortly after, I wrote about the ever-evolving voice option in AAC. In that post, I said, “When I first heard about VocaliD, it was through Rupal Patel’s TED talk . I watched with excitement. When it was over, I emailed it to Renee and our developer with a simple “I want this!” message, like a five-year-old with a Toys-R-Us catalog.”

Making it Happen

We are early adopters of this technology. When we agreed to make it available to the individuals using Speak for Yourself, we didn’t have an elaborate plan. We did it with a “whatever it takes, we’ll make it work” approach. When I say we are early adopters, I mean that Speak for Yourself users will be within the first 15 people in the world to have access to their custom VocaliD voices.   Prior to this update, these custom voices were only available to users of traditional AAC devices from device manufacturers.

Our goal when we developed Speak for Yourself was to offer a high-quality language system that is financially within reach. We knew the iPad would be the only chance that some people with complex communication needs (CCN) would have to get their hands on AAC. Throughout the more than five years that Speak for Yourself has been on the market, our mission has been to make sure that the people who depend on Speak for Yourself to meet their AAC needs, have access to dependable, high quality communication. With this update, we are able to provide the option of a custom VocaliD voice to anyone using Speak for Yourself.

Lemmy choosing his words with intense concentration.

Thank you to Mark, our phenomenal lead developer, and to the team at VocaliD who worked diligently to make this possible. This is just the beginning. It is exciting to be part of new technology and to be able to bring it to the iOS (iPad, iPhone, and iPod) platform. We can’t wait to hear Lemmy and the new voices in Speak for Yourself!

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Independent Reading: Using Augmentative and Alternative Communication (AAC) and Project Core

This is the final post in the six part series on using AAC, Speak for Yourself, Project Core to promote emergent literacy. If you’re just joining in, you may want to start with the first post. 

The impetus for this series was a presentation by the Project Core team at the Assistive Technology Industry Association (ATIA) conference in January called Using Core Vocabulary In Emergent Literacy Instructional Routines.

This week, we’re talking about independent reading. Do you remember when we talked about independent writing and the goal was to have the children enjoy it and want to keep trying it because they feel successful? The goal with independent reading is really similar. However, there is one exciting and awesome exception…now they can apply the other emergent literacy skills you’ve been teaching them!

Here’s the Independent Reading Self-Evaluation form from the Project Core Implementation Resources:

What Are You Teaching With Independent Reading?

Little hands holding the Clara Cow Wraps Up Warm book from the piles.

When I think of independent reading, I picture our sustained silent reading (SSR) times in elementary school. Everyone is sitting silently with a book of his/her choosing. No talking allowed. That is NOT what independent reading looks like as an emergent literacy strategy. No one is expecting you to hand a child a copy of Harry Potter and watch as they sit and read it independently…not yet anyway!;-)

Here are some examples of things your child(ren) can be expected to learn as an  emergent independent reader.

To prepare to use this framework with a student, I gathered a collection of books that were appropriate for the age, interest, and attention span of my student. Choose some books that have repetition with variety. As a side note, all of these Project Core activities were done with the same little student. I wanted to have a consistent example throughout the posts. Plus she already loved books!

Learning to Predict Consistent Patterns

I excitedly entered the room and announced that we were having a “Reading Party!” Incidentally, if you want to do an activity that a child may be hesitant to try, adding the word “party” works wonders. It also works for adults. Think of all of the painting that gets done for free and silver jewelry and leggings that get sold under the guise of a “party.”

Anyway, I set two piles of books on the floor and let my four-year-old student go through them until she chose one. When she held it up, I said, “Great choice! Read it to me!” She looked at it and pointed to the word, “brown.” I said and modeled “brown.” Then I said, “You picked Brown Bear, Brown Bear, What Do You See?” She nodded and said, “Help read.” I read the first couple of pages, modeling “see” and “me.” On the third page, I stopped and looked at her expectantly after I said, “Yellow duck, yellow duck, what do you_____?” And she smiled and said “see.” I pointed to the word “see” in the book. Then I said, “I see a purple cat looking at _____.” I looked at her and she said, “me.” I pointed to the word “me” in the book.

As we went through the rest of the book, I’d point to those words on each page and she would say them. When the book was finished, I said, “You were reading words in that book!” And she beamed…and danced a little. She doesn’t know all of her letters. This little student didn’t sound out those words. She knew what to say when I pointed at the letter combination in a book.

Recognizing Combinations of Letters that “Match” (sight word recognition)…

She looked at the pile of books and excitedly picked up Mr. Brown Can Moo, Can You? She pointed to “brown” and nodded, then she said “brown” on her device. “YES!” I clapped. “It says ‘brown’ just like the Brown Bear book!” We read through part of it, until she closed it and said, “done.”

…And Also Have Meaning

When she looked at the choices, she pointed to the cow on the front of Clara Cow Wraps Up Warm and laughed. I said, “Oh my goodness, it’s a brown cow just like the Mr. Brown book!” She said, “moo” and handed it to me. In the book, Clara has a cold and all of her friends give her clothes to keep warm (all of the clothes have different textures which is engaging). She sneezes on almost every page. The author has the sneeze written very distinctively, as you can see in the picture.

A page from the Clara Cow Wraps Up Warm book showing the sneeze written with a combination of letter “Aaaaa-tishoo!”

The first few times I dramatically fake sneezed, I pointed to that combination of letters. As I was reading, she started pointing to them and saying “ah shoo!” I said, “You do the sneezes.” I stopped and pointed to the letters on each page, and she would pretend to sneeze. She’s learning that letter combinations have meanings.

Little index finger touching the “more” button of Speak for Yourself. The iPad mini is resting on the “Mr. Brown Can Moo, Can You?” book. The message window reads, “read more sticky sticky.’ She’s adding a final “more” to drive the point home. (She was referring to the “If You Give a Pig a Pancake” book.)

When you’re targeting independent reading, you’re teaching a child to enjoy books and giving them confidence that they will learn what those words say. You’re teaching them to pay attention to letters and the shape of words. They’re learning that they can look for ways to help read the book.

When you’re targeting independent reading, you are showing a child that she can cross the bridge from being a passive listener to an active reader. And you’re setting the larger, lifelong expectation for literacy.


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Alphabet and Phonological Awareness: Using Augmentative and Alternative Communication (AAC) and Project Core

Foam (12 inch square) puzzle letters arranged in QWERTY order on the floor.

This is the fifth post in a series of emergent literacy posts. We’ve been talking about using AAC and Project Core to promote literacy. This week, we’re talking about the alphabet and phonological awareness. If you are just joining this discussion, you may want to start with the first post.

The Project Core information comes from a presentation about Using Core Vocabulary in Emergent Literacy Instructional Routines at the Assistive Technology Industry Association  (ATIA) conference in January. The observation/self-evaluation form below is available to print from their website under implementation resources:

Let’s take a more detailed look at the alphabet and phonological awareness. What are we actually trying to teach? Here’s are the targets, according to the Project Core team:

Alphabet Knowledge:

  • Letter-shape recognition (52 symbols)
  • Letter-name recognition (26 letter names)
  • Relationship between upper and lower case
  • Letter writing/selecting abilities
  • Letter sound knowledge

 Phonological Awareness:

  • Distinguish between words
  • Recognize syllables
  • Word beginnings and ending

Getting Ready

Here are some of the planning recommendations from the Project Core presentation:

  • ALL students have an individual communication system that meets their access needs
  • Lessons focused on the alphabet include letters in a format that is accessible to ALL students (e.g., high contrast; large print; braille)
  • The lesson connects to the theme or a topic being studied in some way.

Personally, I had a difficult time early in my AAC career incorporating the alphabet and phonological awareness. I used to look at the children and think there was so much functional language they needed to learn that I didn’t have time to spend on letters. I had been watching my little students with complex communication needs (CCN) sitting in cubicles and learning to touch whichever letters were being targeted. Then learning to match the uppercase and lowercase letters to mastery. And then, they had to go back through all of those letters and learn the sounds. Some of the students were ten years old and had been working on the same few letter targets all year. When I did the math, I calculated that they would be out of the school system before they started to target spelling. Not to mention, it was boring.

During my second year as a speech-language pathologist, I covered a preschool caseload for children who were verbal, but had speech and language impairments. The teacher was phenomenal! She incorporated letters, sounds, phonological awareness, and writing across activities all day.

If you’re having a difficult time prioritizing for your students using AAC, here is the realization that changed my approach…You don’t have to choose between communication OR the alphabet and phonological awareness. Make your alphabet and phonological awareness activities motivating enough that they spark communication.

Some Real Life Ideas

There are a ton of Pinterest and blog ideas to teach the alphabet and phonological awareness. Here’s a post from Angela at OMazing Kids with some great ideas and additional links.

Here are some examples that I’ve seen work in real life that you can do this week:

Use Auditory Bombardment:

If the unit is “apples,” the letter of the week is “A” and the adults in the classroom try to use as many “A” words as they could in their conversation and directions, with an emphasis on the sound. Once you start doing it, it’s a lot of fun for the adults and it’s complete auditory bombardment for the students. As you’re saying them, model core words with the targeted letter on the child’s device. If you’re sticking with the Project Core words, and you’re targeting the letter “A” (for example), “are” and “all” are Project Core words that are on the main screen of Speak for Yourself.

Sing Simple Songs: 

My favorite phonological awareness song dates back to my son’s early magnetic Leap Frog musical toy. When he put a letter into the toy, it would start to sing. It’s catchy, fun, and easy. A word of advice, when you make the sound, try to isolate the sound without vowels following it. Some will be easier than others. Here are the words to the song, which may be familiar to many of you:

The N said /n sound/

The N says /n sound/

Every letter makes a sound

The N says /n sound/

Find words in the device: 

The Speak for Yourself AAC app screen with the search feature open and showing the keyboard and a list of “G” words.

If you have an “extra” device for the classroom, your verbal students may enjoy this also. Here’s a quick story. I was working with a preschooler using Speak for Yourself, who was included in a general education preschool classroom. The class was giving the teacher words that started with “G.” I showed the student the search feature and he found and pressed “G” on the keyboard. When all of the “G” words appeared in the list, his eyes brightened and he scrolled through the choices. He raised his hand, and said, “galaxies.” The teacher said, “Wow, that’s a great word!” The student next to him whispered, “Can I use your talker?” and my student smiled and leaned it towards him to show him how to use the search feature. He chose “gallbladder” and the entire class laughed.

The teacher said that she started pulling out the classroom iPad during their literacy time. She picked five students who got to find a word with the letter of the day, using the search feature.

Target Language with Fun Alphabet Manipulatives: 

Foam letters and an open alphabet book on the floor. We were trying to find the matching foam letters as we read the book.

Combine your goals. If you want your student to use core vocabulary, combine it with a fun activity that involves large foam letters. Model “WHERE H?” and then model, “PUT ON head.” In that brief moment, you’ve modeled a question, used 3 of the project core words, given them an opportunity to find the letter “H,” used a word that starts with the /h/ sound, and given them an opportunity to follow a 2-step direction (find the H and put it on someone’s head). You’ve also probably made them laugh if you let them put a big foam “H” on your head. Learning doesn’t fit into clean data columns. Be creative. The more you practice creativity, the easier it gets.

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