Our next featured domain discussion is around Domain #5, SYSTEM AS OWN VOICE.
The goal: To see themselves as having a voice and, if not using speech, understand their communication system to be that voice.
Domain 5 is by far my favorite domain and in my opinion, the most important to autonomous communication. Though this is critical to those who use Aided Augmentative and Alternative Communication (AAC), the concept of a communication system is key to really understanding this domain.
An AAC system is much more than just a device, PODD or sign language. A system refers to the combination of tools that a person uses to efficiently communicate for all of the reasons they choose. At Two Way Street, we like to think of outcomes for communication related to Autonomy, Belonging, Connection and Opportunity.
When we talk about individuals seeing their system as their voice, we must include all of the times and all of the components of that system. If a person is predominantly verbal, then this domain is usually less of an issue and their voice is nearly always their voice. Sign language too is often more easily adopted as a ‘voice’ but in some cases, limitations on the number of signs taught and understood by those in the environment make it difficult to be called a comprehensive system. There may be times when aided AAC is (or should be) a significant component of a person’s expressive communication, even if they have some verbal speech or signs.
Aided AAC can be adjunct or augmentative communication that is only required in some environments, with certain partners or for specific messages/functions. It may be a means to clarify a message if speech is not understood, or a way to add more detailed information if needed, or say a predictable message quickly. If someone uses sign language, they may also need an adjunct aided system to communicate with those who do not know sign language. Others use aided AAC in the absence of speech as alternative communication to speech, and in this case, it’s even more crucial that they and those around them understand the AAC system to be their voice. If the aided system is an adjunct system, it should be seen as the person’s voice in the situations where it is required. So when we talk about the system as their voice, we mean more than just one mode, particularly when the speech or sign mode is quite limited.
If the adjunct system is an enhancer, then it’s ok to consider the person as primarily verbal and score a 5, but if their verbal or sign communication is limited, then aided AAC should be strongly considered as part of their communication system.
Why is this domain important?
I love this domain because it highlights one of the crucial differences between verbal speech and AAC. It also seems to be one of the key tipping points in progress toward communicative competence for those who use aided AAC. Consider this…
Children who are typically developing speech, begin to express themselves as infants using their cry and vocalisations. This soon evolves to babble and then words. Each time they take a turn and notice a response, they see their sounds and later words as their voice. With it, they can be autonomous and express things that they like, don’t like, won’t do, want to do, or want to share with others. They can even entertain or reassure themselves (internal dialogues or self talk). They quickly learn the power of their voice and are motivated to:
- get the attention of others when they have something to say (domain 3 – initiation)
- speak more clearly so that others understand them (domain 4 – intelligibility)
- become more specific through combining words and expanding their vocabulary (domain 6 – complexity of language)
- use their voice for lots of different reasons (domain 7 – range of functions)
- expand their social interaction with others and take more turns in a conversation (domain 9 – social interaction), and
- learn to solve communication breakdowns or refine the way they communicate over time to be efficient and effective (domain 10 – strategic competence).
As toddlers develop spoken language, this all seems to happen naturally. As they figure out the benefits of their voice they are motivated to improve. In the past, we have often focused aided AAC intervention on getting them to point to symbols to prove that they have learned them, or to use symbols to answer our questions, rather than a focus on helping them to see that they have a voice and can say what they might be thinking. Often, we introduce symbols but the individual continues to use their body language to express their autonomous thoughts. Maybe this is because they do not yet see the symbols as their voice, but only something they have to use to say the things we want them to say. Maybe the way we have introduced, modelled or even talked about this system has led to them feeling this way. In extreme cases, we see individuals who throw or push away their AAC system because they see it as work, or worse still something people use to scold or restrict them (eg. when someone uses their system to tell them to “stop” or “wait” and that they are being “naughty”).
Domain 5 in ROCC is designed to track progress toward a person seeing the AAC system as their voice, or for those with some speech, seeing it as an important component of their voice in the situations in which it is required. Interestingly, after scoring the ROCC, this is the most common area that people set as a new target area. Sometimes I wonder if this was the target of intervention right from the start, would we even need to set goals in other areas? Or would the individual figure out ways to make themselves heard, expand their language and refine their access just like toddlers learning verbal language? Big picture thinking, but something to consider.
The end goal:
Our end goal in this domain is that individuals see their system as their voice. We want to see them using their communication system (including AAC where relevant) for their own intentions, that they look to it when they have something to say and are lost without it. In the words of Gayle Porter at the AGOSCI Conference keynote in 2015. “Would they take it to a party? Not can they take it, but will they take it?”
In this domain, we begin at the emergent level by looking at what we might see that shows that the person is taking an interest in the AAC system and beginning to consider how it might be useful to them.
Usually they can only learn this if we model how it can be used in this way. When we model, we can show them possibilities, or how to say the things they are already telling us with their body or behaviour. They may not learn to do this straight away, but the more we provide them with examples, the more they may become interested in learning to do this for themselves. We may see signs like Level 1 where they show interest in the partner because they seem to be “getting them” and what they are communicating, or Level 2 where they show interest in the system when we model. Sometimes we even get a “ZING” where they show us that the message that we modelled was the same as they are thinking (or at least close). Some might imitate our message verbally, point to the message we modelled, or press the message display to confirm the message. It’s important to see these steps as progress rather than to focus too strongly on getting them to point to a symbol or “Tell us on their device”.
As individuals begin to use their system expressively, this domain only considers success around spontaneous rather than ‘elicited’ messages. If a message is elicited by asking questions, or limiting choices, then the system is not their voice but just an answer booklet for them to tell us what we want to hear. In the beginning, we will see spontaneous messages about highly motivating things. Not just activities, but things they enjoy, making connections, and exerting control over what happens to them. These messages may not be what we want to hear, but they are definitely what the person wants to say! (Eg. “I don’t want to do it” or “hurry up”). In ROCC, there is quite a big jump between domain 3 and 4, but this is the tipping point. This is where the person is figuring out that they have a voice and it is (or includes in some situations) the communication system. Once they start to get that, then moving toward competence is often a matter of practice, confidence and problem solving in terms of things like efficiency, communication partner attitudes and practicality.
Competent and independent communicators in this domain would be those who integrate their use of AAC into their everyday interactions and, within the constraints of their personality, see that they have a voice to share with the world. For some who are partly verbal, they may only need adjunct AAC supports in some situations or with some partners. This domain is not about making them use AAC all of the time, but that it is part of their communication system and can be used on their own terms. Maybe it brings confidence to speak verbally because there is a back up option if they are not understood, or maybe it provides a way for people to understand them more specifically than just trying to interpret their gestural communication, and gives a voice that otherwise may not be heard.
For those who use aided AAC as their primary mode, they may still use other modes when they are faster or more effective, but they know that their communication is significantly limited without their AAC system, and would never be caught out without their system.
What can I do?
Probably the first step is to ask yourself if you see the system as their voice.
- How are you introducing AAC systems?
- What are you modelling? and
- If you were in their shoes, what would you think it was for?
Then think about whether you are listening to their voice, or focused more on getting them to use it. Think about what they are already telling you as a familiar partner, and how they could tell less familiar partners if they were to use the system. Start showing them how to say other things they may be interested to say.
Here are some examples:
- You see them looking at someone with a confused or concerned face. You could say and model something like “Maybe you are saying “I don’t know who that is” or asking “Who is that?”
- You see them push another child because they are coming close to their toys. You could say and model “Oh I see that you don’t want them to touch your toy. Maybe you could say mine”.
- Someone shows you that they are enjoying something and you are enjoying it too. You could model a message like “This is fun” and then pause to see if they take a turn, or for emergent communicators, watch for a ZING to confirm that they agree.
For emergent communicators, try taking the focus away from ‘getting them to use their system’ and redefine success as ‘increasing your ZING rate’. If the person is showing interest in the system and are seeing how it could be used to say the things they want to say, that’s a much stronger foundation for expressive communication than if they can point to a symbol simply to show that they know it, or to get something you are holding back until they do.
Another strategy is to provide opportunities for your child/person to see the system being used in a way that they may be interested in using it. Chat with others using theirs or a similar system, find video or real people who use a system similar to theirs as role models, encourage those in their environment to value the system and see it as an equivalent form of communication to speech. We need to stop writing goals or saying things like “Used his device to say hurry up”, “Signed more” or “selected go on her device”, and just phrase it as we would any modality of communication . Eg, He said “hurry up” and “more” or “She said “go” then walked over to the door. As language complexity increases, the use of symbols, signs or speech will be required to express these messages clearly anyway, so you don’t necessarily need to define the mode.
Another key point is that if the child/person does say something (or for emergent communicators, shows you a ZING when you model a suggestion), then you acknowledge and act on it. Avoid saying things like “Well done for saying more”. Just give them more, or tell them why they can’t have more. Just because someone says something, it doesn’t mean it should happen, but it does mean they should be acknowledged.
Also be sure that if you are going to share what they say with others, that you check in with them first. For example you might say, “Do you want to tell everyone that or just me?”, or “Shall we write that in your book to share with mum?”. Our voice is not just the words we say, but who we say them to, and when we choose to say them.
Useful links on this topic:
You can also learn more about Domain 5 in the context of ROCC by doing the ROCC Basic Training