by Marci Revelli, MS, CCC-SLP (Speech-Language Pathologist); NWACS Board Member

reading time: 4 minutes

The views expressed in this post are that of the author and do not necessarily reflect the views and policies of NWACS. No endorsement by NWACS is implied regarding any device, manufacturer, resource, or strategy mentioned.

Multimodal communication is a term we sometimes use to encompass all the different ways a person communicates.

There is still a misunderstanding that using AAC will prevent children from learning to talk. I have found using and explaining multimodal communication helps families better understand that adding AAC does not mean that we are abandoning speaking. Speaking can still be a goal, but meeting their communication needs now is a high priority.

Following an AAC evaluation, I will make recommendations for a multimodal communication approach. This means meeting the child and family where they are at. It is helping them to embed different communication strategies through daily routines. This can help families feel more empowered because they can work on communication all day long, not only when the device is up and running.

Here are some of the ideas for goals when thinking about a multimodal approach:

Learning to use voice as a goal:

The very earliest goals might be encouraging increased frequency of vocalizing. Or working on a child’s understanding and use of vocal reciprocity. If your child vocalizes (in a calm way), you imitate them and vocalize back. If your child is using their voice like they are singing, you imitate back to them what you hear. You are trying to get your child to expect the back and forth of this game. This website has a fun list of 10 ways to encourage vocal play.

Learning to use gestures or sign language as a goal:

Let’s talk about gestures. Many children can reach but don’t yet point to request items or to show/share items. Many children can push away or turn away to reject or protest but can’t yet shake their heads no. Many children can look at a toy or between two toys to make a choice but don’t then shift their eyes to look back to their communication partner. The goals of shaping

• a reach to a point,

• a turn away to a no head shake and

• eye gaze to a toy only to shifting gaze back to partner

are some of the biggest differences between Level 3 on the Communication Matrix to Level 4. (See https://communicationmatrix.org/ for more information).

Children who have difficulties communicating may also have motor difficulties that prevent them from learning sign language. Many families want to learn sign language but are unable to take sign language classes to be good sign language models for their children. For children who show the motor ability to use a few signs, make a short list of signs that all family members can learn and model around the home (e.g., go, stop, done, more, help, want, play, mom, dad, you, mine, don’t, home, where).

Increasing picture symbol use:

I recommend families use both non-electronic and electronic forms of picture symbol communication. Hanging picture symbol boards around the home helps some families remember to model. They see them as they go into the child’s bedroom or walk out the front door. The time to model is right there in the moment, not some planned time in the future. These picture symbol boards do NOT need to be core boards, which many families have told me don’t make sense to them as they move throughout their day. These boards are also not just noun-based requesting boards (e.g. only pictures of foods). Instead, these are context-specific boards. One family recently told me the context board in the bathtub is working beautifully. The child is now pointing to the picture symbols of “more” and “splash” and then splashing the water joyfully!

Increasing picture symbol use on an electronic system:

There are different types of devices that offer voice output. But some children don’t yet understand that voice output is a useful communication tool. They may respond to a recorded message on a switch or to an app on a tablet as a cause/effect type toy. The goal then is to increase exposure to the use of voice output, increasing intentional use. I teach this through reciprocity. The child takes a turn. I respond to the child and encourage them to shift their attention from the voice output communication device back to me, their communication partner.

In summary, here are some examples of multimodal goals I will use to help families see we are encouraging all forms of communication:

• To increase vocal reciprocity.

• To increase speech sound repertoire through vocal play.

• To increase the ability to point both near and far.

• To increase the ability to look from an item back to the communication partner.

• To increase the ability to look between two items, sustain gaze on the desired item, then look back to the partner.

• Family will model picture symbol use during daily routines.

• Child will increase intentional use of picture symbols on a voice output system by selecting a picture symbol and then stopping, anticipating a response from the partner.