by Marci Revelli, MS, SLP (speech-language pathologist); NWACS board member

reading time: 5 minutes

The views expressed in this post are those 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.

I was recently asked the following question by a family and school team. “What do we do when the child used to use their AAC so well and now pushes it away?” There are so many things to consider.

1.  The child sees the AAC system as work.

There is a real risk when some parents or teachers “teach” the AAC system. This may look like a parent who asks direct questions. “Where is the color red?” Maybe a teacher or behavior analyst drills vocabulary. “Where is cloud, where is sun, now find wind.” The child may not see their AAC as theirs.  The child sees the AAC as a teaching tool that others make them use.

The solution here is partner coaching. Working with AAC partners to bring awareness to how they are using the AAC system. This might include

• Gentle reminders to use statements instead of questions.  Instead of “Where is the color red?” try making a statement such as “You have a red crayon.” 

• This blends perfectly with modeling. The partner can say, “You have a red crayon.” while touching the picture symbol of red.

• Let the child lead the use of their AAC. Wait expectantly and see if they come up with an idea, something they want to tell you on their AAC.

2.  The child sees the system as too hard. 

There could be many reasons for this. I will share three of them.

Cognitive load: Cognitive load means there is too much happening and the brain cannot remember everything. The child is pushing the AAC system away to lighten the cognitive load. AAC is inherently a heavier load because we are asking a child to

• listen to what is going on around them

• filter out all the distractions they see or hear in their environment

• think about what they want to say

• hold this in their memory

• try to remember where the picture symbols are

• use their vision and motor skills to find the picture symbols

That is a lot of things to remember!

The suggestion here is to lighten the load by

• limiting distractions

• give the child extra time to find the message they want to say

• simplify what they need to pay attention to; maybe use a paper-based picture symbol board

• find moments to “just talk” where there aren’t distractions

  • waiting for the bus

  • eating a snack

  • at bedtime

  • in their car seat, stroller, or chair

You do not need to set aside a time to communicate with the AAC system. Communication happens all day long in these small moments.

Individual sensory and motor differences: Consider the child’s individual differences. 

• How do they respond to their world, their sensations (how they see, hear, touch, move)? 

• Are they regulated? Are they in a state where they can attend to you and their AAC system?

• What is their internal state (called interoception)?

  • maybe the child hasn’t been sleeping well

  • maybe the child has been sick

The suggestion here is to support the child’s regulation - their ability to pay attention to you and to the world around them. Talk to your Occupational Therapist for suggestions to help them reach a state where they can use their AAC system to communicate with you. 

Setup of the AAC: The last point in this category is to review the features of the AAC system to make sure that the system itself isn’t causing the child to turn away from it.

• Is the setup of the AAC system too hard? If they were using it but now aren’t, consider building a bridge to the different layouts the child is using so they can go between the old and the new versions. 

• Consider they were interested in exploring it for a while, but because of its complexity, they are finding it challenging to actually use it with you.

You can test this idea by making pages on the AAC system simpler (hiding picture symbols, making the symbols bigger, using more photographs). Does the child show renewed interest?

3.  The child is growing and learning new ways to communicate!

Has the AAC system become too simple? Consider that they may have outgrown the limitations of a more simple setup and are ready to say so much more than what their AAC system offers. Try showing them a more complex layout to see if that sparks their interest.

There does seem to be a tipping point when speaking or signing becomes faster than hunting for picture symbols. It may still be difficult to understand what the child is saying. One solution is to continue to model AAC system use, especially when the partner does not understand the child. 

• You are showing the child how to use AAC to find the picture symbol for what they are saying. 

• You can ask the child to “give you a clue.”

• You can ask the child to try and spell the word they are saying. 

The child may now be showing more interest in and ability to read and spell. You might see them go more to the keyboard to try and spell something. The child might go to the search feature of an AAC app because typing is now a part of their skill set. I encourage partners to embrace this - to go to the keyboard, to model for the child how to sound out words as they type.

4.  The child doesn’t see the value of using the AAC system because others around them don’t use it.

The child stops using their system because no one around them is using it. They don’t see that the system is valued by others who are important to them. This is one of the big reasons why SLPs recommended “modeling”. When partners talk and touch picture symbols at the same time, they are showing the child that using the picture symbols is important, it matters.

In summary,

• Use statements instead of questions.

• Show the child the picture symbols while you talk to them. You touch the symbol and talk at the same time.

• Lighten the “cognitive load.” Try a different time of day, perhaps with fewer distractions.

• Go back and review the setup of the AAC system. Is it too simple or too hard?

• Support all ways to communicate: speech, sign language, typing/spelling/keyboard use, etc.

• Have fun! Communication can be fun! Find the sparkle or “gleam in the eye” that the child gives you when you are enjoying each other’s company. 

Finally, don’t forget to gather all members of the child’s team. Parents, teachers, therapists, other school or family members - we all have a different perspective to share. One person may see something others don’t. These insights can help the whole team better understand and support AAC system use.