Augmentative and Alternative Communication (AAC)

There is a continuum of Augmentative and Alternative Communication (AAC) services depending on age and degree of need in Simcoe County and York Region.  

The Preschool Speech and Language Programs provide service to individuals from birth to start of junior kindergarten. Families, physicians, childcare providers, etc. can refer children by speaking to a member of the child’s Early Intervention team or by contacting Child Development Services, Royal Victoria Regional Health Centre (Simcoe County) or York Region Kids Line (York Region).  Services are provided in the child’s local community and may be provided in a variety of setting including daycare, family home, and clinic.  

School boards have supports available to children enrolled within their board.  Speech and language support may come from a teacher, special education resource teacher, and/or board Speech-Language Pathologist (SLP). Parents can explore the available supports by speaking with the school principal.

Children’s Treatment Network of Simcoe York – Augmentative Communication Consultation Service (ACCS) is an Assistive Devices Program (ADP) accredited general level clinic. It provides support to clients and their local teams seeking specialty team consultation to address specific AAC needs. For example, high technology device assessment and possible prescription with government funding.  SLPs can refer individuals who meet ALL of the following criteria:
 
  • the child/youth is younger than 19 years of age and lives in Simcoe County or York Region
  • the child/youth is a direct accessor (able to point directly to items)
  • the child/youth is an intentional symbolic communicator with picture discrimination (combination of core and fringe vocabulary)
  • the child/youth has more than one communication function beyond requesting
  • the child/youth’s receptive language (understanding) is significantly better than expressive language abilities
  • the child/youth’s communication system is used and supported at home (in addition to daycare, school, or other environments)
ACCS SLPs do not focus on verbal articulation skills directly (although research informs us that use of AAC may help develop verbal skills). Therefore, if AAC is not needed or wanted, the child/youth will be transferred back to local team for articulation supports.

Holland Bloorview Kids Rehabilitation Hospital’s Communication and Writing Aids Service (CWAS) provides specialty consultation support to clients who are indirect or alternate accessors (unable to point directly to items). CWAS has specific referral criteria that can be found on their website.

CTN Augmentative Communication Consultation Service (ACCS)

Watch this informative video for more information on CTN’s Augmentative Communication Consultation Service.



The following document describes the various ways that ACCS can help and how to access the service. Click here to access the PDF version.


Additional resources/forms:

ACCS Referral
ACCS Consult
ACCS Clinic Day
ACCS Re-Referral
Please click on each of the FAQs listed below for additional information, videos, and resources. There is a wealth of information. Please note that any external resource links are provided for informational purposes only. CTN is not responsible for the content, privacy, policies, and terms of use of websites to which we link. The websites listed are not a substitute for professional advice, diagnosis, or treatment provided by a qualified health-care provider.
 

FAQ

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    What is Augmentative and Alternative Communication (AAC)?

    Not being able to speak, is not the same as not having anything to say.
    Rosemary Crossley


    Being unable to speak is one of the most severe disabilities that a human being can experience.  It is difficult to really understand what it is like to be speechless without actually experiencing the condition.  Also, many persons who are severely communicatively impaired with respect to speech are also similarly impaired with respect to writing.  They are unable to write well enough to meet their communication needs.

    If you want to know what it is like to be unable to speak, there is a way.  Go to a party and don’t talk.  Play mute.  Use your hands if you wish but don’t use paper or pencil.  Paper and pencil are not always handy for mute persons.  Here is what you will find: people talking; talking behind, beside, around, over, under, through, and even for you.  But never with you.  You are ignored until finally you feel like a piece of furniture.

    Augmentative and alternative communication (AAC) is a term that is used to describe various methods of communication that can help people who are unable to use verbal speech to communicate.  AAC can benefit a wide range of individuals, from a beginning communicator to a more sophisticated communicator who generates his own messages.  AAC includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas.  We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.

    Some individuals may have a physical or cognitive impairment which disrupts part of the communication process (plan a message, send the message, receive the message, process the message).  This may be due to a disability present from birth such as cerebral palsy or Down Syndrome, or due to an illness, injury, or degenerative disease later in life.  

    People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional.  Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, speech-generating devices, etc.  This may increase social interaction, school performance, and feelings of self-worth.  AAC users will not stop using speech if they are able to do so.  AAC tools and strategies are used to enhance individuals’ communication.  Effective communication occurs when the intent and meaning of one individual is understood by another person.  The form is less important than the successful understanding of the messageAny person with a disability that makes it difficult for them to communicate may benefit from AAC.  Some people need AAC only for a short time; others may use it throughout their lives.  AAC allows an individual to express their needs and wants, and more fully participate in decisions that affect their lives.  AAC also benefits family members and other significant others, providing a way for them to more fully communicate with their loved ones.  

    There is no risk in giving an AAC system to a child.  It will not keep the child from learning how to talk clearly.  Instead, it will help the child learn about words and language.  For some children, an AAC system is something that they will use during their entire lives.  Other children use AAC to lean about language before they eventually learn to speak clearly.  Learning about language helps them learn how to talk. Every way you look at it, having an AAC system helps the child.

    Watch this informative video for an introduction to Augmentative and Alternative Communication AAC.


    Intro-to-AAC-(1).png


    When individuals cannot use speech to communicate effectively in all situations, there are options.

    •    No-tech communication does not involve any additional equipment - hence it is sometimes referred to as 'unaided communication'.  Examples are: body language, gestures, pointing, eye pointing, facial expressions, vocalizations, signing.

    •    Low-tech communication systems do not need a battery to function and include: pen and paper to write messages or draw; alphabet and word boards; communication charts or books with pictures, photos and symbols; particular objects used to stand for what the person needs to understand or say.  This is sometimes referred to as 'aided communication' because additional equipment is required.

    •    High-tech communication systems need power from a battery.  Most of them speak and/or produce text.  They range from simple buttons or pages that speak when touched, to very sophisticated systems.  Some high-tech communication systems are based on familiar equipment such as mobile devices, tablets and laptops, others use equipment specially designed to support communication.  This is sometimes referred to as 'aided communication' because additional equipment is required.

    The Communication Bill of Rights summarizes the importance of AAC!
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    The following are some great introduction to AAC resources:
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    Getting Started with AAC

    Regardless of the symbol set selected or the display used, it is critical to keep in mind that augmentative and alternative communication (AAC) systems are not meant to replace speech. Many families fear that the introduction of an AAC system means that professionals are “giving up on speech”. Nothing could be farther from the truth. Millar, Light and Schlosser conducted a meta-analysis of research published between 1975 and 2003 on the impact of speech before, during, and after using AAC. Of those studies that met the criteria for evidence- based analysis, none of the individuals lost speech production as a result of using AAC. Some of the subjects did not increase their production, but most (89%) had at least modest increases in speech production (Millar, Light & Schlosser, 2006). Linda Burkhart made this statement in her book Total Augmentative Communication in the Early Childhood Classroom (Burkhart, L, 1993, p.37):

    “By providing a child with a variety of means to communicate, including speech, the pressure to produce speech is diminished. In the past, clinicians and parents worried that giving a child another means to communicate would hinder speech development. Children who are given augmentative skills develop speech as quickly as the control group and often surpass them.”

    Several reasons are cited for this phenomenon. The pressure to produce intelligible speech may be reduced knowing that the child has an alternative way to say something. The use of augmentative communication systems allows the child’s language skills to continue to grow and develop. Using speech is the easiest way to communicate. If the child is able to use it, they will choose speech over an alternative form of communication. There is research that supports introducing AAC at an early age before a child experiences communication failure because of a lack of speech production or intelligibility (Romski & Sevcik, 2005).

    For those who cannot use speech effectively, there exists a wide range of AAC system options. These range from simple communication boards or displays presented on paper to high tech electronic systems with voice output. No one system can meet all of an individual’s needs. For example, a child may be able to use head nods to clearly and efficiently communicate yes and no to caregivers. However, when discussing course choices for the coming academic year with family and teachers, an electronic system with the option of spelling and accessing pre-stored messages may be more appropriate and efficient.

    The success of any communication system is highly dependent upon the skills of the communication partners. The communication partners need skills such as modeling the use of the system, interpreting the symbols selected by the communicator, and even low-level technical problem solving. Often when a communication system is introduced, it is the first time a child has ever seen or used such a thing. From an intervention standpoint, it is helpful to think of how an individual learns a foreign language. One would not give a child a Spanish / English dictionary and expect him/her to be a proficient Spanish speaker. That proficiency would be gained only through listening to the language and by repeated practice with an experienced Spanish speaker. The same holds true for learning to use an AAC system. Good communication partners will provide modeling and feedback as to the accuracy and efficiency of the communication attempts in addition to actually using the system itself to communicate with the child.

    To increase the chances of success in learning a new system, activity-based teaching should be used. This model relies on selecting initial teaching activities that are highly motivating to the child, occur regularly, and present multiple opportunities for communication.

    The following are some great resources to get you started with AAC:
    Click here for a great webinar on “Getting Started with AAC for Your Child”.

    Watch this informative video for some ideas of what you can do while perhaps waiting for ACCS:

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    Watch this informative video for ideas of how to use AAC in everyday routines:

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    Partner Strategies for AAC

    Partner strategies refer to ways in which family members and other team members can learn to modify their own communication to best suit the child’s needs and goals.  The idea is to provide the child with ways for him/her to control the environment so that he/she can experience the power and control that communication can give.  

    Watch this informative video about partner strategies for AAC:

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    When trying to help a child to actively participate in communication, there has to be a need, an opportunity, and a reward for his or her efforts. Communicative Temptations are a way to make sure that these three things happen.  One of the most important things that we can do to assist in a child’s development of communication is to not anticipate his or her needs/wants. By not anticipating, you give the child an opportunity to show what s/he needs/wants. If the need is then fulfilled, there is a great chance that the child's efforts will be rewarded, and that s/he will try the communication method again. The child can learn to be an active communicator, not a passive communicator.

    The attitudes, beliefs and knowledge of communication partners are pivotal in the success story of Augmentative and Alternative Communication (AAC). The people around every individual with complex communication needs must believe that everyone has a right to communicate.  We must provide them with a communication system that enables that right. We must believe in their ability to use language and give them a system that enables them to use language. The people around them must believe in their ability to learn language – and we need to implement aided language input and other forms of language and communication teaching and learning to get this started.  Then we once more need to show our positive attitudes and our belief as we attribute meaning to their first communication attempts and then continue to support and encourage them as they move to more and more complex systems.  AAC is most successful because of the environment around the AAC user – adults living the principle of “the least dangerous assumption”.  The criterion of least dangerous assumption holds that in the absence of conclusive data, educational decisions ought to be based on assumptions which, if incorrect, will have the least dangerous effect on the likelihood that students will be able to functional independently as adults.  We should assume competence!

    The following are some resources to help support partner strategies for AAC:
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    Aided Language Stimulation

    Aided language stimulation is a strategy to introduce AAC tools.  This is when the communication partners model a child’s communication system functionally throughout the day.  Partners communicate to the child in the same mode as they are expected to use back.  Partners point to symbols on the tool as they talk to the child.  There is lots of research that shows it’s efficacy (www.joannecafiero.com).  It just makes sense to teach language in the same manner as typically developing children learn language.  Typically developing children have a receptive (understanding) vocabulary of about 50 words before they say anything.  

    AAC-and-Language-Development.jpg

    Why use aided language stimulation?
    • * Allows them to see their tool being used by people around them
    • * Unfair to expect them to automatically use their tools – if not literate, they won’t know what most of the symbols mean
    • * Establishes a solid receptive language base with the expectation that expressive language will eventually follow
    • * Encourages slowing down, shortening sentence length, and emphasizing key words and ideas
    • * Encourages commenting and modeling rather than questioning
    • * Opportunity for learning vocabulary together
    Consider the 90/10 rule when introducing a new communication tool.  Initially, it is expected that 90% of the use of the communication tool will be by the communication partner, and 10% will be by the child.  As times goes on the balance will shift.

    Watch this informative video about aided language stimulation:

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    The following are some other great resources on Aided Language Stimulation:
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    Core/Content and Fringe Vocabulary

    There are two types of vocabulary, core/content and fringe. Core/content vocabulary is composed of high-frequency words that are very versatile. In contrast, fringe vocabulary is composed of words that occur infrequently and lack versatility. Let’s compare and contrast core/content and fringe vocabulary:

    core-content-fringe-(2).png

    What is the priority in an AAC vocabulary? A small set of consistent and highly predictable core/content words that occur frequently, and compose 80% of our messages? Or a very large, unpredictable, and inconsistent set of fringe words that compose only 20% of our messages? Core/content words provide the basic architecture of our messages, and fringe words provide the customized detail. You can say many things using only core/content vocabulary. If you limit yourself to fringe vocabulary, you most likely will supply one word responses. Try to create a meaningful sentence containing only nouns!

    Everyone uses fringe vocabulary, primarily nouns, such as the names of family members, friends, pets, cities, and states. The names that are important to me are unique to me, and probably only of a few of my fringe words would be important to you. Additionally, you would have difficulty predicting the names that are important to another person. Fringe words are very custom vocabulary.

    Watch this informative video about core/content and fringe vocabulary:

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    Watch these videos demonstrating the importance of core/content vocabulary:

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    Types of Augmentative and Alternative Communication

    Please keep in mind that if a child or youth has an AAC system, a Speech-Language Pathologist probably assessed him/her and prescribed the system.  You should not change the child/youth’s AAC system without consulting a Speech-Language Pathologist.  Check out the sections below for more information about specific AAC systems.
     
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    Core Board and Flip n Talk

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    The Flip n Talk is a communication system that consists of a core display board with a spiral bound set of fringe vocabulary strips.  This gives the user quick access to core/content vocabulary and customized fringe vocabulary.

    The following are some great resources for core boards and flip n talks:
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    BIGmack and Step-by-Step

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    A BIGmack is a single message communication device.  A step-by-step allows you to record messages in segments and then replay them in that same order. The initial activation of the device speaks the first part of the message aloud and then stops. When you activate the device again, it plays the second part. And so on.

    Some step-by-steps an added feature that make them even more valuable: different levels.  Communicators with this feature allow you to pre-record several sequences and switch to the appropriate level when needed.  Easy, flexible, and practical.

    The following are some resources for getting started with a BIGmack or Step-by-Step:
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    GoTalk

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    GoTalks are battery powered AAC devices.  Messages are recorded as needed.  An overlay of pictures (or words or symbols) is created. The pictures help the user remember where to find messages. The overlay is slid into the GoTalk, and then the user can “talk” simply by pressing on a picture to play a message. There are a range of GoTalks to meet varied needs (GoTalk 4+, GoTalk 9+, GoTalk 9+ light touch, GoTalk 20+, GoTalk 32+).

    The following are some great resources to get started with GoTalks:
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    Communication Book

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    A communication book provides pages of symbols, usually organized by topic.  Depending on the age, cognitive and physical abilities of the user, the page may have anything from one to many symbols on a page. The topics depend on the age, ability and interest of the AAC speaker.  Communication books can allow a large number of vocabulary items to be stored in a relatively small space, but can be awkward to use.  Communication books containing a large vocabulary need to be well structured and laid out if they are to be practical.

    Communication books are generally developed through use and need. Sometimes unfamiliar vocabulary is deliberately included. The communication partner will then be able to model the use of this vocabulary, and the AAC speaker will learn the symbols by seeing them used in practice. Communication books usually develop to include pages of vocabulary related to: about me; people; feelings; clothes; food; drink; animals; colours; numbers; letters; hobbies and interests; curriculum-related vocabulary. Later, more topics are added such as weather, places, activities, or adjectives - and more words/symbols are added to each topic.

    At some stage some of the topics may need to subdivided because there are too many items to manage on a page. Most books have an overall topic page at the front with links via numbers, colours, letters or tabs to the relevant topic pages. As books get larger and communication becomes fuller, some people have a pop-out section with commonly used words (core page) that can be accessed from any topic page. Other people organize each topic page so that it also contains commonly used words or phrases (core vocabulary) in that topic such as “I want” on the food page, and “I feel” on the feelings page.

    It is important to have a section at the very front of the book which tells unfamiliar communication partners how to use the book with the communicator.

    The following is a great resource to get started with a communication book:
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    Clarification Strategies

    Clarification strategies can help individuals who use speech as their primary mode of communication but have difficulty being understood in some or all situations because of unclear speech.  They may experience frustration, social withdrawal, or limited conversational topics due to repeated experiences of communication breakdown.  Some individuals need to learn that they are not understood by others.  Clarification strategies can increase successful communication experiences, improve social participation, increase an individual’s range of conversational topics, and facilitate continued development of expressive language skills.  

    clarification-strategy-poster.png

    Research shows that:
    • * there is often an increase in speech with the introduction of augmentative or alternative communication. (Zangari, August 2000; Miller, Light & Schlosser, August, 2000)
    • * the use of clarification strategies results in no decrease in speech and significant increase in communication success and repair. (Cumley, June 1999)
    • * using clarification strategies results in an increase in communication effectiveness.  (Hustad & Gutmann, August, 2000)

    The following are some great resources to get started with clarification strategies:
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    Communication Passport

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    Passports are a positive way of supporting people with sensory and communication disabilities who cannot speak for themselves by collecting together important information about them and making this accessible to others with whom they may interact.  Passports do not attempt to incorporate all of the available information about the person. Making a Passport means taking an overview of information from the people in day to day contact with the client. Then making choices about what others 'need to know'. For example, a Passport might have a page right up front that is headed: If you only have a little time to learn about me, these are the three most important things. This section may contain life and death details about techniques of eating and drinking, things that trigger outbursts of difficult behaviour (and ways of avoiding these!) and so on.  Information in Passports is presented in a way that is simple, clear, direct and accessible, succinct, accurate and honest. To be useful, it will be highly specific and detailed and avoid vague generalizations. The passport is composed in a way that assumes the reader does not have any prior knowledge of the AAC user.

    The following are some great resources to get started with a communication passport:
    You can also check out the CALL Scotland site for more information on communication passports.
     
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    Pocket Mod

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    The PocketMod is a small book with guides on each page. These guides or templates, combined with a unique folding style, enable a normal piece of paper to become the ultimate note card. It is hard to describe just how incredibly useful the PocketMod is. Vocabulary can be customized to the AAC user’s abilities and needs.  

    Please keep in mind that if a child or youth has an AAC system, a Speech-Language Pathologist probably assessed him/her and prescribed the system.  You should not change the child/youth’s AAC system without consulting a Speech-Language Pathologist.  

    The following is a great resource to get started with a pocket mod:
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    Remnant Book

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    A remnant book is a book which contains the student’s own news.  It is different from a communication book or display because it includes remnants or items that help the student remember and talk about activities that the student experienced.  The purpose for using the remnant book is to start conversations between the student and his communication partners. (e.g., classmates, peers, teachers, parents, siblings, etc.)  The book provides motivating opportunities within the student’s experiences that (hopefully) they will want to share and talk about as they remember the recent experience.  The remnant book is particularly effective in encouraging interaction with other students since it is likely that most of them will relate to the experiences which will be in the student’s book.

    The following is a great resource to get started with a remnant book:
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    High Tech Communication Systems

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    The above speech generating devices are portable, lightweight, and easy to learn.  Most have strong core vocabulary language systems in multiple display configuration settings.  Some have the capability of being an integrated writing system by connecting via USB or Bluetooth to a computer.  An AAC user must be assessed and prescribed a high tech communication system through an ADP Accredited AAC Clinic in order to access government funding.  CTN’s Augmentative Communication Consultation Service (ACCS) is an ADP AAC Accredited Clinic.

    Please keep in mind that if a child or youth has a high technology AAC system, a Speech-Language Pathologist from an Assistive Devices program accredited clinic assessed him/her and prescribed the system.  DO NOT change the child/youth’s AAC system without consulting a Speech-Language Pathologist.  If additional vocabulary is needed within the system this should be discussed with the child/youth’s parents and they will add vocabulary as needed.
     
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    Visual Strategies (To Help with Understanding)

    Visuals can also be used in a variety of ways to help children and youth understand what is happening around them.  

    A visual schedule represents each activity in the child/youth’s day using objects, photographs, or pictures as tangible symbols. The type of symbols is dependent on the individual’s ability to identify the symbol. The symbol needs to be one that the individual will be able to associate with the intended message.  A visual schedule can also be helpful for breaking down a task that has multiple steps to ensure teaching of those steps.  It is also helpful in decreasing anxiety and rigidity surrounding transitions by communicating when certain activities will occur throughout the day or part of the day.

    A first-then board is a visual display of something that the child prefers that will happen after completing a task that is less preferred.  A first-then board is helpful in teaching children to follow directions and learn new skills.  It motivates them to do activities that they do not like and clarifies when they can do what they like.

    A communication ring is a collection of symbols used to support understanding.  They are used to give information, communicate rules, and support receptive communication.

    A Social Story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Half of all Social Stories developed should affirm something that an individual does well. Although the goal of a Story should never be to change the individual’s behavior, that individual’s improved understanding of events and expectations may lead to more effective responses.

    Natural gestures are things we all do to help our communication.  We all tend to use them such as when we shrug our shoulders to say “I don’t know”, or thumbs up to say “Good work”.  They are also a useful means of communication for children and youth who have difficulty speaking.  Most people understand what pointing and gestures mean.

    The following are some resources to get started with visual strategies:
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    Literacy and AAC Users

    Why work on literacy with students who are not routinely expressing their basic preferences?
    • * Because the longer we wait, the longer it will take to get there.
    • * Because it offers wonderful opportunities to build communication, too.
    • * Because when other people see us teaching reading and writing, it changes their perception of the student in a positive way
    • * Because they will enjoy it.
    • * Because there are mandates for us to address the general education curriculum.
    • * Because if we set the bar high and provide appropriate instruction, they can learn.

    Click here for some ideas of how to maximize the literacy skills of individuals who require AAC.

    Click here for a website with some ideas to get you started.

    Click here for a number of videos demonstrating various literacy activities for individuals using AAC.  
     

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