Developing Symbol- Based Communication Books Access to Communication and Technology (ACT) Contents What, who, why, when , how Pages 3 – 7 Assuming potential Pages 8 - 9 Access to words Pages 10 - 11 Efficient and accessible Pages 12 -14 Show how Pages 15 – 17 Never finished Page 18 Trouble shooting & Top Tips Pages 19 - 20 Referral to ACT Page 21 Websites & references Page 22 How to print this booklet Page 23 What is a symbol-based communication book? In this leaflet we use the term ‘symbol-based communication book’ to refer to: • paper communication books • that use symbols alongside text (written word under / above the symbol), • are organised in a systematic way, • develop the user’s language skills in a way that matches typical language development • Includes alphabet and numbers 0-10 at least • and are used alongside the person’s other methods of communication e.g. gesture, facial expression, natural or synthesised speech Communication books come in different shapes and sizes – here are some examples: Buckley, K (2017) Developing & Using a Communication Book. ACE Centre Porter, G. (2007) Pragmatic Organisation Dynamic Display. Cerebral Palsy Education Centre Latham, C & Buckley, K (2008) Look2Talk. ACE Centre Advisory Trust 3 Who might use a symbol- based communication book? • Children, young people (YP) or adults might use a communication book when they find it hard to use speech or cannot use speech at all • When it is hard to use speech we call this Complex Communication Needs (CCN). This term is be used throughout the leaflet • People might use symbols because their literacy is still developing or because literacy may be a challenge for them or perhaps was never taught effectively, and as a result the person cannot use text or spelling alone to augment their communication • You may also see the term AAC used. This stands for Augmentative and Alternative Communication and is a term used to describe the different communication methods that may be used alongside or instead of natural speech Images from: Put link to ACT video here 4 Why introduce a symbol- based communication book? When supported well, a communication book with a robust language content can: • Help the user to have control and autonomy in what they want to express – to say what they want, to who they want , when they want - as we might expect for their language and age • Help the user be to express thoughts, ideas and needs, have fun chatting and socialising or give instructions, disagree, reject and refuse (see mind map below) • Give the user access to a wide vocabulary • Help the user to understand and use new words and concepts • Give the person access to language structure for building sentences • Help make communication exchanges more efficient for the person and their partner, reducing frustration • Support interaction skills, such as turn-taking and joint attention for both the user and their communication partner From: Birmingham Community Healthcare NHS Foundation Trust, Access to Communication and Technology, 2017. Reference; Kate Ahern- Motivate, Model, Move out of the Way Project 5 When is the right time to introduce a communication book? It is often thought that people need ‘pre-requisite’ skills or specific difficulties before introducing a communication book. You may have heard, for example: Communication books should The person needs to understand not be used until all other what the symbols mean before methods have been tried introducing a communication book Communication books are too People with limited attention complex for people with would not be able to focus on a profound learning difficulties book If a person cannot see or point If the person is not motivated to then they won’t be able to use a communicate they aren’t ready communication book for a communication book However, evidence has shown that if a communication book is robust, supported and designed for the person’s needs, it can be an effective way of augmenting communication regardless of ‘requisite’ skills (Romski & Sevcik 2005). It is less dangerous to assume that everyone has the potential learn to use language than to assume that they do not 6 How to develop a symbol- based communication book A robust language communication book supports the user on a journey that matches typical language development. This means that: 1. We assume that the person has the potential to develop communication and language skills 2. We ensure that the user has access to the types of words that help them to develop and generate language and to communicate in a way that is as clear, specific, independent and socially valued (i.e. using ways of communicating that others will respond to positively) as possible 3. We ensure that the person can access their language as efficiently as possible 4. We show the user how to use their book, using all of the principles we follow for people developing language in more typical ways 5. The work is never “done”! We never stop adding or building on the person’s language or communication book. With these principles in place, the communication book should enable the person to express : what I want to say, to whoever I want to say it, whenever I want to say it (Porter 2007) And be listened to and understood 7 1. Assuming potential When babies and children develop speech, language and communication, we act in certain ways. We: • Talk back when they babble and chat, even though the words are not recognisable • Use new words all of the time to describe what they are doing, seeing, looking at or pointing to • Talk, even though they may be looking away • Talk to help them when they are upset or distressed • Help and model back when their communication is unclear • Carry on using new words and sentences even when they haven’t yet mastered familiar words and sentences • Adapt as they grow, always keeping a step ahead e.g. from single words to short phrases to complex sentences • Focus on the quality of the interaction and having fun! • Help them to understand social rules, such which words might be rude or when it is OK to interrupt (See https://www.chickadee-aac.com/sites/default/files/chickadee-aac-language- development-model-revised-may-4-2019_0.pdf) We do these things because we assume that the child will, one day, use language back to us in the same way. We don’t try to “teach” language, it is simply part of the child’s everyday experience. 8 1. Assuming potential We should make the same assumptions for people with complex communication needs as we do for people learning language in the typical way / with natural speech. We need to use all of these same strategies with a communication book, matching the typical language learning process, using and pointing to the symbols in a book alongside our spoken words. If we don’t do this we are taking away that person’s potential to learn language. We can never really know what a person is capable of until we provide them with the opportunity to learn and show us (Porter 1995) Statistic from Jane Korsten – QIAT Listserv 2011. Photo by Rachel Langley, AAC Specialist 9 2. Access to words The words in a communication book are very important. We need to be mindful not to “gate keep” language, as we don’t do this for children developing speech in the typical way. A robust communication book has: Lots of words! Core vocabulary Fringe More than you (the 400 words vocabulary think, and always that make up (lower ahead of the 80% of what we frequency child / YP say) words) Words for Words & An alphabet different phrases, and numbers functions personalised & page, even if (rejecting, fun for the the person is instructing, person’s not yet using commenting) interests & age these Often the parts of language are colour coded using the Fitzgerald key (Fitzgerald, E. 1949) to support learning and navigation: 10 2. Access to words Example of a core vocabulary page: Clay (2018). Watch this video about core: https://youtu.be/vB_brGVYg7w Example of fringe vocabulary (fringe words on the right hand side): You will notice that the pages contain a mix of verbs, adjectives and nouns. This range is essential for language development and sentence building. Identifying words for a communication book is a team sport – involve all key people, including the user themselves! 11 3. Efficient & accessible Communication books (and voice output communication aids) will always be slower than using natural speech. We should do our best to help make the communication book as easy and efficient to use as possible. This means it should: Be organised in a Be accessible for the systematic way e.g. person based on their with words physical needs e.g. arranged by how their body moves, category or activity how they are positioned, the support they have Be always available to the person (out, Have instructions for: visible and This belongs to… “requestable”) Getting help… If found… How I use my book Have contents pages and double sided tabs to help with Have symbols that navigation stay in the same place i.e. they can’t be moved around 12 3. Efficient & accessible If the person cannot point to a symbol directly with a finger, could they use a whole hand, fist, elbow or eyes to point? Alternative access options could include (from https://acecentre.org.uk/resources/): Larger spaces Combined access (user points to the block then the partner lists through the options) Colour encoding (user looks at the block then colour) Partner assisted scanning (partner lists through the words - with or without symbols - and the user indicates ‘yes’ with vocalisation or gesture when the person reaches the desired word 13 3.