Connection over Compliance

If you were to picture a grammar lesson, what would it look like? How would you teach a small child to use correct verb tenses, for instance? Would you need a chalkboard? Flash cards? A book, maybe? 

Here’s a story that I love to tell: My nephew’s second birthday was at a park. At one point, I was sitting in the sand playing with him, and we had a few toys around. 

He kept saying things like, “cup full!” and I would repeat back, “Oh, the cup IS full!” Then I might dump it out and say, “this cup IS empty.”

After a few minutes of this, he started saying, “cup is full!” and “cup is empty!”. He learned the copula “is” that day, like magic. 

Notice… 

• I didn’t have to quiz him. 

• I didn’t have to make him repeat after me.

• I didn’t have to sit there going, “Say cup… say is… say full!” 

I only needed to know what was developmentally appropriate for his age, and use that grammatical structure repeatedly while we were playing. 

I wasn’t actually expecting him to learn it in one day, but he did! More importantly though, what he remembered about that day was how much fun we had. It’s nine years later, and when we go to the beach, he still loves to play in the sand (albeit with much more sophisticated castle building). 

Typically developing kids learn language through connection and play with adults and older kids. While you may have heard somewhere that kids with disabilities have to learn language through drills, imitation, and repetition… actually, those things don’t work very well for anyone. 

I had a very nerdy series of Instagram posts last year where I talked about this phenomenon in second language learning. There is a very sound theoretical basis to the idea of “modeling” language, and it’s not new. Linguists have been talking about social interaction as a key part of language development for decades. I think it’s fascinating and you can check those posts out here, and here, and here.... OR I can just tell you this one, easy-to-remember thing: Flashcards don’t work for language. Interactive play and thoughtful modeling does. 

Connections between best practices in AAC and Early Intervention:

Recently, I had the opportunity to take Cari Ebert’s excellent course, the ABC’s of Early Intervention (EI), which I highly recommend to any SLP out there reading this! There were some real overlaps between EI and AAC:

• Play-based learning: If you’ve ever parented or worked with kids ages 0 to 3, you know you can’t ask them to sit at a table and do flashcards with you! That’s NEVER going to hold their attention, and it’s not developmentally appropriate. You can maybe try to get them interested in a particular toy, but the better thing is probably to let them decide what to play with. Then you add language. When I’m working with an AAC user of any age, I also use a play-based and child-led approach, with no-expectations modeling. It works beautifully!

• Capacity Building: in EI, the SLP’s goal is not to directly teach the student, but to coach the parent on strategies like modeling. Similarly, as an AAC Specialist in the schools, my work was not directly with kids, but with all the adults around them.
  

• Customary Communication Partners: if a child only uses their AAC device with an SLP once per week for 30 minutes, it will take them decades to catch up to the amount of language exposure a typically developing child would have in a spoken language. Speech therapy can be valuable, but it can’t stand alone. We need the child’s customary communication partners (parents, teachers, etc.) involved too. Similarly, when EI providers coach parents to embed strategies within their daily routines, the child gets more language exposure all day long.
  

• Dosage: in the EI world, there’s a lot of talk about using parent coaching as a way to reduce the amount of time required from the SLP. However, the best available data that we have says that for coaching to work as well as direct services, you have to provide the same dose. That means if you would’ve recommended one hour weekly direct services, to get the same effect from parent coaching, you should also recommend one hour weekly.
  

• Family-centered Practice: when I’m working with a school team as an AAC Specialist, I write goals with my team members, not for them. Similarly, EI SLPs who use family-centered practice are skilled at asking the right questions to learn about the family’s top priorities, and write goals around them. 

In my dream school district (that I nicknamed LUVUSD in previous posts), we would be working closely with early intervention providers in the area. Kids can benefit from AAC as early as 18 months, so of course we’d want them to have it as early as possible. 

How beautiful that would be… for all kids to have access to symbolic communication from such an early age, that they couldn’t even remember their life without it. 

Plus, these principles of connection over compliance, and the importance of play, would be carried through to LUVUSD’s preschool classrooms. 

It’s not just a dream - 

Last February, I heard the keynote address of the AAC Early Starts Conference, by the Positive Development Group. They use a method known as DIR/Floortime, which has shown benefits for behavior, language, cognition, and more. It’s more effective than Applied Behavior Analysis, yet the experience for the child and the provider is gentle, connected, and fun! 

The intervention itself is compelling, and their model is really interesting. They have a collaborative team including an SLP, an OT, a social worker, and a psychologist. They then send developmental paraprofessionals to work with the parent and child at home. It’s somewhat similar to how a BCBA (board certified behavior analyst, someone with a master’s degree) would send an RBT (registered behavior technician; someone with a high school diploma + training & supervision) to work with a child and family, except with Positive Development Group, there’s an interdisciplinary team available, and all of them are involved with training for the developmental paraprofessional. 

I encourage EVERYONE who has an AAC user in their life to go check it out right here: https://www.theaacacademy.org/course/developmental-relationship-based-intervention-autism-and-aac.

Over the next few months of this series, we’ll work our way up through the ages, beginning with preschoolers. Until then - happy holidays!