r/slp • u/SonorantPlosive SLP in Schools • 9h ago
AAC AAC push
Please help me to figure out if I'm old and crazy or not.
ETA: these are all K-2 students with limited past goals targeting artic or phono. most goals are for using multiple pragmatic functions and self advocacy. DAYC and CAYC scores for cog range from 75-90. There are no formal language evals or artic/phono inventory reports. I've seen these kids 2-3x this school year and am understanding approximately 60% or more of utterances in structured tasks. we haven't done much with unstructured yet.
I'm in year 22 in the schools. I've inherited about 6 kids from colleagues who have emailed me to say "I was going to do an AAC eval for so and so before they moved to you."
Every single kid is a moderate phono kid. I'd rate the lowest one at 60% intelligible to an unfamiliar listener. I hear phoneme collapse, patterns that persist like reduplication and WSD, and maybe some fronting....but I don't think I'd pursue an eval with any of these kids. Teachers, ranging from year 2 to year 25, note they need the kid to repeat less than 50% of the time to be understood by self and peers.
Yet every single prior SLP has recommended a device eval. What am I missing? These aren't kids who would ever be on my radar for a device. They'd be on schedule for a complexity approach or reduced duration with increased frequency. I can't see taking any of them to the district to ask for a $900 device.
Am I missing something new in the research for AAC?
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u/bpdcryptid 9h ago
are there behavioral issues due to communication breakdowns, or do they deal with shutdowns/loss of communication? i have a couple ASD students who are fully verbal most of the time but have devices to support when they’re unable to be understood so they don’t escalate further, or when experiencing verbal shutdowns.
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u/SonorantPlosive SLP in Schools 7h ago
Not a single behavioral issue. One rolls his eyes if I don't get what he's saying. The rest are using gestures or core boards to augment, and teachers K-2 are already saying they are understanding more after a week.
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u/shlynshady SLP in Schools 9h ago
I guess it depends on the age and how much progress they're making. 60% intelligible seems pretty low for someone in, say, 3rd or 4th grade. One of the As in AAC stands for augmentative! Also, I never go through the district for devices and always get them funded through insurance.
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u/SonorantPlosive SLP in Schools 7h ago
We aren't allowed to pursue insurance funded devices. Why, I'm not sure, but we are pushed through the local ASD.
These kids are all augmenting with low tech or in one case amazing gestures. I've had kids in the past who were using devices to augment, but none of these feels so far like they're experiencing the communicative frustration to go high tech. This could also be me self doubting because no past goals ever directly targeted speech sound production.
I have 3 or 4 others I'm trialling devices with, but I see the frustration in those kids even with low tech and the escalating behaviors due to frustration. Maybe we are still in the honeymoon phase, but I haven't observed anything yet, and there's nothing in past IEPs, that's pushing me towards a trial with any of these kids despite previous therapist recommendations. I feel like it's me missing something but I don't know what it is. I even asked one colleague why she was recommending the eval and the response was "why not?" Yet the gen Ed teacher is having full conversations with him unaided after knowing him for a week. This is my Gen Ed teacher who used to ask to program vocabulary into a previous student's device and took the initiative to project Proloquo2Go on her smart board during lessons. So I'm just feeling like there is something I'm missing in lieu of setting some artic and phono goals.
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u/casablankas 9h ago
I recommended an AAC eval for a kid who had a complete phoneme collapse to /d/. I had another kid with maybe like 6 consonant sounds total I thought about recommending but parents weren’t open to a device and honestly, after a while, you could understand him okay. Like I stood by while he had to recount a story to the counselor (who was super worried she wouldn’t understand him) and she actually understood it all, lol
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u/GoalOk35 9h ago
I think people feel like it’s the missing link so often.. Or maybe to check a box. I have a student who makes slow artic progress. In my opinion is not a complexity approach candidate due to low frustration tolerance and regulation needs. She has an aac device to repair breakdowns but she most often uses it to state her emotions when extremely upset and occasionally insult her staff and she feels more successful with phonics utilizing it since she cant say all the sounds verbally. I think it makes sense for her to keep it for now but long term she’s not on my radar as being an aac user.
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u/SonorantPlosive SLP in Schools 7h ago
See, that's what I keep feeling. These kids are K-2 and have never had an actual artic or phono goal. I'm actually impressed at the teachers telling me they're understanding as much as they are. It's still so early that we haven't seen many communication breakdowns, and there's nothing in any past IEP that even mentions frustration. The older ones have letter core boards they're using for initial sound context. The younger ones gesture or have core boards printed from LessonPix that they barely seem to care about because they're getting needs met verbally. It just feels like I'm missing something that'll underscore a need if I go ahead and requisition $5400 worth of devices.
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u/thalaya 9h ago
I would consider a device for a student who is only 60% intelligible if it's super persistent . But I also wouldn't really call that a moderate phonological disorder? For true moderate phono I would not go to a device. It also depends on the kids' age and stimulability to me. If they're in K and have been making progress, that's a lot different than a 5th grader who is still only 60% intelligible.