Learning Language, Literacy, and Communication

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Augmentative Communication: Teaching Language, Literacy, and Communication to Children Who are Nonverbal or Minimally Verbal

Jennifer R. Mitchell, SLP.D., CCC-SLP Speech-Language Pathologist


Table of Contents


The Basics of Communicating....................... 3 Cognitive Skills.................................................... 7 Visual Symbols...................................................11 Visual Literacy....................................................15 Communication................................................18 Language............................................................22 Literacy.................................................................25


The Basics

Every communicative act has three components, content, form, and use. These three areas are based on the language model developed by Bloom & Lahey in 1978. By expanding the model, we can include language, literacy, and communication.

Three components of communication An effective communicative act includes three areas: • the content/meaning of the message, • the form/symbol for the meaning, • and the use/function or intent of the message.


Content Content Form Use Use

Content is the meaning of the message.


It is also referred to as semantics.

For example, “cookie� is something you eat and is usually sweet.

Form is the structural aspect of the message that refers to the symbol attached to the meaning. The symbol can be a spoken word, a picture, an object, or a sign. The form/symbol is effective as long as the communicator and listener both agree.

Use is the purpose, function, or reason for the communication. It includes pragmatics and social communication.

5 How does the child learn to attach meaning to a form? By repeated and consistent repetition.

How does the child learn to use the form for communication? After repeatedly receiving something positive to reinforce the interaction.

When is the child ready to communicate?

At Birth

At birth, infants begin learning how to communicate.


Students with significant disabilities communicate when they are happy, sad, or uncomfortable. Adults have the responsibility to attach meaning to a child’s... vocalization, movement, or facial expression.

When a young child reaches up towards the adult, we attach meaning by lifting the child up, saying “up you go”. We can do the same with different types of movements from children with disabilities. Communication can be powerful so teach the power of communication.

Behavior is communicative. Many times the child’s inappropriate behavior was unsuccessful communicative attempts. When completing a communication sample, behavior should be analyzed using the content/form/use model. Once the missing component is identified, it can be taught and may well lead to successful communication and appropriate behavior. The goal is to determine what the student does to communicate and what is missing when the communication is unsuccessful.


Cognitive Skills Research indicates that cognitive skills develop parallel with language and communication skills. It may be beneficial to work on cognitive, language, and communication skills simultaneously.

The cognitive skills that may develop with language and communication include object permanence, means-end, cause and effect, and imitation.

Therapy Techniques for Object Permanence: (Understanding that an object still exists even when not in view) It’s always good to start with noisemakers (wind up music, tape recorder, radio, or even the TV!). Cover the noisy item and then encourage the child to find it.

You can also cover your face while talking or singing to the child. Encourage the child to reach and take off the covering to see where the noise is coming from.


One of the oldest games to encourage Object Permanence is the blanket over the toy trick. Start with something the child likes and wants. Put it in view and then cover it with a blanket or towel. Using the child’s elbow, help her/him to knock the cover off the toy.

If you are using small toys or candy, place it in the palm of your hand for the child to see, then grasp the object and turn your hand over. This game is similar to “Which hand is it in?” just always have the child win by reaching for your hand to get the object. As soon as he/ she reaches, turn you hand over, open it, then give the object to the child.

Therapy Techniques for Cause and Effect: (Understanding that an action will cause a reaction) The sensori-motor skill of cause and effect begins at birth. When the infant is hungry and cries, nurishment arrives or if they want to be held they cry and someone will come to the rescue. In the first few months the infant begins to understand the cause and effect relationship. Although research has not determined that cause and effect is prerequisite for communication, most children have developed cause and effect before 12 months of age.


The best way to teach this skill is through play. Each time the child does a repetitive action like hiccup, clap their hands, or hit something with a hammer, then you should do something silly (jump around in a circle, stand on your head).

Therapy Techniques for Imitation: (Understanding that actions and sounds can be imitated – what you do, I can do)

A fun way to start this activity is to copy the child. Whatever the child does, you do. Do it in short spurts and always have fun with it. Never imitate in a mocking way.

Another way to encourage imitation is with noisemakers. You bang the drum, then give the drum to the child and let him/ her bang it. Use with a variety of noisemakers, then move to imitation without an object (clapping hands, making silly faces).

Therapy Techniques for Means End: (Understanding that you can use a tool to reach an item that is too far away)

For children who are physically mobile, when they can’t reach something, get a chair for them, help them to stand on the chair and reach what they want.

For children who are not independently mobile, you can put a wanted item in view, but out of reach. Velcro an extension to their wrist and encourage them to pull the item to them.

For beginners, tie something special to the end of a rope and help them to pull the rope toward themselves to reach the object.



Visual Symbols A symbol can be an object, picture, written word, sound, or even a marking that represents something else. The meaning is agreed upon based on association or resemblance. Our world is full of symbols that have meaning to many individuals.

Examples of symbols:

International Symbols Religious Symbols


There are also logos and icons that have meaning.

Business Symbols



When you are introducing pictures for communication use a graphic that resembles the item. Picture communication symbols made with BoardMaker are simple line drawings. If the printed word is not under the picture symbol, then it is difficult to determine what the picture represents. For example, here are three pictures. Which ones do you understand best?

Does the child understand what the picture is supposed to represent?

When teaching a child who is non verbal or minimally verbal to use an alternative format of language other than speech, remember to keep it simple. Use the same steps as you would if they were going to learn to use sign language. This means that if you want the child to point to a picture to communicate, then you must model by pointing to pictures to when communicating to the child.

When we teach children to talk, we talk to them. When we teach children to use sign language, we sign to them. Children are natural imitators and providing a model for them is imperative.

What type of symbols should we start with?


If we follow normal child development then the following hierarchy may be a place to begin. Gestures with an object – in context • • • •

Holds an empty cup out to an adult with a milk carton to request something to drink Pushes a plate with vegetables away to reject something While playing with blocks, holds a block out to the adult to request help to build Brings a book to an adult to request read

Gestures without an object • Points to objects to request • Holds hand out with palm up to request what other person has Photographs • In addition to a photograph, another technique is to cut out around the object which will give the shape information, usually referred to as TOBIs (True Object Based Icons) Detailed graphic

Line Drawing

• This would be similar to detailed clipart or cartoon drawing • Stick figures


• scale model to represent larger object


• Formal sign language


• Uses verbal words to communicate meaning

Keep in mind that skills will overlap and not be replaced by preceding skills.

TOBIs (True Object Based Icons) TOBIs - “True Object Based Icons”. TOBIs are usually larger than the normal two-dimensional picture and are cut out in the actual shape of the object. The symbol and shape are thought to give the person additional information for understanding.



Visual Literacy

Visual literacy is the ability to interpret, negotiate, and make meaning from information presented in the form of an image. Visual literacy is based on the idea that pictures can be “read” and that meaning can be communicated through a process of interpretation. Visual literacy is the ability to evaluate, apply, and create conceptual visual representations.


We fill in the missing gaps.

We “see” the glass of orange juice behind the carton.

16 Matching by Similarities

We pair items by similarity.

We identify the silhouette.

Matching by Association

We determine pairs that go together.

We identify an object and it’s purpose.

17 Matching by Patterns

Determining What is Missing



Give as many choices as possible throughout the day. If you don’t have pictures, use the actual objects. If the child is a beginning communicator, attach meaning to movement. For example, when dressing, hold up two pairs of pants and ask, “Do you want the green pants or the blue pants?” If the child looks at the green pants, then say, “Here are the green pants” or if the child reaches toward the green pants, say “you must want the green pants”. Once the child is communicating, you can start using non-linguistic representations (pictures).

Basic communication can be used and encouraged throughout the day. For example

When reading books, hold up two books and ask, “which one?”. Once the child can communicate his choice, you can use pictures. Take digital pictures of the book covers to use on a choice board. You should also take pictures of the characters in the story so when you ask “wh” questions you have a means for the child to answer.


Many children have their favorite movies, TV shows, and songs. Place two representational pictures in front of the child and point to the pictures as you ask, “Would you like ____ or ____?”. If the child looks

at his choice, give the picture as you say the label and then give the child the object requested. As the child begins to communicate, add more choices to the category (TV show, movie, song) from which to choose.

When getting dressed in the morning, give the child the option of color to wear. The adult should point to pictures “what” + “color” + “shirt”? while verbally saying the words. If using a device with voice output, then repeat the phrase after the device says it. (It will only help the child to hear it twice.) Then have a color display for the child to indicate what color he/she prefers. OR…Point to the pictures “shirt”+ “color” + “red” + “blue”? The child should then have an opportunity to indicate “red” or “blue” by using the same pictures the adult used.

Additional opportunities for choices include:


breakfast items “eat” + “cereal” + “bagel” and the child points to cereal or bagel TV: “watch” + “Sesame Street” + “Dora” the child points to choice School Choices: “sit” + “window” + “door” read” + “book” + “CD” for hard copy book or digital book “write” + “worksheet” + “whiteboard” “play” + “blocks” + “legos”? If you are using pictures to help someone learn to communicate, it’s OK to practice. When you practice, try to keep it fun and motivating. One technique that I have found successful is to use a puzzle with separate pictures of each of the pieces. Give the child a choice of which piece they want to put in the puzzle. Here’s how: Scan the puzzle Print the pictures of the pieces, cut out, laminate and put on display board (I use a clipboard with tempo loop on the back) Put the empty puzzle in front of the child, hold up the display of pictures and ask, “which one?” The child takes off a picture, hands it to you in exchange for the corresponding puzzle piece. The child may need a physical prompt to begin. Continue until all the pieces have been placed in the puzzle. Use puzzles that are category based (food, animals, ABCs, etc). Make a communication board with picture symbols that represent each piece. Make another board for yourself with picture symbols that represent your questions (“Which puzzle?” “Need help?” “What piece?”). Use your board to ask and use their board for the response.

Learning to Make a Choice


Use the three different cups or half nesting eggs and play “which one?” Invert them and put a sticker or fortune under one. Mix them up. (This is the fun part, so play around a little.) The student gets to choose one. If you make them different colors, then they can label the color for the choice. Let the student continue guessing until the right one is picked. They get what’s under the cup. Have a scavenger hunt. Let your student find the sticker, certificate, or just a treat. Make little slips of paper and write directions on them or code them using picture symbols. This game is especially useful if you are working on prepositions or attributes, but don’t feel like you have to “work” on anything. You can teach prepositions, attributes, and vocabulary by playing. (For example, “Look in the back of the blue book.”)

Dance and play music. Pick 4 or 5 types of music (opera, rap, dixieland, reggae) Play a sample of each and talk about the characteristics. Then play a sample from one of the categories you introduced and see if the student can guess what type of music you are playing. It’s a great, fun way to learn new vocabulary and categorize. Especially good for older students.



A child’s language is based on experiences. Engage the child in new language experiences as often as possible. It’s a great opportunity to teach new vocabulary and symbols.. Take a nature walk and collect different leaves. Take the leaves back home and talk about Pack a lunch and go on a them. picnic. When you get home, write about it, together, in a Color together in journal. a coloring book or get a pad of paper Go to the public library. and draw pictures of each other.

Bake cookies, cupcakes, or a cake.

Sew up a beanbag and throw it different ways at different targets. Get some chalk and draw pictures on the sidewalk.

23 All About Me Book

If you want to get your child’s attention then try a photographic “All About Me” book. Any pictures will do. You can try a few posed or by surprise. Start with about 10 pictures. Place them in a photo album. Write a word, phrase, or sentence under each picture. You can also target objectives (pronouns, verbs, grammar, or articulation).


Children can learn just about anything using photographs of themselves. It increases their interest and motivation by being active participates in the process of making the pictures. Wh-questions. Take pictures of classmates, teachers and staff, family, friends. Ask “who” questions. Take pictures of the child doing things, then when looking back over the pictures, as “what are you doing?” and you can also ask “where” questions. Sequencing. Great activity for the playground, art, music and other special events. Take 3 to 4 pictures and let the child sequence and talk about them. A good example is using the slide. Take a picture of the child going up, sitting on the top, then going down, and one standing or sitting on the ground below the slide.

Prepositions. Get the children under, on top of, behind, between different objects (furniture or outside playground equipment to take photographs. You’ll be amazed at how quickly they learn prepositions.

Verb tensing. Capture photographs of the child in various activities, then work on past tense when looking at the pictures together.


Literacy Teach phonological awareness skills using visual prompts and voice output devices. Here are some ideas for segmentation and blending: Collect five objects with labels that include two syllables (e.g. ap-ple, puz-zle). Record each syllable of the target word on a different switch. Press each switch, placing a definite pause between the syllables, to hear the word. Repeat the word with a smaller pause while pushing the switches closer together. Ask the student to identify the word by showing the object or picture. When the word is identified, push the two switches together, press, and repeat the word.

Using an All-Turn-it Spinner, customize the overlay with phonemes. Choose a target syllable rime that forms words using the phonemes on the overlay (e.g. at, ook). The student selects a phoneme by activating the All Turn it Spinner. The teacher says the word created and then the student demonstrates comprehension by matching the new word with a picture or object.

Use classic stories (3 Little Pigs) or repetitive stories (Brown Bear, Brown Bear) and leave out key words. Let the children fill in the missing words using a picture symbol or voice output device. When reciting nursery rhymes and fingerplays using picture symbols, leave off the ending picture symbol and let the children fill in the blanks.



by Natalie Hale

Read the book, Spaghetti! by Natalie Hale. If student is a beginning communicator or nonverbal put one or two of the following words on a Voice Output Device (VOD): spaghetti, yes, and no. For the first day, the adult reads the book and uses the VOD for the target words to provide a model of instruction. Make the VOD accessible to the child and on day 3 or 4, encourage the student to “help” read by using the VOD. Language Concepts and Academics: Using spaghetti noodles and multimodality strategies, teach hard, straight (uncooked) and soft, curved (cooked). Each student gets ½ cup each of cooked and uncooked noodles. Encourage the student to taste each one, pull one, break one, wiggle one, etc. Other language concepts to target with multi-modality strategies include more, less, short, and long. Art: Using cooked and uncooked spaghetti noodles, emphasize the language concepts hard, straight, soft, and curved while making pictures. For example, make a tree using the hard noodles as branches and the soft noodles as leaves. Change the verb: (Use a picture or gesture for the verb) Do I blow spaghetti? Do I bounce spaghetti? Do I cook spaghetti? Do I climb spaghetti? Do I throw spaghetti? Do I color spaghetti?




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