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Is it ever too late for AAC? · AAC Access All Areas

• Ruth Jones: Hello and welcome to another episode of AAC access all areas. I am Ruth Jones. Ali Battye (she/her): and I'm Ali Bhatti and today's question is, is it ever too late to introduce AAC? So this came from one of our listeners, think, Ruth, didn't it? And we are trying to address those questions. Even if we take a while to address those questions, we have got your questions and we are coming round to them if we haven't addressed your particular question yet. But we both, we read out our list of questions and we both kind of went, ooh, we liked this one. Ruth Jones: Yeah, today felt like the day. Like this was one that captured both of our minds, I think, didn't it? think, yeah, we Ali Battye (she/her): Mm-hmm. Ruth Jones: can get into this today about AAC and age. Because I think we often see, or I feel like in my... via the, sometimes I think the vacuum within which I live around AAC, that I see a lot of older AAC users who perhaps fall under more of that physical disability, thinking particularly around cerebral palsy. I see Ali Battye (she/her): you. Ruth Jones: quite a lot of adults using AAC, but maybe we don't see quite as much of that with our more hidden disability, autistic. learning difficulties, learning disability clients and individuals that we support. don't know what you think. Ali Battye (she/her): Yes, no, I would completely agree with that, Ruth, because so I'm in the process of writing two books at the moment and nearly completing one, which is great. So just get one out of my brain is good. But for both of them, I was sort of like thinking, right, I'd really like to collaborate with some adult AAC users for this book. So one of them is specifically about neurodiversity affirming AAC. And one of them is, it's the second edition to my first book, which was Who's Afraid of AAC. So that was very much geared towards the diversity of the AAC population. And I know loads of adult AAC users who have cerebral palsy or similar conditions. So, you know, they might be in a powered wheelchair and have a mounted device and that's how they communicate. So I could automatically like think of like 50, 15 or 20 people in my sort of like network, AAC World Network, that can contribute with that positionality of having physical disabilities and maybe sensory disabilities alongside communication disability. But when I was thinking about my neurodiversity affirming book, There are quite a lot of AAC users in the autistic world, but I would say a lot of those have come to it late in life or they are part-time AAC users. And I was really wanting to sort of like capture the experience of someone who'd used AAC from early on in their life as well. Cause I do think that is quite a distinct identity. And I was very fortunate that I have been able to collaborate with an absolutely amazing AAC user and she has been able to tell me about like her introduction to AAC and interestingly that was in her teens for robust AAC. So yeah I would say that there aren't so many role models for full-time AAC use. We might be corrected hugely I mean if you are out there and you are a full-time AAC user and that was introduced to you as a child. Please do get in touch with us because we'd love to hear from you. We'll maybe have you as a guest on the podcast. But I just don't feel as though it is such a well-known identity and there aren't so many people out there. Gosh, that was long-winded. I'm so sorry, everybody. We're at the end of term and my language processing is sort of like on the floor. So I'm taking a very long time to say what I need to say. Ruth Jones: I was listening intently and I agree and I think what's really interesting isn't it is when we think about autistic communication identity we have non-speaking which I think most people can kind of bring to the mind you know or minimally speaking and interestingly Harriet and Kim have just written a new book semi-speaking as a communication identity and I know that Harriet who is at Hatt Talks on social media identifies as a semi-speaking autistic adult and uses AAC in that part-time way, don't they? And I think when I think about a lot of the families and children that I work with, are families and children, or the children are non-speaking, Ali Battye (she/her): you Ruth Jones: quite high support needs in the sense that they're in specialist education or they're accessing resource base or they're on a... alternative provision, education other than at school, packages and I feel as though there isn't necessarily, again like you say, there must be people out there but we're not kind of seeing them and part of me really wishes it was within our professional boundaries which it isn't but to keep in touch with children I've worked with years ago you know who were older children. and wondering like where are they at now with ASC Ali Battye (she/her): Yeah. Yes. Ruth Jones: use because they were children who did have super complex needs. They were living 52 weeks of the year in a residential special school. So we're talking about quite complex profiles that that was the best environment for them. That was the safest environment for them to learn and develop. I think, wonder like what Ali Battye (she/her): Hmm. Ruth Jones: kind of things, where did that go? And I think ultimately the answer to the question is... it's never too late to introduce AAC in a robust Ali Battye (she/her): Yeah. Yeah. Yeah. Ruth Jones: way. And if you have a child who is older or teens and adults where perhaps even when they were younger, iPads weren't as accessible, they didn't Ali Battye (she/her): Yeah. Ruth Jones: exist or the tech was so expensive or even access to charities and benefits to support older children and adults getting access to technology was available that is now, it's not too late to start learning a new language. Ali Battye (she/her): No, absolutely. There's no ceiling to language acquisition. And I think it's sort of like a bit of an urban myth that gets... put around that brain development stops at like 25 years old. And that was, that's just like a misinterpretation of a study that looked at people up to the age of 25 and found that their brains were still developing up to the age of 25. But it didn't, it wouldn't have stopped overnight there. So our brains continue to develop and change. Otherwise we wouldn't ever learn any new skills. So, you know, are what have I learned to do? I am doing strength training now. I'm kind of like doing Zumba. So my brain is still learning new skills now. And it's the same for language, like people learn second languages when they're older. I think we often say, oh, it's so much more difficult to learn a language when you're older. And I don't know whether that is true or not, or whether it's just because if you're learning a second language when you're older you're not like totally immersed in the environment. Whereas if like say you move to a country and you are learning the language you're hearing it all the time. I wonder whether you would actually pick it up as quickly as a child who's going to school and hearing that new language all the time. That's the wonder. I don't know what the answer is. But this has come up in my learning around Gestalt language processing because there did used to be this idea within speech and language therapy that there was sort of like a window of development for grammar especially and that if a child hadn't got sort of like grammar skills by the time, I don't know what age it was, seven or eight, then they wouldn't get grammar skills. And that sort of came from like these really one-off type studies of children who had been found living alone in the forest. And then I think that got like overgeneralised to all children. But what I have found in my work with Gestalt Language Processes, there's definitely no upper limit to grammar acquisition that those older children and teenagers and adults who have sort of been started to be supported with understanding their Gestalt Language Processing is that suddenly their language starts to grow and change. and they can acquire grammar in their late teens, early twenties and who knows beyond, probably beyond that. So that's really reassuring to know that language continues to grow and develop. We all learn new words, don't we? I'm sure I've learned a few words this week. I can't bring any to mind, but I'm sure I have. So there's no reason to think that a child wouldn't be able, a young person or an adult wouldn't be able to and take to AAC later on in life. Ruth Jones: Yeah, and I think it's interesting what you were talking about there is, you know, this idea that the brain stops developing like at 25 and a lot of that research is around just the frontal lobe, isn't it? And actually that's not really the language areas of the brain anyway. And Ali Battye (she/her): Yeah. Yeah. Ruth Jones: when we think about development and how we... kind of challenge developments in the systems, in the research that so often research will be done and it gets shared, people take from it quite often what validates their perspective. Ali Battye (she/her): Yeah. Ruth Jones: And if they have a voice and a platform to then share Ali Battye (she/her): Thank Ruth Jones: that research that backs up their perspective, quite often that's where these myths can start to form Ali Battye (she/her): Yeah. Ruth Jones: because it's maybe one piece of research that if you look at it, We learn, don't we, in speech therapy when you're training about critical analysis. So when you're looking at research, you're looking at maybe how many participants, what was the breadth of that participation, you know, what's the different positionalities and intersections that people within that are coming from? Like how was the research conducted? environment, you know, you do all of this stuff and you take from it bits and pieces. And it doesn't necessarily mean you just do something or don't do something. It's part of a clinic. called thinking isn't it really of weighing up the information and so I think when we think about language learning as research but also what we know is true from being people and living as people is that you know Ali Battye (she/her): Hmm. Hmm. Hmm. Ruth Jones: our brain constantly is forming new connections and Ali Battye (she/her): Yeah. Ruth Jones: learning how to do new motor planning activities like your Zumba, learning new words and I'm thinking a lot about the learning that we're doing at the moment about anti-racist practice and the new vocabulary that I've had to try and get my head around words I'd never heard of you know and so I think we are always learning new skills and actually if we think about older AAC users there's a the term is kind of neuroplasticity and this idea Ali Battye (she/her): Hmm. Ruth Jones: that brain change and shift and grow and form these new connections is that kind of research tells us alongside our lived experience of knowing that we all are learning new things, know that old phrase every day is a school day. applies to our older AAC users. So if you have Ali Battye (she/her): Yeah. Ruth Jones: got, you know, an older child, yes, lot of what we see and capture and talk about can often be introducing it in early years or kind of in primary school, but just because nobody's thought about it for your child or just because they haven't had access to it, it doesn't mean they don't have capacity to use it, which I guess brings us back around to that concept of presuming potential. Ali Battye (she/her): Yes, yes, yes. And I would say, like, I'm just drawing on my previous experiences of introducing high tech AAC to teenagers, which I don't particularly, I do have a couple of children who are growing into teenagers on my current caseload. But I have tended to take on younger children recently. But in my previous role in a regional AAC assessment centre, service went up to 25 and so I was often working with teenagers and they actually would be the most joyous to introduce AAC to later in life because they already had a lot of internalised language and were just waiting for the tool that would allow them to share that language. some of them had literacy skills. so they would straight away be able to use text to speech, which is amazing because that does allow you to just express what you want, when you want, make up new words, be able to use the grammar. You've just got unending potential, limitless possibilities if you can use text to speech. But those young people who maybe were needing that symbol support, they already had all of the language concepts and all the knowledge of the world. So we would sometimes put an AAC device in front of them and they'd just go with it. They already had the experience of using iPads or similar devices. So they very quickly got the hang of navigation, of going into different topic folders, going back, using the backspace and the delete buttons. And so it was sometimes just a question of putting it in front of them and letting them explore it. And then, you know, like the joy of seeing what came out of that, like being able to share what was in their heads when they'd gone for a lot of their childhoods without that. I would say it was a part of a favourite part of my work, actually, sometimes with those older teenagers. So, yeah, I think That would definitely be something that I would be keen to share with people. It's just never too late, even if a child hasn't had access to AAC earlier on in their childhood. Ruth Jones: think almost once you've got children who are slightly older, things like their regulatory strategies are better understood Ali Battye (she/her): Yeah. Ruth Jones: and deployed when needed and things like hormones might have settled down a little bit. There's a lot of physical growth and development that may have happened for a child Ali Battye (she/her): Yeah. Ruth Jones: and then if at 15, 16 you're introducing AAC, sometimes just age brings them to a place where that is a really good time. and you find that they perhaps pick it up faster than they may have done or than others may have done when they're younger. I would still absolutely advocate for early access because the sooner the teachers start Ali Battye (she/her): Yes, yes. Ruth Jones: the better. So that's not to say wait but I do think if you're on the fence over is it too late there is there are kind of like experiences that children have had through childhood that as they're coming into adolescence sometimes, yeah, they're just, they're in a different place, hormonally, physical development, their regulatory development that does create a different vibe and a different space for them Ali Battye (she/her): Yes, yes. Ruth Jones: as communicators. Ali Battye (she/her): Yes, and executive function is developing as well, isn't it? you know, like the ability, I always struggle to define executive function. So forgive, again, my garbled language with this. But executive function is things like being able to control what we are attending to, deciding which is most important in this moment, deciding on the next action that is needed, sort of like coordinating your response to different sensory inputs. Have I missed any Ruth? you think of any other exec? I mean, I know there's loads that I haven't covered there in terms of executive function. Ruth Jones: Yeah, generally like planning and organising whether that's for events, for tasks or you're kind of organising of structures of things. I always think about working memories, that ability to hold something Ali Battye (she/her): Yeah. Ruth Jones: in mind and manipulate it. Emotional regulation I think you've talked about. I feel Ali Battye (she/her): Yeah, yeah. Ruth Jones: like you've got a good list there. It's a lot isn't it? Ali Battye (she/her): Yeah, I've probably forgotten a few, but you know, if you're listening in your car or at home, add your own in there. But our executive function does sort of like develop through childhood. And so if you're working with a teenager, the likelihood is that their executive function skills are more sophisticated than they were earlier on in their life. So you may well find that attention is sort of stronger, that they are able to focus more And maybe, not necessarily, but maybe they're less into that sort of like physical play type stuff and more able to, not that we need them to like sit down and concentrate, but they may just be naturally doing that and have an extended attention for just exploring. Interestingly, I am finding this with some of my AAC users that I've been working with for two or three years. There is a marked difference now for many of them in terms of their play in that I'm just thinking of one child that I've seen this morning in particular, that her attention was like, you know, very flitty in the early days. I would sort of like be moving around with her and she'd move from one activity to another. And I was sort of like going with that and modeling language accordingly. But now, like this morning I've seen her and we had a 45 minute session and I would say for a good 30 minutes of that session we were looking at You Choose which is like one of my favourite books. love You Choose if you're not familiar with You Choose it's just like the best book for a speech and language therapist because on each double page spread it's like got a different category essentially so if you could go anywhere where would you go and it's got a lovely like really complex picture of like the mountains, the seaside, the city into space to a theme park. And then it's got a page for if you could have any pet, what would you choose? And it's got some, you know, like wild and wonderful pets and then the food page. So she really loves the food page. So we spent probably half an hour looking at the food page and there is enough to look at on that food page. But in terms of her executive function of like, no, I really want to focus in on this page. And she was also able to be following what I was modeling on her AAC device and responding to what I was modeling as well. if I was saying, look, there's trifle there. And then I was modeling, I think it tastes delicious. And then she was responding to that. She might have, you know, like said, sweet. or then gone back to the food page and back to desserts and she might have then said gingerbread man or something. So she was very much able to sustain that conversation for one activity as well. Again, very long-winded way of saying that her executive function skills have developed enormously. Possibly in line with language and AAC, you could perhaps argue that AAC has helped with those executive function skills. But yeah, that is the joy of following children through that long-term journey that you really, when you compare them with this time last year or this time two years ago, it's amazing. We often think that children are going to be like they are forever and the difference that a year makes is incredible. Ruth Jones: Yeah, it's interesting. I work with two AAC users that I'm holding in mind that are older, 13 and 15. And they've had AAC for a long time, but they're just sort of getting the therapy input to really enhance it. So they're kind of those kids where they were able to get a device, they've got a device, and then nobody really knew what to do with it. it's kind of been around and you know they're very good at requesting and the team around the child had practiced building sentences for requests and what they could see and all this sort of stuff in that very education based way but I've come in and thought about it more in that affirming, joy, child-led way and one of them in particular we spent a lot of time they loved the minions and like real slapstick humor stuff and Having seen them when I first started working with them, which was a few years ago to now, they're still, I would say, a part-time-ish because they have, they don't have spoken language, but they have like gesture and lots of articulation that they use with their whole body to communicate what it is that they're thinking about. But their capacity to switch between what we're doing and the AAC device and their tracking when I'm modelling and when I'm now noticing and adding new vocabulary to their device and phrases, know, so things like, that's hilarious on the phrases page to do with their leisure and TV watching, those sorts of things. They just have more to say, they just feel, Ali Battye (she/her): No. Ruth Jones: it just feels like there's a sense of humor that's developing in a different way, there's an elongation of conversation that they're enjoying that they didn't before. So I think there is something about it and thinking to the other young person that I work with who is, gosh, I think about going to year 10 or 11 now, in a special school environment, they are developing their typing skills, but they're not just requesting things, which is kind of what they were doing when I first started working with them, that they're commenting, they're using their AAC Ali Battye (she/her): Okay. Ruth Jones: to ask questions and understand responses. And I think part of that is because of that to regulate and think that just comes with age and comes with Ali Battye (she/her): Yes. Ruth Jones: development. And so I think there is, know, the short answer is, is it ever too late for AAC? No. And I'm thinking about Ali Battye (she/her): Yeah. Ruth Jones: our glimmers that we sometimes bring to it. my... thinking about glimmers that link to the theme of an older AAC user and I'm thinking of historical children that I Ali Battye (she/her): and then. Ruth Jones: worked with and I may well have talked about this particular example on the podcast before but there was a young person I was working with who would have been 16 I think and had had pecs. their whole life, know, so were very good at I want taking the sentence strip, they'd sort of tap each symbol and vocalize a noise as they tapped each symbol. And we got them, they don't even exist anymore, but an iPod touch with prologue to go on and... we used to do lots of programming to basically put their pecs book onto proloquo to go with some of the other vocab that was there. And now I know better, I would do better and do things differently. But they were at home and they kind of verbalized a sound that their family knew to mean a type of juice. And because the family had just got the iPod at home for the first time, when that child had gone back for a visit home, they were like, you know, show us in that way that we, you know, think about like prompting and again, now I know, would I recommend that? Maybe not. However, what then happened was this child then said, I want a different kind of juice to the one that mum was going to get. And it was just like, wow, we hadn't really done much teaching. We hadn't really Ali Battye (she/her): Mm. Ruth Jones: done much support. And it wasn't a complex thought that they were sharing, but they were 16. And for 16 years, every time they've made that sound, they've patiently been given the cup of juice that the family thought that that was what it meant and the power to be able just to ask for Apple instead of Blackcurrant. you know, the those moments. And actually, and I'm going to have another one while I'm at it and I'm reflecting and thinking back on what I worked with. Ali Battye (she/her): Or do. Ruth Jones: another child who had an iPad mini. and we got it in place and I remember we were sat at sports day, it was the last day of term and some of the children that I worked with in the special residential school were 38 weeks so they'd go home for the school holidays. This particular child I was sat with their parent, they were actually on my knee and they had their device, I mean they were 15 I'm gonna say, maybe a little bit younger, maybe 13 and they said... they were looking through and they were using an app called SonoFlex. I don't think it even still exists, but Ali Battye (she/her): yeah. Ruth Jones: they were using that and they said car and home. And I looked at this child's mum and this mum looked at me and we both just like, I can feel myself welling up now. It was just one of those moments where you're like the power of having access to words that they just hadn't had. And their mum Ali Battye (she/her): Yeah. Ruth Jones: was like, they've never asked to leave anywhere before. And this child was so passive. so prompt dependent to the point where they would pause over a chair and wait for someone to tell them to sit down because they were dependent on prompts so heavily for them to spontaneously ask to go, even though sports day wasn't finished, literally the mum was like, right, we're off, and like galloped out of the building, like we're going, let's take this advocacy that this child suddenly had. And Ali Battye (she/her): Yeah. Ruth Jones: that, think for me, those experiences I had. early on in my career with introducing AAC to children who'd only ever really had pecs, who'd only Ali Battye (she/her): Mm-hmm. Ruth Jones: ever had the limited number of pictures that were in that book, proved to me from probably a very early stage that it's never too late. Ali Battye (she/her): Yeah, yeah. And that's that's made me think as you were talking of, so there's a couple of young people that I used to work with in my old role that go to the same school as I currently go into in my independent role. And so I just see them on the corridor sometimes. And these two particular ones were both you know, as I described earlier, you put the AAC device in front of them and they just went with it straight away. And both of them started typing very quickly. had a symbolized, they both had symbolized packages, but they chose to move to typing really quickly, which is a joy. if that child is developing good literacy and spelling, they automatically sort of transition to typing because they soon find that it's faster to type things and they can express the sort of like nuances a bit better with typing than sort of like clunkiness, I suppose, with symbols. There can be a bit of a clunkiness if you are using symbols alone. If you don't have any pre-programmed phrases, it can be particularly clunky to just go word by word. But I see them regularly now in the corridors and they've always got their AAC devices with them and they're often typing as they're walking and it's just so lovely to see them now that that is so much part of them, part of their identity. And then another glimmer that I wanted to share is just around having conversations through AAC. So I've been thinking a lot about what AAC can add to that sort of just general acquisition of language and how sometimes we're using AAC as a sort of tool for exploring the world a bit more. So this week I did a home visit with a child and we just accidentally on the space page and we've never been on that space page before. So I just modelled like a few words from that space page like moon and stars and we looked up in the sky and we couldn't see the moon or the stars so we talked about at night we might see it and there was a symbol for telescope so I could model or we can look at them through the telescope at night and then this child was like pressing all of the planets and so I was able to say they are all the planets in the solar system and it was just a way of like sharing information about a topic that he was really interested in and I just know knowing him that when he next stumbles across the solar system on YouTube or in a book or on TV or whatever he will now have a reference point in his AAC and kind of already know something about that topic and then be able to relate it. So I think I've been thinking about that a lot that AAC is like just such a good language builder sometimes of just going into new topics and just having a chat about it. I can think of another child that I used to support where he would go into his animals page and just systematically press one button, say orangutan, and wait for me to give some information about an orangutan. So I'd say something like, I orangutans. of tongues, they swing through the trees, they've got really long arms and then he'd press like Gibbon and I'd say, oh Gibbons are really loud, they sing and I've heard them at Port Limb and that was absolutely delightful for him. He was just using that page as, give me the knowledge, tell me what are your experiences around these animals and he would remember it for next time and refer to it the next time. So yeah, that would be another my little glimmers this week just having a chat and using those pages of the AAC to have a lovely chat. Ruth Jones: It's that thing, isn't it, about seeing communication in a really broad way when we think about AAC. Ali Battye (she/her): Okay. Ruth Jones: It isn't just about that request. It's about where can it take you for interaction rather than just that transaction Ali Battye (she/her): I love you. I love you. Yes. Ruth Jones: of like you give and you get actually that genuine interaction, isn't it? Ali Battye (she/her): Yeah. Yeah. Ruth Jones: So today is our last session recording for this. We weren't going to do seasons, but the natural break in the academic year and the fact that we are off over summer feels like it's kind of leaning into this being the last episode of season. Yeah, I feel like we maybe should have thought about that and done something. No. Ali Battye (she/her): season finale. No dramas, no cliffhangers here though. Ruth Jones: But we are going to be starting recording again in September in the new academic year. So if people are listening and have got AAC questions, even if it feels like it's something really small, please let us know because we can add that to our list. And we're also hoping to probably over the next season start to bring in, if we can get it in the diary, bring in some other people to join our conversations, AAC users, families, AAC users and maybe some specialist teachers and specialist AAC teachers as well. So if you listen and you're interested in what we do and you fancy coming on for a chat then also please do let us know. We just want to keep the conversation going really about AAC and how incredible it is. Ali Battye (she/her): What a lovely way to finish. Ruth Jones: Yeah and we will wish you all a lovely summer and we will be back again in September chatting all things AAC. Ali Battye (she/her): lovely. Thank you Ruth, it's been a joy. Ruth Jones: it really has. I'm going to miss it over the summer time. So I look forward to September. Bye. Ali Battye (she/her): Bye bye.