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Intro
Why Language Development Matters in AAC
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Intro
Kate Grandbois: Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy
Amy Wonkka: Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each
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Kate Grandbois: Welcome to SLP Nerdcast everyone. We are very excited for today's episode. We've We're already laughing. It's going to be a really great episode today. As most of our audience knows, Amy and I have worked as AAC, quote, [00:02:00] AAC specialists for the majority of our career.
And we are here today to talk about this topic, AAC, which is a real passion of ours. And we are here with two researchers and content experts, Dr. Kathy Banger and Nancy Harrington. Welcome Kathy and Nancy. Thank you
Cathy Binger: Thanks. It's great to be
Amy Wonkka: here. Thanks very much. Glad to join you. We're so excited for this conversation.
Um, we had, we had some really nice chat before we hit the record button. Um, but for those listeners who aren't familiar with your work, uh, you're here to discuss AAC and developmental norms. And before we get started, can you please just tell us a little bit about yourselves?
Cathy Binger: Nancy, why don't you start us off.
Nancy Harrington: Okay. Um, I am a speech language pathologist, um, clinician and a researcher, um, from the University of Central Florida. I have been, um, working in the AAC field [00:03:00] for nearly 40 years. I started my career in New York, um, and also worked in Ireland for about 20 years and have been at UCF since 2013, where I was very happy to join the research team of Dr.
Binger and Dr. Kent Walsh. And we've got a lot of exciting stuff going on.
Cathy Binger: Great. Thanks, Nancy. And I'm Kathy Binger. I'm at the University of New Mexico, where I'm a professor. I'm also an SLP, and I want to make sure we give a very firm and loud shout out to Dr. Jennifer Kent Walsh, who's working at the University of Central Florida with Nancy, um, who's also, we're going to be talking about, um, her work as well, because it's all of our work together.
So, um, yep, she couldn't be with us here today, but she's with us here in spirit. So,
Amy Wonkka: shout out to Dr.
Kate Grandbois: We're so [00:04:00] excited to get into everything. Um, for our listeners who are not aware, we actually have. hosted, um, Dr. Bringer and Dr. Kent Walsh on the show before to talk about AAC and language development.
Today's episode is definitely not a replacement of that. It is very much an extension of that, but if anyone's listening and would like more information about AAC and how it intersects with language development, we will link that episode in the show notes as well. Uh, before we do get into the good stuff, I need to read our learning objectives and financial disclosures.
I will try and get through that as quickly as I can. Learning objective number one lists three reasons to use a developmental model in planning AAC intervention for children. Learning objective number two, describe aspects of a developmental language framework when planning AAC intervention. And learning objective number three, describe the benefits of ensuring access to both core and fringe vocabulary for aided [00:05:00] communicators.
Disclosures, Cathy's financial disclosures, Cathy is employed by the University of New Mexico and has funding from the National Institutes of Health. Kathy's non financial disclosures, Kathy is a member of ASHA and Special Interest Group 12. Nancy's financial disclosures, Nancy is employed by the University of Central Florida and has funding from the National Institutes of Health.
Nancy's non financial disclosures, Nancy is a member of ASHA and ASHA's Special Interest Group SIG 12. Kate, that's me. I'm the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosure is I'm a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children.
I'm also a member of the Berkshire Association for Behavior Analysis and Therapy.
Amy Wonkka: Amy's disclosures. That's me. My financial disclosures are that I am an employee of a public school system and co founder of SLP Nerdcast, and my non financial disclosures are that I [00:06:00] am a member of ASHA. I'm in Special Interest Group 12, and I participate in the AEC Advisory Group for Massachusetts Advocates for Children.
All right. Let's get into the exciting stuff. Um, our first learning objective talks about the developmental framework. And I think, you know, I work in a public school. I work in AAC. I'm working with a lot of people who don't necessarily have an understanding of typical language development. Uh, and I would love to hear you both talk a little bit about how important that is.
Cathy Binger: Well, it's very important. So, um, I, you know, just as a starting point, I'll tell you, and this is Kathy, that, you know, I go back. Over and over and over and over and over and over and over and over and over again to the developmental model when I'm trying to figure out goals and [00:07:00] objectives for kids who use AC and also for kids who have developmental language disorder, kids who have whatever I go, I go back to that model.
All the time and teach my students, um, hopefully teach teaching and learning are two different things, but at least try to teach my students the importance of of doing that, because it, it helps us figure out where the gaps are. Um, so that I know where this child I'm working with is doing relatively well and where their holes are and for me to figure out where their holes are, I need to have an understanding of typical development.
Um, and am I going to make sure they're on track with all of the domains, pragmatic, semantic, syntax, et cetera, all at the same point at the same time. That's probably not going to happen with our kids, but I want to know. Where their relative strengths are, as well as their relative weaknesses are, so that we can help boost [00:08:00] those things up because, um, in language development, all of those things develop at the same time, right?
And in applying a developmental model paper, um, Amy, you were saying before we, before we recorded that you really like the graphic that's in there. So I just want to call attention to that. If anybody wants to see that, um, you can look at a paper and look at that graphic. And it really tries to demonstrate.
the, how simultaneously these things are coming, right? Kids start to develop their pragmatic skills before they ever speak, and then they say their first words, and that's when semantics comes in. And then at about 18 months in typical development, that's when two word combinations start, right? So by the time a typically developing kid is 18 months old and has 50 words, They're putting words together.
That's syntax, starting to work on their syntax. So that's really early in development. 50 words isn't very many words. Um, I mean, it's many words for kids with [00:09:00] certain impairments, but, um, you know, for a lot of kids, that's not that many words. And so that's the beginning of syntax. That's the beginning of grammar.
And we want to make sure That we're not ignoring one domain like syntax or morphology or grammar as a larger whole, um, while we're only working on something else, like semantics, where we're, for example, in AAC, trying to teach a kid how to find 500 words on their device, but meanwhile, we're not really focusing at the same time on helping them learn how to put those words together in a structural way, which is What we do see happening with kids who have, um, kids in typical development.
So we want to make sure we're supporting all those things at the same time because that that model really teaches us that kids can do that and kids do do that and kids are cognitively ready for that if you're looking across these different stages. So, Nancy, you want to add anything to that?
Nancy Harrington: Yeah, um, [00:10:00] and I think for all of you who are speech language pathologists, um, providing language intervention, this doesn't sound very different, does it?
To what you do with your children using natural speech to communicate. It's what I tell my students all the time. We're still doing language intervention. It's just that we're using, uh, additional tools and additional modalities to communicate. And I think that's so important for all of us as clinicians to remember.
Amy Wonkka: I think one, one other piece that As somebody who's, who's working in the field and working with people who possibly didn't, you know, I'm thinking of my like BCBA colleagues who I've worked with over the years, um, or maybe even, you know, OTs or PTs who don't get the instruction in developmental language that we do as speech language pathologists, is Also sometimes see that we're working on skills that are too many steps above where we've, we've busted out of the zone of [00:11:00] proximal development.
If we're like way down the hill and then we're like, Oh, why, why isn't this student able to do this? They can do these other things. So I think that's something else that, that for me, at least has been very valuable in using that sort of developmental language lens to think about what the students I'm working with are doing or not doing.
Um, and, and often. When I see we have somebody who's not achieving these objectives that we've set for them We're missing there are gaps like you were saying like there's gaps that need to be filled in and if we didn't kind of Zoom back out and take a look with that lens Could have easily missed it.
Kate Grandbois: I want to Make it a comment.
That's an extension of that and In, in terms of working with AAC, like Nancy, when you said it's, you know, we're still doing language intervention. I think it feels very different for a lot of clinicians because there's this thing, right? There's this like thing. And [00:12:00] you're supposed to, and when you start working in AAC and Amy and I, you know, we were trained in this years ago, but you know, one of the first things you have to learn is like, how do you program this thing?
Like, what do you do physically with this thing? And. I think that that thing ends up inadvertently influencing what we end up doing in therapy and it might even end up influencing the targets that we choose or the goals that we write. And this is, you know, where I think we're going to kind of navigate into talking about this, you know, this concept of vocabulary within this developmental model.
I want to just give an example real quick. So a lot of the high tech devices that we see often, you know, they have, you know, boards that are full of core vocabulary and they might have a Fitzgerald key. Anybody who isn't familiar with that, you might be color coded where the verbs are green and the nouns are color and, and it's organized in this nice, you know, in this beautiful [00:13:00] way.
And It's very tempting to leverage what the device can do or what the device can look like and try and map it onto our student or our client. Um, and I think that there's a really interesting intersection there between this thing that just happens to be in the room and how it. accidentally in or might inadvertently influence the way we're thinking about our language intervention.
I don't know if that's kind of like a, a springboard into talking about this, you know, how we end up choosing what, you know, what we're working on in therapy or, or if you agree or disagree, feel free to, to tell me that I'm completely wrong. 10, 000%.
Cathy Binger: No, Kate, I'm really glad, you know, you brought all of that up and something that, um, we've done a lot of talking about.
Over the years is exactly what you said is just, um, getting over the thing, right? That's it's just a thing. [00:14:00] It's a mode. That's all it is. And I think, especially when we're when we're talking to SLPs who know language and sometimes, you know, need a reminder of this or that. But, you know, we were all taught typical language development at some point.
And if you have this scary experience of, oh my gosh, there's this kid on my caseload now, and they're using this device, and they don't know what to do, blah, blah, blah, blah, blah. To me, it's really comforting to think that my job is to go back to language, which is something that I know, right? So, you know, one of the first things I always used to do when I was working in the schools or wherever I was working was, of course, going to the file to look at the IEP and look and see what goals and objectives are.
I expect the, by and large, the goals and objectives for a child who's using AAC to be the same as a child who's using spoken language. Um, the communication modes are expanded. But the objectives need still need to be language [00:15:00] based in general. I'm not saying you're never going to have one that's not but that's what that's what we do is we help focus on language and that's what AAC is supposed to do and should do is help build language skills,
Nancy Harrington: but I think we also have a role as clinical educators and within the profession to help everybody to understand that and get over the thing as we're calling it.
Um, I recently had a student, um, talk about her experience, um, in clinic with me because she was seeing an AAC client, um, in the university clinic. And she talked about how initially she was, you know, fearful because of the technology and, you know, learning all about that. But then she came to realize. It's just about teaching language.
It's not so different than what she's doing with other children. And I think that's something that we really need to hit [00:16:00] home hard in as many different ways as we can. I think, um, and now I have, um, a bit of scope to look back over because I've been in the field for a number of decades, um, across, um, A couple of continents.
But, um, I think it's improving to some extent because people are more familiar with technology than they were years ago. Um, but we still have to get over it. And maybe it's very timely as people are more familiar with technology to help them really see it as just another modality.
Cathy Binger: Yeah, and it's never about at the end of the day, there's no such thing in my view.
And in my experience of the perfect device or the one perfect solution. A lot of these solutions can do very similar things. It's all about what we do with it and, um, you know, what we focus on and using that, going back to that familiar, at least again for [00:17:00] SLP, that a familiar developmental model to help us figure out, you know, Um, what we, where the child is, where their strengths are, where their relative weaknesses are.
It helps guide me, helps tell me where to go next and what to focus on next. Oh my gosh, we've been doing so much with building single word vocabulary. We've forgotten to work on syntax and work on these early word combinations and these rule based combinations and. Gosh, you know, so we need to, you know, we need to make sure we're doing also doing something to help facilitate that at the same time.
And I just use that as one example, but I think that's a really common example that we see, or, or we're focusing so much on pragmatic skills or so much on request, even within a domain, maybe we're focusing so much on requesting that we've forgotten about commenting and question asking and, you know, other very Yeah.
Yeah. You know, early developing communicative functions that are really important. So both within our domains as well as across our domains, [00:18:00] um, using a developmental model can help remind us of the other components of language development and communication development that are happening.
Amy Wonkka: And in, in one of the papers that we're going to link on, on the website, you are talking about the developmental approach and you talk specifically about some of the different types of intervention approaches.
Um, you know, I agree with you, Nancy. I think, I think the, the thing is at least a little less scary now because we all carry computers in our pockets, but Some of the intervention approaches are, are, do feel a little different. They do feel a little different than if I was just using my oral speech. So maybe you could both talk to us just a little bit about some of those approaches and, and how that might look incorporating the thing as we've called it.
Cathy Binger: Yeah. Nancy, do you want to start with that?
Nancy Harrington: That's fine. So there's, you know, there could be. various approaches in terms of looking at vocabulary. How are we going [00:19:00] to choose the vocabulary? You know, in the, in the early days, you might've had, okay, we're going to have a whole bunch of nouns so that somebody can request, they can finally ask for what they want.
Isn't this exciting? This is amazing. AAC is just so wonderful. So you might have, um, A grid, you know, whether it's a communication board or a static display device or a dynamic display device where you have a whole bunch of maybe familiar toys and food and people. And isn't that wonderful. They can finally request things and, um.
So it's all that fringe vocabulary, looking at all those, all those things that are within your, the environment that are important. And then maybe you'll, you know, you. Add in then your verbs and your descriptive words and all those words that are associated with the context that you're playing in. So maybe we'll have an activity specific display, which, um, we've used a lot [00:20:00] in our research where we'll create a display that's set up with specific vocabulary.
Thank you. for the routine. Now, it could be a play routine. It could be a mealtime activity. It could be a specific storybook. It could be any of those specific activities, but it's set up with diverse vocabulary across different parts of speech, but with the relevant vocabulary that's For that activity, so that, um, rather than presenting the child with a really complicated setup initially, where they have to think about the operational demands of navigating through lots of different pages, they have the vocabulary there, but it's Many of these are sentences, but we're going to talk about some of the syntax that's set up in a way that they can create sentences.
So, we're looking at syntax they can use varied vocabulary [00:21:00] across different parts of speech. We have pronouns. We have nouns, we have verbs, we have adjectives, we have prepositions, we have. Morphological endings because, you know, think about it, even, you know, an 18 months to two year old, an early two year old is starting to add an I N G to the end of their, um, verbs.
So we want to make sure that there's access for all that. So we're teaching it. In a little bit of an easier context so that the vocabulary is there for them, but they can, in fact, um, build sentences, build that syntax, use some more diverse vocabulary within their lexicon, and also talk about What's happening, you know, during the play routine, whether it's to request something, whether it's to comment about on something, whether it's, you know, [00:22:00] to ask where something is, you know, whatever it might be, there are different options available.
Now, that's not the be all to end all. We have, you know, what happens when they want to talk about something tangential, and that grid is up there, so we have to think about that as well. So there's, you know. There are different approaches, and there are pros and cons to each of them, but we need to be thoughtful and think about how we apply them so that children have the opportunities to not only have access to vocabulary but To communicate their most basic needs, but also to learn how to build that language to learn how to, you know, move from single words to two word utterances to increasingly more complex utterances with diverse vocabulary.
Cathy Binger: Yeah, and I want to go back to a [00:23:00] 2nd for a 2nd, you know, back to that noun based vocabulary. We're talking about Nancy. So, you know, I think for a lot of the kids we work with, um, when you're using a developmental model, um, going to a almost exclusively noun based, um, kind of an approach, that's not really warranted based on typical language development, right?
Kids never go through a period of development where they're only using nouns. Um, if you look at the first 50 words, again, using a developmental model, we go back to typical language development. Um, the first 50 words that kids use, only about 50 or 60 percent of those words are nouns. They still have 40 to 50 percent of their words that are not nouns.
They have social words, they have, um, action words like up, they have, you know, they have all kinds of different, they have adjectives like hot, um, and big. So, you know, they have this diverse vocabulary and you need that diverse vocabulary if you're ever going to combine words. You can't make sentences out of nouns.
Um, so, you know, one of the things, things that we talk about in our developmental [00:24:00] model paper. Is as Nancy said, the pros and cons of each of these approaches. Some of them have more more cons. Um, if you're only using if you're only using that approach, and this is something I'd love to hear from you, Kate and Amy, about what you think about this and you're what you've been exposed to with this.
But, um, in my world, um, and giving some of the sort of getting I've heard a lot of, you know, Back from a lot of SLPs and what I seem to hear a lot with, um, kids who use AAC is that they tend to be getting just one approach. Um, and so that's when I think. You know, and I understand why some, you know, it's life is hard and they're like, there are all these real world complications that we need to be taking into an account.
And that's another topic. We probably shouldn't get into because we still have way more progress to make in the world of intervention to bring all these things together. But anyway, where I was originally [00:25:00] headed with this is that, um, you know, when you, if we put ourselves in a box and we only take one approach.
And only that approach, so only noun based system, or, or almost exclusively noun based system, or exclusively an activity, um, specific kind of display or, you know, that Nancy was talking about where we have a page for playing with cars and a page for playing with cooking or whatever, um, if that's the only thing they get.
Then we're going to end up in trouble at some point. Um, so I think, you know, really, the next phase, I hope of where we're going is with doing a better job of taking this developmental model into account and finding solutions where we can bring these things together. We can be working short term, for example, on building those early sentences and phrases and clauses like we do [00:26:00] with our activity.
Specific displays in our research, which have been around forever, by the way, like, we didn't create these. They've been around forever. And then people threw them out because it's have to, you know, go to a page for vehicles every time they want to say, um, crash. But maybe they're talking about crashing something else, right?
Like, it doesn't make sense. Um, but. you know, so you can't just have, if you just have one approach, then you're going to get stuck. If you only have a really complicated display where there are thousands of pre programmed words, and from the start, you're trying to teach a kid to put words together using that, it's going to probably take them quite some time because there's a, there's a very real cognitive load there.
Um, so I don't know if all of this is making sense or not, but there's just, There's a way to go with what we need to do. And then we also need to be making some decisions right now before we have all these better kind of solutions that are out there. And right now, I think the best that we can do is, you know, make sure that we [00:27:00] sometimes are focusing on syntax and, uh, Um, grammar and building those utterances and Nancy and I just finished two randomized controlled trials where we've just spent the last five, six years working on that with priests with a couple different groups of preschoolers.
And at the same time, we need to be building vocabulary and we want to be putting vocabulary in a permanent place where kids can find it over the long term. Right, like all of these things are going on and trying to figure out how to do it all isn't the easiest thing in the world, but knowing and being honest about, you know, where we are and where our gaps are going to help guide us in terms of filling in those gaps.
Nancy Harrington: And it goes back to diagnostics. What do we look at when we see a client walk into our clinic? Where are they developmentally? What do they need to communicate about? What context do they need to communicate in and [00:28:00] with who? And how are we going to assist them with that? And we should, that all has to be looked at within the context of where the child's at developmentally and that's really what we have to think about and be thoughtful of considering all the different approaches and different, um, types of vocabulary selection.
We need to make sure that the children we're working with have access to the rich vocabulary that, um, Typically developing children have, and that we're not limiting them based on the thing, as we said earlier.
Cathy Binger: Yeah, so Kate and Amy, what, what are your thoughts?
Kate Grandbois: I was, I was just about to say, I, I think that, AAC is one of these scopes of our practice.
It's an area that is complex, right? I mean, it's [00:29:00] assessment, you know, the, the variables that we have to look at and the questions that we have to ask are intertwining. Um, a lot of the, you, the individuals that we work with in AAC, not just myself and Amy, but just, you know, Generally speaking, you know, we're talking about complex communication needs.
We might be talking about complex bodies. We might be talking about a lot of complexity. And for me, and this is my opinion, this is just my opinion. When I hear I'm going back to your earlier question, Kathy, you know, do we see kids who get just one or the other? So do we see kids who tend to get just core or just fringe?
Um, My in my experience the answer is yes. I I do see that happen, uh happening. Um, I think the opinion that I Very quietly just put on the shelf, but I'll put I'll pull back out is that any time in intervention, if you're approaching the problem with a one [00:30:00] size fits all approach, there is a, I'm going to hold my breath, you know, like, I don't, this is a red flag for me.
Right. And I see it. I do see it in the AC, but not just with, well, we, you know, we're just giving a core approach and we're just giving a, uh, a fringe approach. I also hear, well, we just, we do touch chat here. This is just what we do here, right? So there is a lot of status quo, uh, culture that I find, and this is my opinion, you know, comes into play when people are making decisions about intervention strategies, targets that they choose.
Um, and I think it's, you know, not necessarily the fault of the speech pathologist, it could be the professional workplace culture. It could be, uh, lack of resources for training, um, because this is genuinely a complex, um, area of, of, of clinical expertise. Amy, I don't know if you have a different experience or, you know, Agree or disagree.[00:31:00]
Amy Wonkka: I, I agree. I agree with a lot of what you're saying. I mean, I can say personally, like I started off in the field. I was, we were talking about this before we hit record, but I started off in the field as a teacher's aid in the nineties. Uh, we used packs. It was exactly what you described, Nancy, which was like.
Oh my, isn't this amazing? Now we can ask for all the things. This is huge. And it, and it is. It's huge to see somebody go from not having access to any of that to being able to request all of these specific things. Um, but then I, you know, I was in school at the time I was going back to school for speech pathology.
Uh, it, there are inherent, uh, Weaknesses when you try and map an all fringe or all core system onto developmental framework. It's very hard in reading your paper. You know, it's very hard to generate a simple narrative with a very limited subset of vocabulary. Right. Um, so then I, I went to conferences, I learned about core vocabulary.
I was like, yes, this is the answer. You, you can't make a two word combination without [00:32:00] core. This is key, you know? Um, and I sort of got really enthusiastic in the other direction. And. Kate, to come back to your point, yes, obviously it, it is one, one approach is never the best approach for everybody. And finding a more measured place in the middle is obviously where I have settled, you know, in, in my current practice.
Um, I do think, you know, there's also this other layer, which is wanting to give people access to To a really robust system and Nancy Cathy's you guys were talking about the activity displays, you know, I think sometimes we feel like on the one hand it's complicated by Time and people having time to do these things and create these, create these different displays.
Um, so that's a limiting factor there, but I'm just thinking, you know, we, we really don't do that. And it doesn't have to be either or like, it doesn't have to be, you have access to word power and all this vocabulary. So we can't, we can't try an activity based display [00:33:00] to give you an opportunity to like, relieve some of that navigational burden and work on morphology.
Like it doesn't have to be one or the other. And I think That's a piece that every time I read something like your paper, I'm like, ah, that's right. You know, it's, it's the combination of all of these things. Um, so yeah, I don't know if that answers your
Cathy Binger: question. I have a slide that I put up when I, you know, whenever we give these talks of, it doesn't need to be one or the other.
It can be both. And I'm not, and again, like it's complicated. Everybody doesn't have, no one has all the time in the world, you know, blah, blah, blah, blah, blah, blah, all that stuff. And. Like, you can use for a child for whom it's appropriate, a more complicated kind of system with lots of words, blah, blah, blah.
And, you know, as you can. develop some activity displays in specific motivating activities where somebody can be helping to facilitate those word combinations, the clausal development, the phrasal development, [00:34:00] you are in all likelihood going to see that kid make way more process, way more progress. With their syntax development and their grammar development and their morphological development, if they can just have sometimes, not all the time, but sometimes for certain activities, an activity specific display where they don't have to be hunting for other things.
Um, they can just focus right here. And as I mentioned a few minutes ago, we just finished, you know, two long studies where, um, we're getting both of them out the door now, right now. And, um, so we'll come back on if you want at some point to talk to you in detail about those 2 very large studies. And, you know, we just saw kids, not only kids.
with typical receptive language, which I know is the minority of kids who use AAC. We did do one study with kids with typical receptive language and also a study with kids with Down syndrome. And in both cases, um, we saw them make substantial gains [00:35:00] in their length of utterance, um, you know, over a four month period of time, um, where, you know, they really Probably pretty stagnant with that beforehand and they didn't have access to any before that for most of them.
So, so, yeah, we can, we can do a lot, but it doesn't have to be all day every day. They're doing 1 thing.
Nancy Harrington: And I also want to note that, um, you know, we can consider this too with, um, you know, many of our users who use alternative access. Yes, it might take more time. It might be slower for them to select the vocabulary that they want, but even though they may not be able to produce so many different symbols with at once within a set period of time, we still have to consider developmentally where are they?
What vocabulary do they need access [00:36:00] to? How can we set up their devices and their displays so they have access to the lexical and vocabulary diversity so that they can produce A range of utterances, um, and learn to use syntax and grammar.
Amy Wonkka: I think that's such a, such a good point too. And, and it makes me think about, you know, just, just back to this, what did you say?
Yes, and, or both and, but I, but both and so, because there are also times when that's the purpose of the activity, right? So back to operational demands, whether that's because you are using switch scanning or something, it's a more cumbersome access method, or because you're learning to navigate your system and that's a cumbersome Access method for you in the moment.
Um, sometimes the focus of the activity is to work on that [00:37:00] morphology and sometimes it's not right. So I think also being flexible within kind of what areas, I mean, back to that figure that I really like in the paper, but just thinking about, you know, there's, there's different things that are happening at the same time within those different developmental bands.
And it doesn't mean we have to be working on the highest level of performance of all of those things simultaneously. Either. That's right.
Cathy Binger: That's right. Like to have, you know, a couple activities a week where you're really honing in on the sentence development, the phrasal development, the plausible development, whatever, you know, putting those words together in a rule based way.
But that doesn't mean you're doing that all all day every day. Right? Yeah. There are times and places for these things and different access methods, even, you know, that you may use for, um, to make things easier so that they can focus more on. The learning of this rather than this in a particular in a particular moment,
Nancy Harrington: and that's the. Um, [00:38:00] beauty of a lot of our new technology is that burden can be more on the technology and less on the user. Um, and then back to your point as well that we also we need to consider all aspects of language. We need to consider the The semantics, the pragmatics, the, you know, I think back to years ago when I first went to graduate school, I remember learning about, um, Bloom Leahy and form, content, and use.
Those three circles that intersected, it all went together and we, it's still relevant. We have to be thinking about that all, you know, with our, um, clients that we're working with. We have to think about all aspects of language. From a developmental perspective.
Amy Wonkka: I wonder if now is a good time for us to talk a little bit about the other paper that we're going to link in the show notes and just talk a little bit more about kind of that, [00:39:00] that division between the core vocabulary and the fringe vocabulary and how that's used now that intersects with the developmental piece.
Cathy Binger: You betcha. Let's do it. So, um, before we go down that road too much, I made a little note. I want to come just cut touch back on something that's related. Um, as I'm shaking my clothes pin at you, um, I know we all have our sensory things that we do. So anyway, Kate, you had mentioned, you know, that anytime you see like everyone taking the same approach that sets bells and whistles off for you, right?
Um, if everybody's doing the same thing, um, I, I just, I want to say, I don't know where we're heading with all of this, but I do. Also understand that sometimes that happens because, um, you know, sometimes people don't know what else to do. [00:40:00] Um, sometimes people have a whole classroom that's a really complex kids with, um, you know, not necessarily a whole lot of help or a whole lot of background in what they're doing.
Um, and it's not necessarily a C, isn't there a huge specialty? Like, there are all these things that are these very, very, very practical real world pressures that are out there on working clinicians, working educators, educational assistants, you know, all these folks who are trying to. Just do the best job they can with what they have.
So, um, you know, looking down the road, I really hope see think that the next phase of what we're going to be looking at is taking those things into more into consideration than we are right now with most of our interventions and so that we can be doing the kinds of things that we're talking about today and doing it in a practical kind of way.
So, um, yeah, so that, that then takes us, [00:41:00] do you want to ask us a question about the, the paper we wrote on, um, foreign French vocabulary, or do you just want Nancy and I to launch into it?
Kate Grandbois: I think it would be really helpful to hear what the data is showing and what.
What the what direction the science is is pulling us in if you know, I love that that vignette that you just painted of like, where are we headed with this, knowing that looking backwards, you know, we started in a place with a AC where it was like, Oh, my gosh, we can use symbols. Oh, my gosh, people can request things.
This is amazing. And then it was Oh, my gosh, look at the power of core. And we've gone all the way into core. So where is the I would love to know, like, where the science is taking us next. And I think that's a really important conversation, not only because of the real world limitations that people face in terms of resources and time and knowledge gaps, but also I find that this topic gives people a lot of feels.[00:42:00]
There are a lot of fields that come with Talking about how to choose vocabulary with AAC. And that is not a judgment. That is you, everybody's allowed to, I hear I'm here to validate everyone's feelings. Everybody's feelings are valid and it is, it is okay. Um, I feel okay, Kate. Okay. Okay, good. But you know, I, I think that knowing what.
Taking a look at what we know versus what we don't know is a really nice way to unpack those feelings.
Cathy Binger: I, I could not agree with you more, so I want to start really zoomed out here, which is, um, something that I, I just see and hear, you know, here and there in the AAC world is that, quote unquote, we know so much about core vocabulary.
And that's a place where I will take a firm stand and say, no, we do not. We do not know much at all about core vocabulary. We know how to create word frequency lists. We're really good at that. There are lots of word frequency lists out there, and [00:43:00] people are constantly publishing more and more lists. And that's what core vocabulary is, and the way that we define it in AAC are words that are used frequently, um, across a group of people, right?
So preschoolers in home settings and in, um, daycare settings or, you know, or in school settings or whatever it is, right? So that's core vocabulary. We have a number of research papers that are out there on establishing core vocabulary lists, but, um, we don't, I have many empirical research studies beyond that.
So that was really the, um, the impetus for the paper that we just recently published on, um, core, what like core, core vocabulary, fringe vocabulary, the combination. So the context for the paper is that we decided to look at fairly young kids, They're two and a half years old. We got our hands on an online.
They're wonderful online databases. [00:44:00] Now of transcripts that you can do to do all kinds of analysis. So we found a good set of transcripts from kids who are two and a half years old. Um, we had. I want to say about 60 kids and about well over 100 transcripts that we analyzed. And these kids were at daycare settings and in home settings.
And they were talking both with a parent as well as with, you know, in the classroom. So they had, you know, they were doing all day record, they were doing recordings of them. So, not all day recordings, but, you know, they were doing recordings in both places. So, anyway, so it was a really nice pool of language samples, and what we did with these typically developing kids, our question, our big question was, how is core vocabulary and how is fringe vocabulary being used in the real utterances of these kids?
Right? So if you just take a say, um, then we ended up with 10 over 10, 000 utterances that we did our initial [00:45:00] analysis on and we looked at, um, the percentage of utterances that of these 10, 000 utterances, what percentage of them consisted only of only core vocabulary, what percentage of these utterances consisted of only fringe.
and what percentage of these utterances consisted of both. And then we looked at six different four vocabulary lists. They're all English. We didn't look at any other languages. We just looked at English to see what was in the, our samples were all English, English speaking kids. And what we found was that, um, well, first of all, with these six Stop me if I'm like going into too much detail and wave at me or something and I'll take it back off.
But to give you the context, there are six lists that we looked at. Two of them were very, very short. Two of the lists were the Banerjee, Banerjee list that has 23 words that's frequently used. There's another list [00:46:00] that's universal core that's being used for, um, especially for kids who have very significant multiple disabilities in some classrooms.
And that list only has 36 words on it. And, you know, that list in particular was made with the thought that. You know, it's used for whole classrooms. These are the same 36 words that are given to all the kids is my understanding. And, um, you know, these kids don't, there's not a lot of real estate they can get access to.
So how do we make the most out of the real estate that they have? Right. But the thought behind it is an excellent one for sure. And then the other four lists were much longer. They were at least 250 words. Okay, so what we saw with what percentage of these 10, 000 utterances consist of only core vocabulary for that 36 word universal core, it was only 5 percent of their utterances.
consisted of only that universal core vocabulary. So very, very, very few utterances, and those utterances tended to be very, [00:47:00] very short. We also did MLU, um, we have MLU figures on all this stuff. They were very short utterances, and they didn't have a whole lot of content in them, as you might imagine, because, you know, 36 words.
The other short list, the Vonagee list, Vanagee, sorry, I'm so sorry. I never know how to say that name. I, my apologies. Um, That list was 22 percent of those 10, 000 utterances were core only, but. Over 85 percent of them, or it was 85 percent of them, were made up of yes and no. Um, so almost all of them were yes and no.
So basically, you know, those lists perform very similarly in that there are very, very few utterances that those kids were saying outside of yes and no that consisted of only core vocabulary. Which, the take home message there for me is, kids are not using only core vocabulary when they're talking. Even at two and a half years old, they're not just using core vocabulary.
They're using the fringe too. So, you know, I won't [00:48:00] get into the details of all the graphs, but, um, you can see in our paper that, you know, you get, you know, there's some utterances that are only core, some are only fringe, and some are both. And then you can look at the samples of them and what those utterances look like are dramatically different.
Depending on if you're looking at a core only utterance, a fringe only utterance, or a core and fringe. And no surprise, the ones with core and fringe were way longer and way more complex than the utterances that were made up of only core or the utterances that were made up of only fringe. So it's kind of a flashback for those of us, all four of us have been around in the field for a long time.
Like I learned back in the nineties that, you know, we need to be using core vocabulary and fringe vocabulary. But To my knowledge, nobody has really looked objectively. Um, at what that really means and what our kids utterance is really made out of, um, Emily Laubscher and Janice Light did a nice study.
They compared, they looked at core vocabulary [00:49:00] through the lens of the MacArthur Communication Development Inventory and had, you know, they found, you know, of course, like, there's not enough content if you're just looking at the core lists, um, and this is just looking at that same issue through a different lens where, um, where we see that.
And if you look at the mean length of utterance, Um, I mean, for the samples that we took, it's, it's what we really expected, which is again, that, that those utterances that have both core and fringe are way longer and way more complex than the utterances that are only consisting of core or only consisting of fringe.
So the table message is, guess what? Kids need both core and fringe, um, if they're going to be making the most of, of their language skills. So that's my, my intro to all of that.
Kate Grandbois: So what I'm hearing you say is that kids need more, your study was on. Non AAC users, so children, typical children using [00:50:00] oral speech and kind of circling back to our previous conversation looking at the importance of Pinging our clinical thoughts and questions back to a developmental model and sort of you know Really embracing this developmental model what we now know based on this study and it sounds like the data was pretty clear What typically developing children who use oral speech are producing by far and large are utterances of both core and fringe?
Cathy Binger: Well, percentage wise, so for the longer vocabulary list, the ones that were at least 250 words, the core list that were at least 250 words, um, about 50 percent of their utterances were made up of only core vocabulary, but they had a lot more words to pick from. Right. Like if you have a much larger corpus that you're starting with and that the kids, I mean, I shouldn't say have access to because you know, these were typically developing kids, but if you give, if you give a kid all 250 words on the [00:51:00] Cleman list, he's gonna have a much better shot at putting together some decent utterances, right?
Like two, three word utterances. You're gonna get what we end up with an MLU of, you know, 2.2 to 2.5 with those longer lists. Okay, so you still get, you get a substantial number of utterances that are only core. But contrast that, MLU wise, right, mean length of utterance wise, with that Buchelmann list we saw, okay, on average the length of utterance for the, if they have just, are made up of just the Buchelmann core vocabulary, they have an MLU of 2.
2. Well, if you look at the core and fringe. utterances, right? The utterances that had both core and fringe vocabulary in them, their MLU was at 4. 6. So we went from 2. 2 to 4. 6, and that was consistent across all the longer lists, like we saw exactly the same pattern, the numbers changed a tiny bit, but exactly the same patterns where, you know, a typically [00:52:00] developing two and a half year old has an MLU of two and a half or three, um, they're getting way higher when they have, they're using all those different words versus just a small, uh, Subset of that, that core vocabulary.
So, um, yeah, it did, it did depend on the kind of list, but it was really like, what's going on with those longer lists versus what's going on with those shorter lists. Those shorter lists, especially one of them was really doing the kids no favors at all. Like, they couldn't say anything. With those that we have a whole list in the article.
We have a very long appendix that has samples of has all the samples that we used to analyze the MLU data and you can see for yourself what those utterances work that we randomly sampled from that big 10, 000 utterance corpus and they're very stark. And if you want, I can read a few off to you if that's of interest, but, um, Okay.
So anyway, it varied depending on the list, but the message was still the same. Well,
Amy Wonkka: and it makes me think [00:53:00] back to our earlier conversation just about the developmental language component there. And if we're thinking of 50 or fewer than 50 words, and then you had mentioned that of those first 50 words, about 50 to 60 percent of those are, are nominals, they're fringe words.
And then the remaining 40 or 50 percent are core words. I mean, it, it. The research doesn't, research doesn't always make sense and like jive with what seems logical, but in this case, it sounds like it does in the sense that if you're going to have, because our students are all individual and I, you know, you may have motor access or visual complexity that, that necessitates a smaller amount of vocabulary, at least to start off.
But I think, you know, for me as a clinician, hearing you talk about that, it makes me think it's almost more important. Is it important to have that balance the smaller your vocabulary is? Yeah. I mean, if,
Cathy Binger: if all you [00:54:00] have, like, let's take this as an example. You said, Amy, earlier, you were so excited when you learned about core vocabulary initially because kids had different parts of speech that they need to build sentences, right?
But some of those lists, especially the tiny ones, some of them have no nouns on them at all. Like, so you may have the word and. Like, as an article, but you need a noun to attach it to, like, and you may have, um, he or she or it, but it doesn't do you much good if you don't have a reference that you can first refer to.
And maybe you can do that by pointing, right? Maybe there's a, there's some multimodal ways, but from a developmental perspective, um, And for Nancy, I promise I'll give you a chance to just like, wind me up and off I go. Keep going. Words like this or that. Um, which are very common on even the very, the shortest core vocabulary list.
So those are very, very useful words, [00:55:00] right? What do you want? I say this while I'm pointing at something or touching something, and I say that while I point at something that's across the room. Those are incredibly useful words. They're very powerful. They are also indicative. In kids with spoken language disorders of a language disorder, because they use those words to cover all kinds of territory.
They point to, you know, the pink monkey, when they want the pink monkey, what do you want? That. I want that. Like you hear kids with, you know, preschoolers with language disorders say this stuff all the time, but what they should be learning to say and need to learn to say is the pink monkey. Right, like that's part of development.
So, um, you know, we don't want to be teaching our kids to overuse those things. We don't have to, um, in terms of language development, you know, it [00:56:00] teaches us that. We need to be filling, helping them to learn those words and fill in and using those more precise words so that they can develop again those, that phrasal and clausal and sentence kind of development.
Nancy Harrington: Absolutely. And we also need to think about the different types of words because what we do often with core is perhaps we might have the verb eat. And there might be something very specific that the child wants to eat. Maybe they want to eat cake. No, maybe they want cookies. Maybe they want chicken nuggets.
Maybe they want pizza. Maybe they want applesauce. Or maybe they want to eat somewhere else. Maybe they want to go out to eat. But there's But all they have there is eat. They have nothing else. And that's not what we do with typically, how typically developing children learn language and express themselves.
And what we're doing is we're, we're kind of almost teaching these metalinguistic skills to try to [00:57:00] figure out how you can use one word to say lots of different things. But we're, and we're not giving the, providing the vocabulary to. Or those building blocks of language.
Cathy Binger: Yeah, I think that's something that goes overlooked, and I'd love to hear what Kate and Amy think about this too.
That, you know, if you give kids a very, very, very limited set of vocabulary and that's all they have, they're, they're often taught to use that vocabulary in ways that no one else uses that vocabulary. Right, um, and to cover all, like, let's take the word go, right? So I use the word go not just for, as I normally would, but I might use it for, you know, it being in a car and moving forward.
I might use it for, I don't know, all, you know, all kind, walking. I might use it for running. I might use it for sprinting. I mean, everything is go, and if everything is go, It's so imprecise that and it's used it. We can teach kids to use it in ways that nobody else [00:58:00] really does. And then, as Nancy said, like, that can potentially really create a linguist metalinguistic demands on them.
And it's not, it's not part of typical development. So, have you, Kate and Amy, have you experienced, like, that kind of thing and this kind of very odd use of vocabulary that you see sometimes when kids only have access to very limited vocabulary?
Amy Wonkka: I feel like yes and no. I think, um, one, one area that I'm thinking about is just the descriptive teaching approach.
So using, you know, maybe two tier two, tier three curriculum vocabulary, and then recasting that back using core or, you know, tier one type fringe vocab. I think that can be helpful. I think that that's a helpful intervention approach. Um, yeah. Not only just to shift sort of the, the way that we're teaching, but also to get people to really think about the definitions that they're, that they're giving students who, who probably might not have room on their [00:59:00] AAC system for that, like tier two, tier three vocab.
I do think. You know, back, back in the day, back in the day in the nineties, early 2000s. Yeah. I mean, I think that that, that sort of what, that was my takeaway and it could have been, you know, I took away the wrong message from some of the, the PD that I did. Um, but my takeaway was sort of, you're better off teaching that, uh, sort of less.
Typical phraseology because it could be more versatile. And I think now the more nuanced way that I would look at it, particularly through the developmental lens would be like, okay, but is that something that is that a clinical choice that I'm making? Because we have actual real limitations on system size for this particular person.
Because I do think that is true. That is true for some communicators and that might be where you think about that. You know, like you were saying, Kathy, with the, this and that, like, okay, if this person, okay. I mean, one thing that pops up on systems is like high and [01:00:00] by, well, if you, if you are able to move your body and gesture like that, perhaps we can give that real estate to something else.
Kate, I don't know if you've seen sort of that. That funny funny utterances as a result of of limited access to vocab.
Kate Grandbois: I definitely have and I I think I've seen it play out in a couple of different ways. Um, One of the things so I tend to work with, you know, emergent communicators and One of the things that I have seen quite often is an over reliance or a clinician over relying on core when the situation that you've just described and, and having the concern that these are very ambiguous terms, right?
So the go looks different, running looks different when even just a verb, running looks different when you do it, then versus core. Then when I do it, when it's slow or when it's faster and within different contexts. And I think that there, you know, is [01:01:00] definitely. I've seen some issues growing out of this limited approach where we have, you know, we're not really acquiring a lot of, you know, there's really, really slow progress, if any progress at all.
And then the recommendation is, well, we're not modeling enough or there isn't enough immersion. Um, and, you know, there might not be enough attention paid to some significant executive functioning components or sensory need, you know, sensory needs that are, are kind of mapped onto this. I also see. The limited vocabulary, um, and rigidity play out in terms of making almost the swinging in the complete opposite direction, making things entirely too specific.
So, you know, choosing vocabulary that means something to that particular individual, but outside of this educational context, no one is going to know what this one tiny thing is. I think that the decisions that get made for [01:02:00] vocabulary Um, they tend to be like going back to the beginning of our conversation, really heavily influenced by so many other variables, um, based on the context and the environment and the workplace culture and knowledge gaps and, and all kinds of stuff.
And it's not great when it's limited in either direction.
Cathy Binger: Well, and there's another factor we're talking about variables that that all that made me think about, which is motivation. Um, what little kids learning language is really exciting. They love words, you know, kids who we're talking about, you know, kids who are symbolic and kids who are, are have that, um, cognitive ability and blah, blah, blah, who are, who are learning more words and, you know, being able to say, Hey, Again, let's go back to our vehicles routine and saying go for everything every time you're moving a vehicle is one thing, but being able to say crash is another thing [01:03:00] altogether.
Right. And then laughing, you know, you see kids like, you know, just being able to talk about that. Um, and, you know, Even to little tiny things. Well, yeah, so I'll just put a put a, um, ending on that, like that, looking at how motivating, um, vocabularies in different contexts, I think is, is something to remember.
If you ever get a chance to just look at typically developing little kids in the vocabulary that they, that they're using, and they're so excited about. And that reminds me of another point that we haven't talked about yet, which is grammatical morphemes. Nancy mentioned earlier that we give kids access to those early on, depending on where they are in that developmental, um, using that developmental model again.
And I think we tend to think about grammatical markers as fluff. Right? Like why would you take up real estate with something like an ING and Amy, I see you nodding your head very [01:04:00] vigorously. Yes. Vigorous nod. The fact is, um, at least the part little kids. Start using grammatical morphology so early because it's really useful like even take something like a versus the write something indefinite versus definite there's two very different meanings to those two words or Plural versus singular.
There's a big difference between cookie and cookies Ask for cookies That's right. It's a lot more fun to ask for cookies. So, um, you know, that, that using that developmental model helps remind us. Um, the, the, when that comes in and how early that comes in. So what were you thinking, Amy, when I was talking about that?
Amy Wonkka: I was just thinking it was a good example of one of those funny gaps I was talking about. We might be working receptively on find, find the plural, find the cookies. Find the crayons, [01:05:00] but we've never worked on it expressively so that so that student didn't even have access to play around with that concept.
Yeah, like they would have if we had. So yeah, I just had a big, big head nod feeling, head nod feelings. But, um, I think it's, I think because so much of it is also tied to bigger concepts, right? It's tied to when we think about verb tense markers, that's also tied to ideas about time. And that's such a, that's such a big, that it's such a.
Piece about narratives and, and being able to talk about something that's happening already happened is going to happen. Like there's all these funny, and I'm guilty of the, like, that's fluff and shouldn't take up space by the way. So like, if anybody's listening.
Cathy Binger: Right. We don't want to Nancy and I've been very spoiled, at least in our research.
And this has been a choice of working with kids who are direct selectors and who don't have, you know, who, who, who can access a number. Of symbols using direct selection, and a lot of you out there [01:06:00] are working with kids for whom that is not the case. So I don't want to in any way, um, minimize the, the challenges of working with kids who have really significant access issues.
Um, and you do have to maximize use of that real estate. I just. I think that, um, we're not, well, I'll save this point till, well, I'll make my mic drop moment now. We're not done, people. I love it. We're not, we're not done. We're like, we, I think about the, um, quote all the time about looking at things with this passionate objectivity, right?
Like, where are we as a discipline? Um, as soon as we think we're done growing and as soon as we think we know everything, um, we're toast. So we have there's so much we don't know about how these things work over time and how to best facilitate what's going on with his kids and how to merge. All the real life [01:07:00] issues of working with kids in whatever setting, um, that are very challenging and very challenging and that we need to be working with our instructors and our teachers and our educators and our speech language pathologist to help develop interventions and have their input.
Um, so that what we are meaning researchers are developing is truly useful for them because we built it with them and we have so much growth to do in that area. So I don't want to gloss over all of that. That stuff is so profoundly important. And so is using a developmental model to help us know where we're best supporting these kids and and where their gaps are.