Developing Communication Autonomy – A Guide

Avaz’s resident SLP, Niveditha, brings you a step by step guide on developing communication autonomy. This is Part II of a two part series on communication autonomy in the in the context of AAC.

We have established that communication autonomy enables self determination in Part I of this series. Let us now discuss how we can go about developing communication autonomy.

Supported decision making is the way to go about it. It is a structure that supports people to have more autonomy. This framework can be divided into a few key steps. This step by step process requires a little bit of effort to begin with. That said, the gains from doing so make it well worth it.

Let’s look at how we can help users to make choices and indicate their preferences, on their own. Even if they are just beginning to communicate 🙂

Step 1 – Support Preference Expression

The first step in developing communication autonomy is to support people to express their preferences. We want to know what they like and what they don’t like. Here are two ways to do this.

1. Communication Chart: A communication chart is our understanding of what the user means by a particular gesture or vocalisation. It could have the following subheadings-
   • At this time
   • When this happens
   • When the person does this
   • We think it means this
   • We need to do that.

Eg. If it is noisy outside and the communicator is restless, we think he is bothered by the excessive noise. We may give him earphones to listen to music. This is our interpretation of his behaviour. This is written down for others also to read and follow.

2. Verbal Referencing:

The life of a non-verbal person can feel like a constant interrogation the number of questions we ask them is are so many! Instead, we can invite the expression of preferences using declarative statements rather than questions.

A declarative statement is like, “I think you like that.”
We can state what we see and also map language onto what the user is doing.

So, if we say, “Oh, you like that, you know, you’re laughing. I really think you’d like that!”

And if the user looks with a shared smile, we can confirm it and  say, “Oh, you’re nodding and smiling. I think I got that right!”

Step 2 – Preference Affirmation

The next step  is looking for ways for the user to affirm their preferences.

When asking for their choice we may ask, ”Do you want to watch Spiderman or Black Panther” – but do we realize that this is a false choice?

What if they want neither? Or what if they want more information on the choices provided, to be able to make a better choice?

Try giving them options on their AAC system like “I want something different.” or “Tell me more.”

We also have to make sure that they have ways in their system to communicate things like, “I don’t understand” or “You don’t understand” or “That isn’t what I meant”.

Speech is difficult to understand especially because its fleeting. In addition children may have other reasons like sensory processing reasons, auditory processing reasons, intellectual disability – which can make it harder to understand speech.

Discuss with the team members  and have a consistent means of describing the world to the user. We should build structures for them to understand the more abstract things that happen. Explain things ahead of time, making sure that they are comfortably positioned to use their visuals from their high tech AAC system. . 

This step is all about having a consistent and thoughtful way of making sure that the other person understands the options that we’re putting in front of them rather than creating false choices.

Step 3 – Concept of Ranking

The next stage is introducing the concept of ranking.

Access to language like most and least , worst and best, favorite or love versus like and okay is very important. This will ensure communication of more nuance about what’s really important to us, what we really like and don’t like.

Talking mats can be used for this purpose.

Remember to always provide choices in the same structure. For instance – the left side can denote positive and the right is always the negative with the neutral in between.

For eg- the like is always on the left side and then not like on the right side and the OK or sometimes is in the middle. 

With this the communicator will understand that here’s our topic, here’s our ranking system. Whether you say, “Yes, I like this”, “No I don’t” or “Sometimes I like it”, we’re going to move images around to be able to indicate what we thought about them.

We should  support people to be able to compare their options and begin to rank their preferences. This is because comparing things is actually a really important step of decision making.

We need to find out what they really want to do, what they don’t want to do, what is negotiable and what is not. Decision making is being able to compare different options and then select one. 

Step 4 – Authority to Make More Decisions

The last stage is about how we’re really expanding somebody’s authority and their right to make more decisions. One of the tools that can help us do this is a decision making profile.

A decision making profile or agreement includes an inventory of all of the decisions that we,(including the user )are making for this person. It could be really important to the communicator’s quality of life to be able to choose what they eat today or whether they take a bath and when they take a bath or whether they take a bath or a shower and what they wear. However, other people couldn’t care less about these issues. We can list down all these important decisions.

For making decisions, some people may need time to think, others may need visual pictures or videos. Some others may need to personally experience it before being able to decide.

So, we have to list down the decisions that this person has shown us are important to them. And we can be structured about how they must be involved. And we have to be really clear about who has the final decision making authority- this will (and should) however change as the person gets older. At that time, we should aim to keep shifting the final decision making authority to them as much as possible. 

So, decision making agreements can be about anything from what we wear or where we’re going to go or how we spend our money. It is also about putting a more formal structure into place while constantly asking if we can move more choice and control to the person themselves.

Conclusion

AAC is universal and we all use it. Using the chat window, text message, email etc. are all  examples of using an alternative to speech. 

I believe that when doing so we will want nothing less  than a robust set  of symbols to be able to communicate all that we have to say. To have Autonomy. Then why should we settle for anything less for our AAC user?