Songs to Self-Advocacy: How Customizing an AAC Device Supports Buy-in

Without trust, we don’t have a foundation.

“Customization of the device creates safety and builds trust because it communicates that the device was made for THEM and that we pay attention to their interests.”

I had the coolest session last week with my client that uses an AAC (Augmentative & Alternative Communication) device and is also a Gestalt Language Processor (GLP). He came into the clinic with his music page open on his AAC. He loves music and has perfect pitch and tempo, so anything that is said or done with melody, is a hit! We made a fort, he laid down in it, and as I covered the top of the fort with a blanket, I used a sing-song voice to model the phrase “put it on, put it on, put it on.” He immediately sang it with me and then proceeded to say, “let’s add it” to advocate that he wanted me to include a button on his device that had an audio recording of us singing, “put it on, put it on, put it on.” I created a new button on his AAC in the music tab that has a symbol of an object being put on top of a box, the audio recording of us singing, and the label “Put it on.” He used the button throughout the session when we were putting the wild animals on the shelf, stacking the foam blocks, and putting his shoes on after the session was over. The “put it on” button was not only meaningful to him, but it also prompted him to use oral speech to further communicate because of the intonation, melody, and emotion that came with the button. Now, when the session is over and I say “ it’s time to go,” he will sing, “put it on, put it on, put it on,” as he is putting his shoes on. 

Gestalt Language Processing (GLP) is a natural language acquisition style where an individual learns language in intonation-rich chunks or phrases rather than word-by-word. These phrases are often from media, songs, or familiar routines. Rhythm and intonation mean a lot to GLPs and oftentimes the scripts or phrases that they use have a lot to do with the feelings and emotions of the time that they heard those phrases. When providing speech-language therapy to GLPs, using songs or familiar melodies to model language makes the language easier for the child to process. I have noticed that when I model language in a monotone voice, sometimes the model goes unnoticed, whereas when I use varying intonation or have a melodic quality to my model, I will see the paralinguistic behaviors that constitute connection like: looking at me, repeating the modeled phrase back, smiling, etc. Making requests for GLPs looks different than requesting for an Analytical Language Processor (ALP). ALPs may request by asking, “Can I have a snack please,” whereas GLPs may request by using a script that was modeled or said to them when they were hungry like, “Do you want a snack?” Neither of these communication styles is “better,” needs are just expressed and processed in different ways and it’s our job to meet the child where they are and do our best to understand their language and what they are expressing to us. This is comparable to if you were texting someone and they were only communicating with you using emojis or memes. The delivery is different but you are communicating the same message and both messages are equally as valid. 

With gestalt language processors for whom we are considering or attempting to implement AAC, the most optimal way to create buy-in is by customizing AAC devices to fit the child and their interests. When the device reflects the individual and is customized to them, there’s a shift. When you can include their favorite songs, pictures of their family, or their favorite jokes, it becomes an extension of them rather than just a tool that they can use to communicate.

Customization of the device creates safety and builds trust because it communicates that the device was made for THEM and that we pay attention to their interests. There is a ripple effect that can happen when we customize devices… more use means that they are practicing navigating the device more which leads to more confidence in their communication.

Using tunes or melodies that the child already knows reduces the cognitive load and demand because it’s already in his memory. The melody is a vessel that made the language modeling seamless and meaningful to him. Songs on his device are also there for different reasons. His music page is full of songs that are sung by him and I as well as songs that he really enjoys listening to, like Bohemian Rhapsody by Queen. This is his device, and if we leave his favorite things out, we are doing a disservice to the potential progress he can make when that buy-in is strong. Adding in his favorite songs is more of a relationship decision rather than a clinical decision because that relationship to his device is such a huge priority! A song that he loves in his daily life that he requests to be played in the car, now being on his device means that the gap has been bridged and the device is in his daily life with the songs he loves. Another song that he enjoys listening to on his music page is a song that we sang together when we added the audio to his AAC, which is the, “I did it,” song. I love this song for many reasons especially because he is a GLP. When I model this song it gives him the power in his accomplishment that he doesn't necessarily get when he is told “good job.” “I did it,” is a narrative that he can carry and he gets to register that something happened and he was a part of it. This song doesn’t just work in the therapy room, which is intentional. Using this button and song across different settings marks his accomplishments and also helps build self-advocacy. Language sticks best when it matches the child’s routines, body movements, and moments. The moments create the songs and then the songs can be carried over and modeled in a variety of situations. 

When the addition of new songs stopped being something that I always did for him and rather something that we did together, I knew the buy-in was established. It started with me adding songs to his page that were meaningful to him, both songs that I sang and songs that he enjoyed listening to; which then turned into him handing me the device to communicate that he wanted me to include the song on his music page if I sang a song that he enjoyed. Now he uses oral speech and says, “let’s add it,” if I sing a song that he likes. The progress that has been made with his AAC device has been monumental. He can hear something in the car or on TV and then proceed to navigate to the music page on his device to make a request to add a button, which is a self-initiated chain of communication. This request is spontaneous, functional, and has generalized across environments. It was unprompted and he requested customization on his own. I also love the fact that he will bring his device to me to add the button together. We collaborate, we are a team in this, and we have a shared purpose! 

Independent and spontaneous navigation on the AAC means that the child is using the device to initiate a conversation, share the thought, and then find the words to advocate. Prompted communication and asking a child to, “tell me what you want,” with the AAC is pushing for compliance over communication. This moment was unprompted and he independently asked me to add a song, which showed me that his internal drive to communicate and customize his AAC to be able to further communicate is there and thriving. He has completely taken ownership of his device and his pages. The dynamic started with me modeling without expectation and morphed into him editing and advocating to customize his device. Seeing a child genuinely want to say something and communicate is when you know you have set up your sessions and modeling for success. 

This is why it is so important that we always presume competence because regardless of how a child communicates, by assuming that they have the desire to learn and capacity to understand, you have offered them respect and the opportunity to grow. It is the “least dangerous assumption” to assume that the child you are working with is able to understand what you are saying even though the way they demonstrate understanding may not be conventional or shown in a way that you are able to recognize. The ability to speak does not equal intelligence and when we foster a learning environment that begins from a point of aspiration rather than deficit, we believe that a child has limitless potential and our job is to support them in reaching their goals. 

I decided to record my own voice and add it to his AAC when I saw how much my songs stuck with him and realized that the familiarity and comfortability matters more than the production quality of a song. I try to attach my songs to functional moments, whether that’s achievements, activities, or transitions. Songs are helpful especially because when they are tied into a routine, they can make transitions and those difficult changes easier to do. Following their interests and tailoring your therapy and targets around things they like is a game changer, and in doing this we eventually got to where he was asking me to customize his AAC device to add things he is interested in. It is the most empowering and beautiful thing to watch when a child takes ownership of their device and their communication. It is our duty as professionals and caregivers to provide that power and access to communication to them in a way that feels safe and comfortable. This can all start by modeling a phrase as simple as, “let’s add it!” while you customize an AAC.