Posted in Uncategorized

Introductory Post- Assistive Technology and Accessibility

In the very earliest stages of childhood, babies and toddlers are learning how to develop and nurture relationships, express their wants, needs, thoughts, and ideas, navigate and explore their environments, and begin to care for themselves and help others. In addition, young children use exploratory, constructive, and early symbolic play to learn about themselves and their worlds and develop and practice new skills in all areas of development.

Many infants and toddlers have disabilities that affect their ability to see, hear, eat, speak, and move. In addition, some disabilities make it extra hard for babies and toddlers to manage their feelings, keep themselves safe, and relate to other people. Assistive technology can be used to help children with disabilities to participate in the same activities as their family members and other children their age in order to help them learn and grow.

Assistive Technology refers to “Any item, piece of equipment or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of children with disabilities.” (Individuals with Disabilities Education Act, 2004). Assistive technology devices can be as complex as a computer controlled with movements of the eyes or as simple as a spoon with an easy-to-grip handle. All children with disabilities can use assistive technology, but different types of assistive technology will work best for different children.

The purpose of this website is to help parents and professionals to access ideas, information, and resources relating to the use of assistive technology with infants and toddlers with disabilities. The primary goal is to help children with disabilities to access the world around them via augmentative communication, adapted play, assistive mobility, and self-care equipment.

Accessibility allows us to tap into everyone’s potential. Debra Ruh, Disability Rights Activist. Ruh is the mother of a child with Down syndrome.

For people without disabilities, technology makes things convenient. For people with disabilities, it makes things possible. Judith Heumann, Disability Rights Activist, former Special Advisor on Disability Rights to the US State Department under President Obama and Assistant Secretary of the Office of Special Education and Rehabilitation Services at the US Department of Education under President Clinton. Heumann had polio as a toddler and has used a wheelchair since early childhood.

“Disability is in the eyes of society. It is not in our eyes. If provided with opportunities, we can prove our worth.” Quotes from children with disabilities in Nepal.*

*Lansdown G, “Disabled Children in Nepal: Progress in Implementing the Convention on the Rights of the Child,” Disability Awareness in Action, London, 2003. Included in Save the Children UK and Sweden’s “Disability: See Me, Hear Me- Quotes from Children” and extracted from the Child Rights International Network at https://www.crin.org/en/library/publications/disability-see-me-hear-me-quotes-children.
Posted in Uncategorized

AT for the Holidays: Purim Fun! from Tech it Issie

The Jewish holiday of Purim will fall on Wednesday, February 28th and Thursday, March 1st this year (next week!). I love this post from Dana Cappel, Occupational Therapist, at Tech It Issie, about ways to incorporate assistive technology in order to modify Purim activities for young children with complex communication needs who celebrate. I definitely recommend checking it out!

Purim Fun! By Tech It Issie


Posted in Communication, Play, Literacy, and Learning, Self-Help and Self-Regulation

AT for the Holidays! Part 1: Halloween

Right now, my living room features ghost-shaped flashing string lights, a daybed with Halloween-themed throw pillows, and about 7 pumpkin and/ or oddly-shaped squash directions. The first week of October, I made my roommate decorate a light-up Halloween tree, which arguably isn’t even a thing.  And I’m currently wearing Nightmare Before Christmas socks. So I can tell you that we (OK, so it’s mostly me) absolutely love holidays in this house.

Because of this, one of my favorite ways to incorporate assistive technology into the lives of young children and their families is by helping children to participate in their own family holiday celebrations and traditions. Many times, families experience stress about how their own traditions with their extended families, friends, and/ or communities will be experienced by their child with disabilities. In general, while in some areas of AT we obviously want to stress skill acquisition, in terms of holiday celebrations my primary focus is just on making sure that the child with the disability is an active participant, just like the rest of the family, and is able to make meaningful memories and build social connections during these family traditions.

Since it’s October, I’m going to be focusing on Halloween-related examples in today’s post, but check back in in a couple of months for some winter Holiday themed editions! 🙂

Halloween Stories: Listening to and telling stories has always been a huge part of the Halloween experience for me. While toddlers and preschoolers aren’t going to be ready for classic “ghost stories,” there are a number of Halloween-themed board books and audiobooks designed for young children. Below are some ideas for adapting Halloween story-reading activities for children with disabilities.

Adapted Board Books: One toddler I worked with was a huge fan of the “Halloween Jack” book by Roger Priddy, which features a series of rhyming lines about various “spooky” characters (e.g., witch, robot, vampire). Several of the popular toddler/ preschool board book series, including Pete the Cat, Little Blue Truck, and Llama Llama, also offer Halloween editions. Board books and other picture books can be adapted using page fluffers, spacers, or turners, which are objects that are attached to the pages to help separate them/ make them easier to turn for children with disabilities. I usually do this by attaching Velcro to the corners of the pages, but there are a variety of strategies you can try. Carole Zangari’s Page Fluffers and Spacers post on PrAACtical AAC offers some great alternative suggestions; just be careful to supervise babies and toddlers when reading these adapted books, as some items (e.g., pom poms, foam stickers) may present a choking hazard.

Story Boxes: If you aren’t familiar with the concept of story boxes, check out my “story boxes” overview post from June. The Paths to Literacy for Students Who are Blind or Visually Impaired website, run by Perkins, has a post about creating a Halloween story box for the book, “The Little Old Lady Who Was Not Afraid of Anything.” Other Halloween stories can also be paired with custom story boxes by collecting a variety of objects with multisensory components (e.g., tactile, auditory, even olfactory) pertaining to each story and encouraging children to explore these objects while listening to their corresponding stories.

Audiobooks: Audiobooks are another great way to make literacy activities accessible for children with disabilities, particularly children with vision impairments (or, as kids get older, children with print disabilities such as dyslexia). Sparkle Stories is a subscription-based original audiobook service designed for children; they offer some fall and Halloween-themed story options that may be appropriate for older preschoolers. Audible also offers some Halloween-themed stories.

Arts and Crafts/ Sensory: WonderBaby, by Perkins school for the Blind, has a great post about Halloween-themed sensory activities for children with vision impairments. I particularly like their “accessible coloring book” and “grow a pumpkin in a pumpkin” ideas! Most Halloween-themed sensory table/ bin ideas, such as those on this Halloween sensory activity list from Kids Play Box, can be easily adapted for children with motor disabilities using easy-grip scooping tools (e.g., the O-Ball scoop bath toy) and adapted seating/ positioning solutions (e.g., standers/ walkers, adaptive seats). Switch-adapted pouring cups, such as this adapted pouring cup from Enabling devices, can help children with disabilities to take a more active role in creating sensory/ slime activities. If making edible slime or playdough, using a Powerlink to switch-adapt a blender or food processor as described in my post about Environmental Control for Toddlers, could also help children with motor impairments to participate more actively in creating sensory materials. Pumpkin decorating traditions can also be made more inclusive for children with disabilities by encouraging children to paint the pumpkins with easy-grip paint rollers and sponges, use multisensory decorating materials like puff paint, glow paint, or tactile foam faces, use easy-scoop cups to help scoop out a pre-carved pumpkin, or use picture communication boards or communication devices to direct an adult in decorating the pumpkins.

Choosing a Costume: Low and high-tech picture choice boards can be used to allow children with complex communication needs to select their own costumes from an array of choices. Children’s sensory and mobility needs may also play a role in costume selection. The Mighty has an article about sensory-friendly Halloween costume solutions for children with sensory sensitivities/ sensory integration disorder. In addition, there are many excellent posts and Pinterest boards regarding building Halloween costumes that incorporate children’s wheelchairs or other mobility equipment. There is a non-profit called Magic Wheelchair that donates costumes to children over 5 who use wheelchairs, and there are many DIY resources for parents seeking to create their own costumes for their children who use mobility equipment, such as this “Wheelchair Halloween Costume Ideas” article from Parents Magazine. 

Switch-Accessible Music and Decorations: Although in recent years many toys are being built with increasingly complicated internal switchboards and thus are more difficult to adapt for switch access, holiday decorations often continue to operate via a simple on-off switch with a single function. Many battery-operated decorations such as talking skeletons, string lights, or my light-up Halloween tree (pictures to come) can be adapted for use with a switch by inserting an inexpensive battery interrupter into the battery compartment. Simple decorations that plug into a wall outlet are often usable via a PowerLink or other switch control unit. In addition, cassette tape players or radios can be adapted via a PowerLink and used to play Halloween-themed music, or you can use a bluetooth switch, like the Blue2 Bluetooth switch from Ablenet, to adapt an iPhone or iPad for switch access and play Halloween music that way.

Communication While Trick-Or-Treating: Trick-or-treating often involves communicating with strangers, who may not be aware of the child’s communication needs. A sequential-message voice output device (such as Ablenet’s Step-by-Step with Levels) or multi-message voice output device (such as Attainment Company’s GoTalks) can be programmed with Halloween-related messages, (e.g., “Trick-or-Treat,” “I’m a dinosaur,” “Thank you!”), or a Halloween-specific communication board can be created within a communication app or printed and laminated for use as a low-tech AAC strategy.

Sharing About Halloween Experiences: In the days and weeks after Halloween, kids often want to talk to each other and their teachers about their experiences trick-or-treating, attending Halloween parties, or handing out candy. Messages related to kids’ Halloween experiences can be recorded on a single or sequential-message voice output device, or pages can be created within a personalized photo album (as described in my Personalized Photo Album post) to allow children to share about their holiday experiences.

Teal Pumpkin Project: Finally, though not directly related to assistive technology, I wanted to take this opportunity to talk about the Teal Pumpkin Project. The Teal Pumpkin Project is a movement run by Food Allergy Research and Education (FARE) to promote awareness of food allergies and the provision of allergen-free treats at Halloween. Since many children with disabilities may have very specific feeding needs or may not eat by mouth, many of the principles of the Teal Pumpkin Project (e.g., providing small toys to trick-or-treaters instead of or in addition to candy) may be applicable/ helpful.

I’m planning on adapting many of my own decorations for switch access and/ or use via electronic personal assistants (e.g., Amazon Alexa, Google Home) in the next week or so, so check back in for updates, and I hope you all have a happy Halloween!! 🙂



Posted in Communication, Play, Literacy, and Learning

Universal Design at Circle Time: AAC and AT During Group Singing Activities in Toddler and Preschool Classrooms

Recently, I’ve had many toddler and preschool teachers ask me how the children in their classrooms with complex communication needs (CCN) can be better integrated into classroom routines. One routine that I’ve worked on a lot has been the “circle time” or “group time” routine. I LOVE when I have the chance to work with my kids during circle time because it’s a time of day that can be very easily modified to offer so many naturalistic and motivating opportunities for communication across a variety of communication modalities (e.g., speech approximations, signs, picture choices, voice output devices, speech-generating devices). It’s also usually a high-engagement time for many of the kids I see, as most of them are highly motivated by singing and/ or reading activities.

When working on integrating kids with disabilities into childcare and preschool classrooms, I try to use a Universal Design for Learning (UDL) approach whenever possible. If you haven’t heard of Universal Design for Learning, it’s worth checking out the CAST website’s Universal Design for Learning pages as well as online resources from the National Center on Universal Design for Learning. UDL comes from the architectural concept of “universal design,” which refers to the concept of designing and constructing buildings with the access needs of people with disabilities in mind from the beginning, rather than first constructing a building with only the needs of people without disabilities in mind and then adding accessibility features after the fact. The idea is that if the needs of people with a diverse range of abilities and accessibility needs are considered from the beginning, accessibility features can be better integrated and time and money can be saved. Universal Design for Learning is a similar concept; the philosophy is that curriculum activities and classroom routines should be planned with the needs of all children in the classroom, including those with disabilities, in mind. This helps teachers and peers to include children with disabilities in activities more easily and naturalistically, rather than requiring teachers to plan special, separate activities for the children with complex needs while simultaneously trying to meet the needs of the rest of the children in their classroom.

The framework of Universal Design for Learning uses the key principles of “multiple means of representation,” “multiple means of action and expression,” and “multiple means of engagement,” (National Center on Universal Design for Learning at CAST, 2012). This basically means that information should be presented in multiple ways so that children who have difficulty perceiving information (e.g., due to vision, hearing, cognitive, or language needs) can access it, and that activities should include multiple ways of participating and demonstrating knowledge so that children with disabilities can be active participants and demonstrate their skills. Below are some examples of how these 3 key principles can be incorporated into singing/ music circle time activities with toddlers and preschoolers.

Multiple means of representation:

The most common way that information is presented during circle time singing activities is auditorily, via speech and singing. Some children with disabilities, particularly children with hearing, receptive language, or cognitive impairments, may have difficulty understanding information presented via speech alone. One easy way to modify circle time activities to be more inclusive to children with disabilities is by pairing speech with signs and gestures. I will often recommend that daycare and preschool classrooms begin by implementing a “keyword signing” approach. The Kid Sense Child Development Website’s Keyword Signing overview is a good resource for learning about this approach. Basically, “keyword signing” refers to the concept of signing the “key” (main) words in each sentence while simultaneously speaking the sentence. To use keyword signing at circle time, try introducing the activity by signing along with speaking. For example, you can say “it’s time for circle” or “it’s time for music” while signing the keywords “time,” “circle,” and “music.” Keyword signing can be incorporated into songs by signing the key words within songs. Below are some keywords that I focus on modeling signs for during popular toddler/ preschool songs as well as links to “baby sign” videos for each keyword from the Baby Sign Language Dictionary website:

Wheels on the Bus: wheelbusgobabyMommyDaddyI love youUpDown, door, open

Itsy Bitsy Spider: spiderupwater, down, rain, wash, out, sun, dry, again

Old MacDonald Had a Farm: oldfarmoncowpig, horse, chicken, dog, cat, sheep

Multiple means of action and expression: 

In many classrooms, toddlers and preschoolers express themselves during circle time by using spoken words to request songs. Children who do not yet speak also benefit from opportunities to make song choices in order to practice requesting and increase their symbolic communication skills. There are a wide variety of ways that children can do this, but some of my favorites are as follows:

Sign Language: If signs are being modeled during songs, some children who cannot speak but have adequate fine motor skills for signing may be able to use signs to request favorite songs or fill in words within songs.

Pictures: Photographs and/ or picture symbols or even drawings can be used to represent each song (e.g., Spider for Itsy Bitsy Spider, Bus for Wheels on the Bus, Star for Twinkle Twinkle Little Star) as well as specific lines within songs (e.g., pictures representing wheels, wipers, doors, lights, horn, etc. for Wheels on the Bus). These photographs and picture symbols can then be used to allow children to make song choices. Depending on the motor skills of the children, space constraints in the classroom, and preferences of the teachers within each setting, picture choices can be presented either by holding the choices in front of each child or by presenting them on a wall-mounted felt board and having each child come up to the board to make a choice on their turn. For children who cannot move their hands, pictures can be presented on an eye gaze board (i.e., clear piece of plexiglass or a cardboard frame held in front of the children at eye level to allow them to look at pictures in order to select them.) For children who benefit from voice output, photographs and picture symbols with corresponding recorded/ synthesized messages representing song choices can also be programmed into mid-tech voice output devices and high-tech speech-generating devices.

Objects/ Tactile Symbols: For children who don’t seem to understand or can’t see photographs or picture symbols, objects can also be used to represent songs and parts of songs. For example, a toy bus or steering wheel can be used to represent “Wheels on the Bus,” a plastic spider can be used for “Itsy Bitsy Spider,” a toy boat or boat paddle can be used to represent “Row Your Boat,” etc. Children with vision impairments should be encouraged/ helped to feel these objects with their hands in order to make a selection. If needed, objects can be presented one at a time, and children can be taught to give a “yes” response (smile/ vocalization/ eye contact/ tapping object with hand) to make a selection. To increase comprehension, it may be helpful if these objects are also used as props during the song (e.g., all children get a toy/ cardboard steering wheel to use during Wheels on the Bus, and then one of these wheels is used as the symbol to represent the song when it’s time to make a choice). Both object and picture symbols can also be used for “multiple means of representation” by presenting these symbols to children with disabilities to help them understand the choices made by other children in the classroom.

Multiple means of engagement: 

In many classrooms, children’s engagement during circle time largely occurs by sitting together on the floor, visually attending to the teacher, and filling in words or singing entire lines within songs. Some children with difficulties with attention, impulse control, and comprehension may have difficulty sitting and attending to activities. Additionally, children who do not speak may not have the opportunity to participate socially by singing along to songs. Below are some ideas for providing multiple means of engagement during circle time music activities:

Flexible Seating: The “flexible seating” movement is currently popular within elementary school classrooms as a way of redesigning classrooms to meet children’s diverse learning needs by providing a variety of seating options (rather than requiring all children to sit at desks or tables). Toddler and preschool classrooms generally have a greater variety of seating options throughout the day than classrooms for older children, but there are not always multiple options available during circle time. Children with atypical muscle tone, sensory integration disorder, or difficulties with attention may benefit from a variety of seating options beyond sitting directly on a rug or mat. Having adaptive floor seats like the Special Tomato Floor Sitter or Firefly GoTo and Floor Sitter accessory,  as well as sensory-friendly options such as beanbag chairs, floor cushions, or Wiggle Seats may be helpful for meeting children’s diverse seating needs. Some children with vision or cognitive impairments as well as many typically-developing children may benefit from anything tangible that marks a defined seating area, such as an individual rug or mat for each child (maybe even with a photograph of that child attached to it). However, be sure to work closely with physical and occupational therapists to determine the best seating needs for each child with a disability in your classroom.

Instrument or Prop Play: Most young children have difficulty sitting and attending passively to activities, as this is not yet a developmentally appropriate expectation for one to four year old children. To be honest, passive attention to activities is a skill that even I haven’t totally mastered yet :). Some kids may attend better and be more willing to participate in circle time activities if given instruments to play or props to use during each song. There are a wide variety of instruments that are accessible to children with disabilities, including switch-adapted musical instruments such as the adapted instruments available from Enabling Devices. The new Skoog device from SkoogMusic is also an instrument with amazing accessibility features for a wide variety of disabilities. Hand bells that strap to children’s wrists, large maracas that can be loosely grasped, and bongo drums may also be accessible to many children. I’ve found that many kids with significant physical disabilities are also still able to strum my ukulele, as it requires significantly less pressure to strum a ukulele’s plastic/ nylon strings than a guitar’s metal strings.

Simple Voice Output Devices: I love using single-message voice output devices like the BIGMack by Ablenet and sequential-message voice output devices like the Step-by-Step by Ablenet or BigTalk Triple Play by Enabling Devices to allow children to fill in parts of songs. Inexpensive, simple single-message recordable devices are also available online and at times in toy stores, such as these Recordable Answer Buzzers from Learning Resources. Key lines or words from songs can be recorded onto these devices, and children can activate the buttons to “sing” parts of each song. This can be useful for increasing social participation, practicing switch timing skills, and working on turn-taking, initiating, and language comprehension. I find it works especially well to record lines that are repeated frequently within songs (e.g., “EIEIO” in “Old MacDonald,” “all through the town” in “Wheels on the Bus,” “ah-ah-ah-ah-ah-ah-ah-ah-ah” in “If All of the Raindrops,” etc.). I also like to record high-excitement, high-interest lines, such as the scream at the end of the “alligator” version of “Row, Row, Row Your Boat” (“and if you see an alligator, don’t forget to scream!”). For children who cannot use their hands to activate a voice-output device, these devices can be attached to switches mounted by a child’s head, foot, finger, etc. Ablenet’s QuickTalker S may also be useful for children with particular types of motor impairments in that it is activated by proximity rather than pressure, meaning that the child just needs to get their hand (or foot or other body part) close to the button in order to activate it rather than exerting pressure to push down on it. The therapy team for individual children (SLP, OT, PT) should be consulted to determine the best access method for children who have difficulty activating simple voice-output devices directly.

With the right resources and a little planning, circle time can be a fantastic opportunity for children with disabilities to be active participants and to practice and show off their communication skills across a wide variety of communicative modalities. Check back in a few weeks for a follow-up article addressing AAC and AT during group reading activities, too, and feel free to comment below with your own ideas about circle time engagement and universal design for learning!


Posted in Communication, Play, Literacy, and Learning, Self-Help and Self-Regulation

“Can I Play Too?”: Involving Siblings in AAC/ AT Intervention

Miraculously, since before this week I hadn’t posted anything new since June (which is also when I started this blog!), I do still seem to have some followers who’ve been checking in over the past few months. Since then I have switched from a full time position in Early Intervention (EI) to a full time position as an AAC and AT Specialist, though I’m continuing to work in EI 1 day per week. So, lots of changes and exciting new experiences lately, but I’m hopefully just about ready to start updating again!

One of the things I’ve found most valuable about my experiences working in Early Intervention has been the ability to have family members integrally involved in intervention with the infants and toddlers on my caseload. Over the past several years, the principles of effective practice in Early Intervention have been modified to reflect an increased focus on family involvement and on embedding interventions into children’s daily routines (read: real lives). We know from research within the fields of child development, psychology, and education that young children learn best in context and with experiences that are repeated many times. In addition, young children’s understanding of the world is embedded within their relationships with family members and their role within the family unit.

One thing that’s important to note when involving siblings in intervention and when discussing families’ daily lives is that the siblings of children with disabilities have specialized needs and experiences of their own that require awareness, compassion, and support on the part of family members, teachers, and other caring adults. While working with infants and toddlers with severe disabilities, I’ve encountered preschool and school-aged siblings with a wide range of feelings and behaviors towards their brothers and sisters. Some children may feel jealous and resentful towards their siblings because of the increased attention they often receive from parents and other adults (including EI therapists, who they’re told come in specifically to play with/ teach their siblings) and the ways in which their daily lives are changed by their siblings’ needs (e.g., having to attend medical appointments, not being able to travel to certain places or do certain things if the sibling is medically fragile or can’t tolerate certain environments). Other kids may dedicate themselves to their younger siblings fully, even to the point of mistrusting therapists and viewing themselves as their younger sibling’s primary protector and teacher. Most kids will fall somewhere in between, or move back and forth, depending on the day. I’ve seen multiple young children with dramatically different perspectives and interaction patterns with their sibling with a disability even within the same family. It’s important to ensure that parents have access to information about the needs of siblings of children with disabilities as well as relevant resources, such as sibling support groups. The Center for Parent Information and Resource’s website has a ‘sibling issues’ page with quotes from siblings of children with disabilities, links to other articles discussing siblings’ needs, and links to local support groups. If you live in Massachusetts (like me), the Massachusetts Sibling Support Network website is a great resource for finding local sibling groups and services. I also found this post from M&L Special Needs Planning helpful in it’s discussion of signs of sibling stress as well as resources for supporting siblings.

In terms of involving siblings in AAC & AT interventions, I’ve seen a few different types of strategies work depending on the age and personality of the sibling and the child with the disability. The ways in which I’ve had success in increasing sibling involvement can be broken down into the following three categories: Siblings as (Mini) InterventionistsCooperative Play, and Little Caregivers.

The “Siblings as Mini Interventionists” approach encourages siblings to be “teachers,” “helpers,” (or even speech/ occupational/ physical (etc.) therapists, if the children know these words) for their (typically younger) siblings. I’ve found this approach to work really well with early school-age children (often aged ~5-10) who have a strong interest in and protective/ caregiving feelings towards their brother or sister. This also works well if the sibling has a strong interest in/ bond with the EI therapist, and is eager to please/ be helpful/ gain attention from the therapist by being his/ her “helper.” I’ve had success with this approach for involving siblings in the following types of tasks:

  • Gathering materials: Have the sibling collect and set up their brother or sister’s favorite toys and books and AAC tools (e.g., picture communication boards, voice output devices) at the start of the therapy session.
  • Taking photographs: Let the sibling use an iPad, phone, or digital camera to take photographs of their brother or sister’s favorite toys/ foods/ books, or have the sibling collect these materials and place them on a black background so that an adult can take the picture).
  • Assembling materials: Have siblings cut/ attach Velcro to/ laminate (with close supervision) materials for low-tech communication boards
  • Presenting picture choices: Teach the sibling how to hold up two photographs/ picture symbols in the air or present a communication board, then bring the selected item to their brother or sister once a choice has been made.
  • Selecting Messages: Ask the sibling to help you brainstorm messages that their brother or sister might want or need to communicate. Since siblings are closer to the child’s age, they may be even better at this than parents, therapists, or teachers :).
  • Recording voice output devices: I know a (then) 6-year-old girl and a (then) 5-year-old boy from different families who both immediately learned to record sequences of messages on Ablenet’s Step-by-Step with Levels on behalf of their 10-month old and 1.5-year-old siblings. I also worked with a 2-year-old boy whose 6-year-old twin brothers helped their mother to record messages on single-message Talk Blocks from Learning Resources (which are, sadly, no longer available) in order to make the messages sound more like a little boy, in terms of voice, intonation, and phrasing (so for example, they recorded things like “Mama, get over here!” in a horror movie-esque fake voice instead of “Come here please, Mommy” like maybe an adult would’ve recorded :P).
  • Aided language input:  If you don’t know what aided language input is, check out this introduction to aided language input Youtube video for a simplified explanation, and search “aided language” on the PrAACtical AAC blog website for research evidence and implementation ideas. Basically, though, aided language input refers to the concept of using a child’s AAC system to talk to him/ her in order to teach the child how to use the system to communicate expressively. Even toddlers and preschoolers can be taught to model aided language using a child’s AAC system by making selections on a communication device, signing key words, or pointing to pictures. And seeing older (or younger!) siblings using the system will help motivate the child to use it, since we all know toddlers want to do everything their brothers and sisters are doing!
  • Training other family members/ caregivers: The five and six-year-old children I described above have both been amazing advocates for their younger siblings. The little girl frequently told nurses, new therapists, etc., “that’s how my brother talks” in reference to his AAC system, and she was able to train caregivers to use it appropriately. The little boy reminds others to immediately reinforce his sister’s picture choices and teaches new ASL signs to family members regularly.

The “Cooperative Play” approach focuses on siblings as play and communication partners for the child with the disability. Many sibling sets will end up using a combination of the “Mini-Interventionist” and “Cooperative Play” approaches. Cooperative Play is also helpful for engaging younger (even infant) siblings, siblings who may be reluctant to engage with their brother or sister with a disability, or siblings who are feeling envious of the toys/ attention afforded to their sibling (which is a perfectly normal and appropriate reaction that they should not be made to feel ashamed of). Some ideas for using the “Cooperative Play” approach are as follows:

  • Blowing bubbles: The child with a disability can turn on and off a switch-adapted bubble machine, and siblings can share in playing with the bubbles and even take turns operating the switch. I’ve seen this work well even with a preschool boy who normally was not very interesting in playing with his toddler brother. Another option is to have the child with the disability use a voice output device, speech-generating device, or picture communication board to direct play with bubbles (e.g., say “go” to tell a sibling to blow the bubbles, choose whether the bubbles should be blown up or down, popped or stomped on, etc.).
  • Music: The child can use a switch to control a radio or tape player (with a switch control unit, as discussed in my Environmental Control for Toddlers post), or operate a switch-adapted musical toy. Siblings could play “freeze dance” by freezing whenever their brother or sister turns the music on or off. The child can also use AAC to select a song to sing or play or an instrument to play. For example, I’m working with a baby who is learning to make picture choices, and a few weeks ago we practiced having her choose a song, then having her 6-year-old brother play that song for her on his guitar while we sang.
  • Giving Directions: While siblings might not love being bossed around, there are many typical preschool and early school-age games that involve one person giving directions. The child who uses AAC could activate a sequential-message voice output device to give directions for games such as “Simon Says,” “Red Light Green Light,” “Mother May I,” “Fishy, Fishy, May I Cross Your Ocean,” etc. This will give the child a sense of control while letting the siblings be actively involved in the play.
  • Board Games: As children reach the preschool and school-age years (or for some children, even late toddler years), participation in early board games may be a great opportunity to engage in cooperative play with siblings. There are a variety of adapted dice and spinners available (e.g., dice domes that may be easier to press such as this dice dome from Learning Resources, switch-adapted dice rollers such as this dice roller from Enabled Solutions, switch-adapted spinners like the All-Turn-It spinner from Ablenet, etc.). Additionally, Ablenet makes a version of the Step-by-Step called the Step-by-Step Gameplay that includes “randomization,” “random elimination,” and “choice-making” modes to support participation in a variety of board and card games. I also love adapting the game Zingo with pictures of relevant vocabulary (e.g., Boardmaker symbols for core words, pictures of family members), as this game is already easier to access than most because of the large, easy-to-operate chip dispenser.
  • Computer/ iPad Games: With a switch and compatible switch interface, there are many switch-accessible games available on the iPad and online.The HelpKidzLearn website and HelpKizlearn iPad apps are excellent sources of many switch-adapted activities. Some of these games support dual switch access and can be played as 2-player games, such as the “Bumper Cars” game.

The third and final type of sibling play I’ve seen in Early Intervention- what I’ll call “Little Caregivers”- has occurred when the child with the disability is the older sibling and has a younger infant brother or sister. In this case, it’s often appropriate to use some of the Cooperative Play suggestions, such as having the child with the disability blow bubbles or play music for their infant sibling. If the child has a propensity for caregiving towards the younger sibling, some of the following suggestions may also be helpful.

  • Toy and Book Choices: The child could use a speech-generating device or low-tech picture communication system to choose a toy or book for their infant sibling.
  • Story Time: The child could use a switch-adapted storybook app, such as Pictello, a recordable story book, or a sequence of messages recorded on a sequential-message voice output device to “read” to a younger sibling.
  • Lullabies: The child could use a sequential-message voice output device to sing to an infant sibling, especially if the sibling is fussy.

In my own practice, I’ve worked with some amazing older siblings who’ve been incredibly passionate about helping their younger brothers and sisters to communicate more effectively and access play activities. I’ve also worked with some toddlers with disabilities who were themselves passionate caregivers for their infant siblings. I’ve found assistive technology to be an incredibly helpful tool for increasing children’s opportunities to engage meaningfully with their brothers and sisters and be included in family routines.

Feel free to share other suggestions for sibling play using assistive technology below!


Posted in Play, Literacy, and Learning, Self-Help and Self-Regulation

Environmental Control for Toddlers and Preschoolers: Switch Control Units

Anyone who works with toddlers, has a toddler… or has ever seen a toddler in passing knows that a desire for control is a fundamental characteristic of 1-3-year-old children. Erik Erikson, one of the most influential early developmental psychologists, developed a theory of psychosocial development that included 8 primary developmental phases, each with a defining “conflict” at the center of emotional development (see Kendra Cherry’s Psychological Stages article on VeryWell for a good overview of Erikson’s psychosocial stage theory). According to Erikson, between the ages of 18 months and 3 years, children’s psychosocial development is defined by the conflict of “autonomy vs. shame and doubt,” where toddlers strive to prove to themselves and others that they can do things on their own and make their own decisions. Although the field of developmental psychology as a whole and our understanding of young children’s social-emotional development in particular has advanced considerably since Erikson developed this theory, and we now know that psychosocial development is a lot more complicated, the drive for autonomy continues to be a defining component of toddlerhood, at least within many Western cultures.

Environmental control is an area of assistive technology that addresses the ability of individuals with disabilities to operate equipment within their environments. This includes the ability to control lights, appliances (e.g., fan, remote control, microwave, dishwasher), entertainment technology (e.g., TV, radio), communication technology (e.g., phones), and security equipment (e.g., alarms, door lockers/ openers, security cameras). Recent innovations in this area, including the expansion of integrated “smart home” technologies, have dramatically increased opportunities for people with disabilities to live independently and/ or increase their independence in many aspects of self-care.

Many environmental control units (ECUs) are actually mainstream devices used by people with and without disabilities. For example, TV remotes and personal assistant devices such as Amazon Alexa and Google Home are widely used regardless of disability status.

While typically-developing toddlers are probably not normally in charge of turning on the air conditioning or monitoring the security cameras (but who knows- I don’t know your kid), they do have plenty of opportunities to begin to “control” their environments. I know many 2-year-olds who are obsessed with light switches and love pushing the buttons on TV remotes. I even worked with one 18-month-old who seemed to prefer turning the air conditioner in his bedroom on and off over playing with his toys (which for obvious reasons, we worked on redirecting 🙂 ). In addition, typically-developing toddlers practice influencing their environments through spontaneous play, experimentations with early mobility, and by communicating with others (for example, when asking for something from a parent or bossing around a sibling).

Toddlers with severe/ multiple disabilities often have decreased opportunities to experiment with and explore their environments. In addition, sometimes families and childcares have a hard time helping children with disabilities to be active participants in daily routines and special celebrations. Adapted environmental control activities can be incredibly useful for increasing children’s opportunities for cause-effect experimentation and social participation within their daily lives.

Switch control units, such as the PowerLink 4 by Ablenet, are an incredibly effective means for allowing young children to experiment with early environmental control. These units connect to a capability switch and have a set of outlets which simple, standard electronic appliances can be plugged into, allowing children with physical disabilities to turn on and off simple appliances such as lights, fans, radios, blenders, etc. Below are some ideas for using the PowerLink (or a similar switch control unit) and a switch to help a child with physical disabilities to participate in daily routines. (Note: I’m going to refer to the PowerLink for the rest of this post because it’s the most common switch control unit, in my experience, and the one with which the most professionals are familiar. But I’m in no way affiliated with Ablenet, and I think you should use whatever similar device you have available to you 🙂 ).

Music and Stories: The PowerLink and switch can be paired with a radio or cassette tape player to allow the child to turn music on and off. If there are siblings or classmates present, the child could direct a game of “freeze dance” in which all children “freeze” whenever the music is turned off and resume dancing when it is turned back on. In addition, if you happen to still have a cassette tape player, the PowerLink can be paired with it to allow a child to turn on and off music or cassette tape audiobooks (maybe they could lead a story time activity?).

Temperature Control: Many of the children  that I have worked with have had significant trouble regulating their body temperatures. The PowerLink can be connected to a personal fan, which a toddler can be taught to turn on and off to gain increased control and self-help skills related to maintaining a comfortable body temperature. In a preschool or elementary school setting, a small desk fan or space cooler could be secured to a child’s wheelchair tray or desk and connected to a switch to allow the child to regulate his/ her own temperature (note that an outlet in the room would need to be available so that the PowerLink could be plugged in, however).

Lights: Floor lamps, table lamps, plug-in nightlights, etc. can all be connected to a PowerLink to allow a child to turn them on and off. I used to work with a toddler whose home health nurse had set up Christmas Lights in the shape of a tree on his bedroom wall. We then connected these to the PowerLink to allow him to turn them on and off.

Cooking: If you like to involve your kids in cooking, the PowerLink is helpful for allowing young children with disabilities to take an active role. Simple appliances with a wall plug and on-off switch, such as a blender, hand mixer, etc., can be attached to the PowerLink and turned on and off by the child. Just be sure to take all appropriate precautions to avoid any risk of cuts/ burns when involving your toddler in cooking activities.

Get Creative!: There are a lot of different ways in which switch control units can be used to give toddlers and preschoolers more independence in play and self-help activities within their daily lives. For example, a professor of mine in an Assistive Technology for Infants and Toddlers course that I took as part of the University of Illinois at Chicago’s Assistive Technology Certificate Program suggested attaching a hair dryer to the PowerLink, then helping a toddler with motor disabilities use it to blow down blocks in a tower. If you come up with any non-traditional ideas for using the PowerLink of your own, definitely share them in the comments section below!

Ultimately, as with all assistive technology, switch control units can help toddlers to increase both their self-help skills and their opportunities to connect and engage with others. It’s never too early to teach children that they have a role in controlling their own environment, and it’s never too early to incorporate them into family traditions and routines :).

Posted in Play, Literacy, and Learning

Story Boxes

Story boxes are collections of toys and objects that correspond to specific books and can be used to help tell a story. When using a story box within literacy activities, objects corresponding to each part of the story can be provided to the child for tactile/ visual/ auditory exploration and play while the story is read aloud. This can help to reinforce the storyline and concepts within the book. Story boxes are most often described in the context of interventions for children who are blind/ have vision impairments. In addition, story boxes are also extremely useful for making stories more cognitively accessible to children who might have difficulty attending to and comprehending the stories without more concrete, physical representations. Even typically-developing infants and toddlers can benefit from the use of story boxes, since at this age children are concrete learners and are just beginning to develop symbolic understanding (the realization that one thing can stand for another, such as a picture standing for a real-life object or a word standing for a concept).

The WonderBaby blog sponsored by Perkins School for the Blind describes Story Boxes and their benefits for children with vision impairments in this post: Story Boxes: A Hands-On Literacy Experience. They also include some example story boxes corresponding to popular books for young children. The Paths to Literacy website, also by Perkins, provides further suggestions about how to make and use story boxes, particularly for children with vision impairments. The Texas School for the Blind website also provides additional story box examples: What Is a Story Box? by Texas School for the Blind.

Here’s an example of a story box that could be created for the popular board book Little Blue Truck along with explanations of how to modify the activity for different types of access needs:

Little Blue Truck by Alice Schertle, Illustrated by Jill McElmurry:

  • Toy little blue truck and dump truck: You can use any blue toy truck + toy dump truck. Or consider adapted options to meet kids’ motor/ sensory-perceptual needs.
  • Play “muck”/ mud. You could use kinetic sand, brown Play Doh, etc.
  • Something to represent the animals in the story: sheep, cow, pig, chicken/ hen, baby chick, goat, horse, duck, and toad. You can use plastic animals, beanie babies, stuffed animals, animal finger/ hand puppets, animal form puzzle pieces, felt animals for a felt board, etc. The types of animals you may want to use are going to depend on your specific child’s access needs. For example, for a child with significant vision impairment, you will likely want animals with a tactile component (i.e., touch-and-feel animals with different textured surfaces that kids can feel and explore) or auditory component (i.e., animals that make sounds, such as by pressing a button to hear a recorded sound or manipulating a crinkle toy). For a child with motor impairments, you will want animals that are easy to grip and manipulate, or that can be moved around without picking them up (e.g. switch-adapted or remote control animal toys). Some examples are described below; I have not purchased/ used all of these options, but I’ve used some and others just look promising. Note: I don’t benefit financially from the sale of any of these products and have no affiliated with the companies listed (despite the ridiculously high number of examples of Melissa and Doug products that I listed). These examples are informational only.

Tactile animal options:

Large Soft Touch Animals from Discount School Supply (includes pig, cow, sheep, and horse). These are large plastic animals with soft, textured surfaces.

Melissa and Doug Farm Animals Touch and Feel Textured Wooden Puzzle (includes sheep, cow, duck, and horse). The wooden puzzle pieces each have different textured cloth surfaces that cover part (but not all) of each piece.

Auditory animal options

Melissa and Doug Take-Along Baby and Toddler Play Mat (includes cow, pig, chicken, duck, sheep, goat, horse, and 2 farmers). This is a cloth play mat that folds up into a carrying case and includes small soft animal toys that crinkle, squeak, and/ or rattle when manipulated.

Melissa and Doug Meadow Medley (sold separately; available animals include cow, pig, duck, lamb, frog, horse, and more) Meadow Medley Cow, Meadow Medley Piggy, Meadow Medley Duck, Meadow Medley Lamb, Meadow Medley Frog, Meadow Medley Horse

Easy grip animal options

Learning Resources Jumbo Farm Animals : Large plastic farm animals that are easy to pick up. Includes horse, pig, cow, goat, sheep, rooster, and goose.

Fisher-Price Little People Farm Animals: Like all Little People toys, these farm animals are easy to grip and hold. Includes cow, pig, duck, horse, sheep, chicken, goat, and more.

Switch-adapted animal toys

Switch-adapted animals from Ablenet: Includes horse and pig options.

Switch-adapted animals from Adapted Tech Solutions: Includes cow, pig, frog, lamb, duck, and more.



Posted in Communication, Play, Literacy, and Learning

Personalized Photo Albums

Personalized photo albums allow infants and toddlers to participate in telling stories about their favorite people, favorite activities, and daily lives. These albums provide opportunities for building pre-literacy skills, which are the skills that children need to learn in order to read well when they are older. Some important pre-literacy skills that kids can learn from personalized photo albums include book orientation (holding the book right-side up), book navigation skills (e.g., turning pages from left to right), increased comprehension of narrative language (the type of language used to tell stories), and increased vocabulary. Objects with environmental print can even be incorporated into the books to build early print recognition skills (e.g., an empty, clean piece of an apple sauce pouch with the label visible could be attached to the page to allow the child to share information about favorite foods).

Personalized photo albums can also increase young children’s opportunities for participation in activities with other children and adults, and can build social and turn-taking skills. For example, if a preschool classroom typically has a “show and tell” time,  children who have speech delays or disorders could use a personalized photo album to take their turns and share about things that are meaningful to them. If the childcare or school classroom teacher is willing and able to take photos and either print them out or import them into the child’s iPad, then personalized photo albums can be used to allow children to share information with their parents about what they did at school.

There are many different ways to create personalized photo albums for your child. One option is to create these books on the iPad using a photo album app. These apps allow you to import your own photographs, type text to go along with the photos, and record yourself speaking a message for each page. There are several apps that do this, but some good ones to try are Pictello ($19.99), Story Creator (free), and Book Creator (free limited version, or upgrade for $5). Keep in mind that if your child has a physical disability and has trouble using his or her hands, Pictello has the most options for supporting your child’s access (it is switch-adaptable, and the pages can also be turned by tapping with a full hand anywhere on the iPad’s screen for children who cannot point and swipe). You can also create electronic story books on the computer in Tar Heel Reader.

Physical recordable photo albums, meaning photo albums that let you record auditory messages, are available both from companies that make products for individuals with disabilities (e.g., Talking Photo Album by Attainment Company) and sometimes commercially on Amazon or in regular stores.

You can also use a regular photo album or a baby book with spots for adding photos (like the Sassy Look Book here: ) to meet the same goals! In addition to photos, you can try adding things like wrappers from favorite foods, kids’ drawings, stickers from a visit to the doctor, ticket stubs, or objects from nature as reminders of family events and daily routines. One way to do this is to make a “Baggie Book” by putting pictures or drawings in Ziplock bags and stapling them together (e.g., see this description of Baggie Books on Dr. Jean’s blog). Just supervise very closely if you use these with young children, since staples can be sharp and/ or a choking hazard and Ziplock bag zippers can come off and be accidentally swallowed.

Personalized photo story books are a great early learning and communication activity for any baby or toddler- even children without delays or disabilities. They can help your child to build close relationships with others, express concepts, learn about their world, and practice early reading skills. And they are good practice for kids who are learning to use photos for communication!

Posted in Communication

Other Websites for Early Childhood AAC

I wanted to compile a list of other web resources for families who might be seeking information about AAC use with infants, toddlers, and preschoolers.

Websites and Blogs by AAC Professionals:

Early Intervention for Young Children with Autism, Cerebral Palsy, Down syndrome, and Other Disabilities by Janice Light- This is an amazing resource that family-friendly explanations of how to use AAC with very young children. It also features many videos of infants and toddlers with significant disabilities using AAC in real-life functional contexts such as participating in songs, reading with parents, and playing peekaboo. This is a completed web resource rather than a blog; it is not updated regularly.

PrAACtical AAC by Carole Zangari- PrAACtical AAC is an absolutely amazing blog that covers AAC use across the lifespan, but primarily focuses on children. I would say that the bulk of the posts pertain to school-age children, but there are definitely over 100 posts, videos, etc. that discuss AAC use with infants and toddlers as well. The blog allows you to search by tag; search tags, “Early Intervention,”infants,” “toddlers,” and “preschool” all bring up many posts that are relevant to this age group. There are new posts several times per week as well as weekly summary posts and videos.

There are many, many other blogs by professionals that have tons of great information about AAC, but I wanted to highlight those two to start, as they very consistently have excellent information that is relevant to this age group. I also find them to be relatively easily to navigate and accessible to parents. Janice Light and Carole Zangari are also both leading researchers within the AAC field.

Blogs by Parents of Children who Use AAC:

Uncommon Sense by Dana Nieder- This blog tells the story of a child with an undiagnosed (until this month) rare genetic disorder and her journey with AAC. Dana Nieder began her interest in AAC because of her daughter, and has since also started grad school for speech-language pathology. Her daughter, Maya, uses Speak for Yourself on the iPad as her primary form of AAC.

Star in Her Eye by Heather Kim Lanier-  This blog is written by the mother of a little girl, Fiona, with Wolf-Hirschhorn syndrome. Fiona also uses Speak for Yourself on the iPad to communicate.

Fighting Monsters with Rubber Swords by Rob Rummel-Hudson- Rob Rummel-Hudson is the father of a teenage girl with bilateral perisylvian polymicrogyria named Schuyler. In addition to running a blog about his daughter’s life and experiences, he also wrote a novel about Schuyler’s life called Schuyler’s Monster (St. Martin’s Press, 2009). Schuyler uses a dedicated communication device made my Prentke-Romich Company to communicate.

We Speak PODD by Karen Owens- This is actually a Facebook page rather than a blog, but Karen posts several times per week with updates on her children’s communication journeys. Karen has adopted four children with severe disabilities who all use PODD (Pragmatically Organized Dynamic Display) communication books and/ or apps (depending on the child) to communicate. She regularly posts videos, photos, and descriptions of AAC use by the whole family in real life daily contexts.

Assistiveware, the company that makes the Proloquo2Go communication app as well as additional assistive technology software, posted a list of additional family-run blogs featuring AAC on their website here: 5 Fantastic Family AAC Blogs.

Websites from AAC Device Manufacturers and App Developers:

Although sometimes developers/ manufacturer websites can be biased towards their own products, there are many that provide excellent information.

Tobii-Dynavox Implementation Toolkit-  Tobii-Dynavox is one of the biggest manufacturers of dedicated AAC devices and has also designed several AAC apps. The Tobii-Dynavox website includes their Implementation Toolkit, which has some information that is specific to operation of Tobii-Dynavox devices, but also has a variety of general introductory AAC information. I would recommend going to the “Learning Paths” section (included in the link above) and looking into the AAC 101 and AAC Myths Revealed sections if you are new to AAC. There are also some helpful handouts in the Tools for AAC Users section, and there’s a specific section on AAC and Autism that provides summaries of relevant research and some implementation ideas.

AAC Language Lab by Prentke-Romich Company (PRC)-PRC is another one of the largest/ most well known AAC device manufacturers. Their “AAC Language Lab” includes separate pages for speech-language pathologists, parents, and educators as well as a blog page. Some information is free, while there are other sections that can only be accessed via a paid ($84) annual subscription. Within the AAC Language Lab free resources section, the “Getting Started with AAC” and “Choosing an AAC Device for Your Child” documents have some helpful introductory information for parents.

There are many, many more resources: I will continue to update this over time. Just wanted to get a partial list out there to start! 🙂

Posted in Mobility

Powered Ride-On Cars for Toddlers: Go Baby Go!

**Note: Mobility is outside of my scope of practice as a speech-language pathologist. I have received additional education about assistive mobility via assistive technology coursework and collaboration with other professionals, but it is extremely important to note that all mobility decisions should be made in collaboration with an occupational and/ or physical therapist, which I am not. As a result, this post should be taken as informational rather than as medical advice.

I first learned about Go Baby Go! as a speech-language pathology graduate student during a clinical placement. There was a physical therapy (PT) student who was completing the placement at the same time as me. At the end of the placement, the PT student gave a presentation on the Go Baby Go! organization as well as some basic background information on the importance of early mobility.

Go Baby Go! is a non-profit program that was started by Cole Galloway, a physical therapy professor at the University of Delaware. Information about the program is available on the University of Delaware’s website. More information is also available through this article from National Swell (Cheney and Templin, 2014) as well as the Go Baby Go! introductory Youtube video, which I would HIGHLY recommend watching.

The basic premise of Go Baby Go! is that commercially-available power-operated ride-on cars, such as Power Wheels by Fisher price, are electrically and mechanically modified so as to be accessible to children with physical disabilities. Often the cars are adapted so that the child can activate a switch or use a joystick to control the cars, instead of the buttons already on the cars that may be too difficult for them to activate. Adaptations can also be made to the car’s seats to support safe positioning for children with disabilities. In the Youtube video, Cole Galloway also discusses the modification of some of the cars in such as way as to provide “custom physical therapy” for individual children’s needs (e.g., placing the switch to control the car under the feet of a child learning to stand or behind the head of a child who is working on head control).

This is an amazing program because it is extremely difficult to get access to power mobility options for infants and toddlers. Early access to mobility promotes cognitive and language skill development, so it’s really important that for kids with physical disabilities resulting in mobility challenges, alternate forms of mobility are provided early and often. This article from Mobility Management does a GREAT job explaining why early access to mobility is SO important. I will likely do a follow-up post at some point with further research regarding the importance of providing early assistive mobility access for kids with physical disabilities.

There is a Go Baby Go! branch in Connecticut that offers workshops and will adapt cars for children if they attend with their families (information available on the Go Baby Go Connecticut Facebook page). You do not need to live in Connecticut to go to the workshops or receive an adapted car, but you do need to be able to transport yourself and your child there for the workshop. For people with access to electrical engineers, Go Baby Go! has also made the information about how to modify the cars publicly available.

Posted in Communication

Why Use Augmentative Communication?

When babies and toddlers have speech that is absent, delayed, or hard to understand, they benefit from the addition of other forms of communication, including signs, pictures, and voice output (buttons or computers that “talk”). These additional forms of communication are referred to as augmentative and alternative communication, or AAC.

Sometimes, parents are afraid that if other ways of communicating are added, kids might not learn to talk as early or as well. However, research has shown that introducing AAC increases speech 89% of the time and never decreases speech (meta-analysis by Millar, Light, and Schlosser, 2006).

Parents and some therapists also might wonder if it’s too early to introduce AAC to a young child. However, a systematic review (a professional article that summarizes the results of many different research studies) of AAC in Early Intervention (Romski, Sevcik, Barton, Hulsey, and Whitemore, 2015) showed that AAC had lots of benefits for babies, toddlers, and preschoolers. The research included in that systematic review showed that introducing AAC helps to improve young children’s language skills in the following ways:

  • Increases expressive vocabulary (Adamson  &  Dunbar,  1991;      Barton,  Sevcik,  &  Romski,  2006;  Bondy  &  Frost,  1994;  Lüke,  2014;      Wright,  Kaiser,  Reikowsky,  &  Roberts,  2013)
  • Increases multi-‐word combinations  and grammatical  skills    (Binger  &  Light,  2007;  Harris,  Skarakis  Doyle,  &  Haff,  1996).
  • Increases the functions  for  which  children communicate  (Light  et  al.,  1985  a,  b,  &  c)
  • Increases children’s conversational  turns   (Light  et  al.,  1985  a,  b,  &  c)
  • Increases the number  of  back- and- forth   interactions  between  children  and  their  parents  (Pennington  &  McConachie,  1999;  Light,  Binger,  &  Kelford  Smith,  1994).
  • Increases  language  comprehension  (Brady,  2000;  Drager  et  al.,  2006)

Other research has shown that introducing AAC can help kids with their behavior and self-regulation skills. For example, studies of found the following benefits of introducing AAC:

  • Decreases negative behaviors caused or worsened by difficulty communicating (e.g.,   in   combination   with   functional  communication   training   (Durand,   1993,   Mirenda,   1997)
  • Improves transitions between activities (e.g.,  Dettmer,  Simpson,  Myles,  and  Ganz,  2000)

Overall, if children are having trouble communicating because of a speech delay or disorder, using AAC strategies like sign language, pictures, and communication devices can help kids to talk more, develop stronger language and social skills, and improve their behavior. It’s a good idea to start using some of these strategies as soon as possible to keep kids from becoming too frustrated or falling too far behind.


Adamson, L. B., & Dunbar, B. (1991). Communication development of young children with tracheostomies. Augmentative and Alternative Communication, 7, 275–283.

Barton, A.,Sevcik, R.A., & Romski , M. A . (2006). Exploring visual-graphic symbol acquisition by pre-school age children with developmental and language delays . Augmentative and Alternative Communication , 22 , 10 – 20.

Brady, N.C. (2000). Improved comprehension of object names following voice output communication aid use: Two case studies. Augmentative and Alternative Communication, 16, 197 – 204 .

Binger, C. , & Light , J . (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC . Augmentative and Alternative Communication, 23, 30–43.

Bondy, A.S., & Frost, L.A. (1994). The picture exchange communication system. Focus on Autism and Other Developmental Disabilities, 9, 1– 19. Dettmer, S., Simpson, R.L, Myles, B.S., and Ganz, J.B., (2000). The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15:3, 163-169.

Drager, K., Postal, V.J., Carrolus, L., Castellano, M., Gagliano, C., & Glynn, J. (2006). The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism. American Journal of Speech;Language Pathology, 15, 112 – 125.

Durand, V., (1993). Functional communication training using assistive devices: effects on challenging behavior and affect. Augmentative and Alternative Communication, 9:3, 168<176.

Harris, L., Skarakis Doyle , E., & Haaf, R . (1996). Language treatment approach for users of AAC: Experimental single-subject investigation. Augmentative and Alternative Communication, 12, 230–243.

Light, J.C., Binger, C., & Kelford Smith, A. (1994). Story reading interactions between preschoolers who use AAC and their mothers . Augmentative and Alternative Communication, 10, 255–268.

Light, J.C., Collier, B., & Parnes, P. (1985a). Communicative
Casey Bryn McCarthy Benefits of AAC for Young Children, 2015 Light, J.C., Collier, B., & Parnes, P. (1985b). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part II – Communicative function Augmentative and Alternative Communication, 1, 98 – 107. interaction between young nonspeaking physically disabled children and their primary caregivers: Part I – Discourse patterns. Augmentative and Alternative Communication, 1, 74–83.

Light, J.C., Collier, B., & Parnes, P. (1985c). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part III – Modes of communication. Augmentative and Alternative Communication, 1, 125 – 133.

Lüke, C. (2014). Impact of speech-generating devices on the language development of a child with childhood apraxia of speech: a case study. Disability and Rehabilitation: Assistive Technology, 0, 1–9.

Millar, D.C., Light, J.C., and Schlosser, R.W. (2006). The impact of augmentative and alternative communication on the speech production of individuals with developmental disabilities: a research review. Journal of Speech, Language, and Hearing Research, 49, 248-264.

Mirenda, P., (1997). Supporting individuals with challenging behavior through functional communication training and AAC: research review. Augmentative and Alternative Communication, 13:4, 207-225.

Pennington, L., & McConachie, H. (1999). Mother–child interaction revisited: Communication with non-speaking physically disabled children. International Journal of Language & Communication Disorders, 34, 391 – 416.

Romski, M., Sevcik, R.A., Barton-Hulsey, A., and Whitmore, A.S. (2015). Early Intervention and AAC: what a difference 30 years makes. Augmentative and Alternative Communication, 31:3, 181-202.

Wright, C. A., Kaiser, A. P., Reikowsky , D. I. , & Roberts , M. Y . (2013). Effects of a naturalistic sign intervention on expressive language of toddlers with Down syndrome. Journal of Speech, Language, and Hearing Research, 56, 994–1008.