AAC at mealtimes

How to use AAC to help improve communication at mealtimes

This post is about Augmentative and Alternative Communication (AAC). We’ll talk about how to use AAC at mealtimes to help communication. We will expand on the use of AAC picture cards, as a supportive tool for a healthy and varied diet. Scroll to the bottom of the post to see the instructions on how to make an AAC binder and cards for mealtimes.

How to use AAC - cover page for AAC at mealtimes binder
Cover page for the AAC at mealtimes binder

What is AAC

Before we can go into detail about using AAC at mealtimes to introduce a more diverse diet, we’ll begin by explaining shortly what AAC cards are, and how they can contribute to the daily functioning of people who have difficulty communicating verbally.

What is the PECS method

PECS picture exchange communication system – a behavioral approach to using AAC picture cards or communication boards on electronic devices.

In this method, the child points to a picture of a word that he wants to say, and if the child can, we encourage him to say the word or some of the syllables (for example, carrot. We will see the picture of a carrot on the picture board , say the word carrot, break it down into syllables Ka-Rut, and try to help the child express it). The use of PECS should be taught gradually.

First the child will be encouraged only to point at the image with the assistance of the parent. We will move the child’s hand on top of the images until he stops. We’ll say the word aloud, and pass it on to the sentence strip, to signal that that the child has chosen. We will introduce the contents of the image, either in the real product or in a product that simulates it for example a plastic carrot for the carrot image.

Next we’ll add actions images, for example an image that expresses the term “I want”. At first, we help the child transfer the action images along with the object images he wants, in order to build a sentence with the images. First, with one object image at a time, and slowly we expand the image binder, with images that the child can use. This stage can take a short time, or take years to complete. It is hard to anticipate what the child’s ability will be in advance.

Using the PECS method to encourage verbalizing

When the first stage is already established, and the child knows how to use the picture panel himself to communicate his desires, we can attempt to try the next step: encouraging the child to verbalize the content of the images. We’ll point to a picture the child has chosen and pronounce it aloud, while helping the child pronounce the word, breaking down the word into syllables. We will continue with the same method as before, but with a little more emphasis on verbalizing. We will be very patient with children and attentive to their needs. This stage is very difficult for a lot of children.

According to some studies, the use of PECS does not encourage verbal communication, but they do encourage the initiation of communication. A well-practiced child will make more attempts to ask his caregivers for what he wants. This behavior can be used in conjunction with other methods to encourage verbalizing, according to the child’s ability.

AAC versus PECS

The purpose of AAC is to give voice to children and adults who are not verbal. The cause can be vary: autism, selective muteness, surgeries involving vocal cords, to Alzheimer’s or age-compatible memory decline. It’s important to work with a lot of patience, make sure the images are clear to the user, and be consistent. Many people object the PECS method due to reported malpractice and the rigidity of behavioral science methods. AAC does not have to be used with the PECS method, and can be introduced to the child in a way you will decide.

Technological versus physical AAC

You can use a tablet, and there are excellent apps for AAC. If you get along well with technology, it can be excellent, and it becomes much more accessible, searching between hundreds of cards for the right picture.

But the tablet has very significant drawbacks: it’s expensive (and good AAC apps also cost money), fragile (even with very durable covers, kids with bursts of rage manage to shatter them), not waterproof (easy to solve with an appropriate cover), slow (you wait for the tablet to open, then the app, then find the right chart, and this can feel like an eternity during a tantrum), and requires charging (not always a problem, but sometimes when you need it the most, it needs charging).

If you want to use an AAC device at mealtimes, you better have a good waterproof cover for the tablet.

Physical AAC

Using physical AAC is sometimes very cumbersome, and it’s a hassle to make, but used alone or in conjunction with apps, it sometimes completely changes the atmosphere at home for the better, because the child feels less frustrated, when he can express his wishes.

If you don’t get along with technology, or if you want a less expensive option than with equipment that might be stolen, Making your own AAC picture card binders are a great solution. They are durable, not a product that is usually stolen, will not break or tear easily and cheap. It’s convenient to send the child with a mini binder out of the house. Special needs kindergartens usually have a combination or tablet. A good place to start, is an initial guidance from the kindergarten staff, or therapists that accompany you. At first it’s hard but slowly it gets easier. Keep the tabs in an agreed upon place, where the child will get used to reaching them himself.

How to use AAC at mealtimes

How to use AAC at mealtimes:

1. First, all the cards related to the meal must be prepared: I want, a plate, utensils, a glass/bottle, thirsty, hungry, and all the foods that will be on the table.

2. Place the AAC meal pad on the table, and place all the cards on the top bar, and the empty child’s plate.

3. The child is seated, and according to his ability, cards are used to communicate what is put on his plate.

4. To ask for anything, the child points to the card they are asking for, and alone, or with your help, will move it to their sentence strip. That’s how to mark the execution of a request. Immediately after the request, we will give him what was requested. It is important to perform it immediately, to solidify the context between the image cards, the request and the result.

How to use AAC at mealtimes - example meal
Sample breakfast, with communication tabs

Why use AAC at mealtimes

ASD kids usually have problems around food. Usually because of problems with sensory processing disorders and sensory regulation. Sometimes because they just can’t sit on a chair. They’re usually very picky with food. AAC won’t solve all the problems, but it might encourage them to experiment with foods that are on the table, and with AAC they’ll have a way to ask for it with less frustration.

How to introduce the use of ACC cards at mealtimes

In the initial stages, we will point to a card with one hand and the food in the other to make the link between image and tangible food. You can pick up your card and get it close to the food. Say aloud the name of the food (use different voices or anything that will make the ceremony more interesting). Repeat several times, and do so with more foods. There’s no need to get a positive response from the kid, and definitely stop if he seems frustrated with the new drama. We’ll repeat the ceremony until we feel there’s an understanding.

Then we’ll point for the kid at the cards, put the cards on the sentence strip for him, and put the food on a plate according to the selected cards. We’ll narrate every action we take. Use minimal narration: a short, clear sentence. For example, rice. We’ll point to the rice card and say rice. We’ll move the card to the sentence strip from the word bank, and then put rice on the plate.

Initial independence in use

Next, the child will point to a card himself, or with the help of an adult, physically guiding the child to move his hand between the pictures, and we will put the card for him on the sentence strip, before we put the food item he has chosen on the plate. We’ll narrate all the actions, (hopefully he’ll understand that he also needs to verbalize the actions, and we can encourage him to communicate).

Independent use

Next, the kid takes his own card, puts it on the sentence strip, points to the card, and then gets the food. We still narrate each action.

Advanced Independent use

In advanced stages, we will instruct the child to create a sentence to express his wishes by combining cards. For instance, “I want” + “cucumber”, or “I want” + “to eat” + “cucumber.” The child should at least point to the words in the correct order, after placing them on the sentence strip. They can be arranged for him in the right order, if he couldn’t do it alone. If he’s verbal, he can be asked to say the sentence (alone or echo after us).

AAC for snacks

When the child is sufficiently practiced using the method you can apply it out of mealtimes and other situations. We taped a velcro strip on the fridge with a small number of common options. When the kid wanted to snack or something from the fridge, he could use the cards to pick out a snack, without opening the fridge (usually cold schnitzel, yellow cheese, vegetable, fruit or cake).

The card binder was always available in the kitchen in case he’s frustrated with hunger, and wants a snack that’s inaccessible to him.

How to make an AAC communication binder for meals

The process of creating a physical AAC binder is not complex, although the work itself is a bit arduous.

Required equipment:

  1. Hard Binder
  2. Lamination machine
  3. Lamination Pages
  4. Printed images for AAC cards
  5. Hook and loop velcro straps with sticky backs
  6. scissors
  7. hole punch

How to make an AAC food binder , step by step

1. Make an inventory of all foods and actions related to eating that the child eats or uses (add extra food items that are common in your house).

2. Create the images for the cards. You can use an AAC app or website to create grids to print, you can download photos from the web and edit in an MS-Office program, you can take pictures, you can request images from the preschool, you can draw the images, and more. Write the context of each image below the image to produce consistent language: so a tomato will always be called by one word, rather than another, or in another language. All types of tomatoes are tomatoes, unless we put a separate picture (i.e. cherry tomato). Language consistency is important. If you decide to read the words in one language, stick to it while using AAC.

3. If you’ve decided on a tablet app, build the menu in the app. If you decide on paper cards continue to the next steps.

4. Print the tabs – preferably on a color printer.

5. Cut the images.

6. Place spaced in lamination pages.

7. Laminate in a lamination machine.

8. On the back of each card stick a piece of male velcro.

9. Cut the plastic around the cards.

How to use AAC at mealtime - food cards in different stages of preparation

Stages of work for making a binder

1. Prepare dividers for the binder with female velcro strips for the cards. You can use laminated pages in a machine to get a hard sheet for the divider.

2. Punch holes and put in the binder.

3. Fill the dividers with cards.

4. Prepare the AAC meal pad: a picture of a plate in the center of a page, and transfer in lamination. (example below)

5. On the meal pad, tape female velcro strips at the top and sides.

6. Punch holes and add to the binder.

7. Place a cover photo on the binder to make it clear that this is the AAC food binder.

How to Use AAC at mealtimes - AAC meal pad
Meal Communication Surface

More tips on how to use AAC at mealtimes

1. Arrange a permanent place for the AAC equipment. The child will adjust more easily to use it himself, and you will have an easier time if you don’t have to look for it all over the house.

2. Always save backup AAC files on your computer and smartphone!

3. Make extra cards and meal pads in case of wear and tear, or loss.

4. Fill the meal pad, with cards of food that are usually on the table, even if the child does not normally eat those. He might want to taste something the parents eat that he couldn’t ask for.

5. At the beginning of the meal, all the food items on the table must be presented and cards provided, so that the child can make a choice. If you usually put together a plate in the kitchen and serve it to the table, you can put together the plate with the cards in the kitchen, or you will have to serve food to the table in separate bowls to choose from.

6. If the child needs to take medication along with the meal, the appropriate card can be present on the meal pad.

7. This method should be used consistently because it will create a clear food-related routine for the child. Autistic kids function much better with regular routines.

Pleasant work

Shira and Hagai

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