Thursday, November 20, 2014

Communication Breakdowns & Repairs, with AAC

Although the phrases "communication breakdown" and "communication repair" may be new to you, the concept isn't. I guarantee you've experienced many of this situations, especially if you have children, or a spouse.

A communication breakdown happens when there's a disconnect between the sender of a message (the speaker) and its receiver (the listener).

Think about how often this happens in daily life--even for adults with normal hearing and typical speech skills (the ability to speak loudly, to clearly articulate sounds, etc). Maybe I take special notice of my own communication breakdowns because I hate repeating myself----but it happens pretty often. Now imagine how often it would happen if you couldn't speak clearly.

Listen to Maya speak in the video below. You may be able to guess what she's saying, but it's more likely that you won't. In the second loop of the video I provide context and captions---clues that serve to repair the breakdown, and everything becomes more clear.

 Maya's speaking life is more or less one big communication breakdown. I expect that this will shift, that as her articulation improves she will be more understood, but I also expect that the shift will happen slowly. Unfortunately, people are so eager to understand her speech, to validate and encouraging her speaking, that they often jump in, make assumptions, and kind of run her right over. She'll say "bug" and they'll reply "Bus? Yes, you rode a bus to school. Your bus is yellow, right? Do you like to ride the bus?" More unfortunately, when these breakdowns happen Maya tends to just stare blankly at her listener, or wanders away to something different. Rarely (very very rarely) does she take the initiative to stand her ground, to tell the listener they misunderstood, to try to get her point across. She doesn't try to repair the breakdown, she gives up.

This isn't unexpected, really. It's taken her a long time to speak at all, and if she tries and it doesn't work . . . well, then what? She's got a limited repertoire of speech sounds, and it's hard to think on your feet and come up with another way to more clearly express something that you couldn't say the first time. More than that, communication partners speak quickly, change topics quickly, and move on quickly. Life doesn't pause while you try to come up with another way to say "bug." She also has had a lifetime's worth of experience of not being able to keep up verbally. Frankly, I'm consistently impressed at her dogged pursuit of speech, and the amazing proliferation of speech and sound attempts that have occurred over the past 2 years. And, while sometimes she can use her talker to clarify what she's saying, sometimes the word (or sentence) she was saying just isn't there---or maybe she doesn't think to switch from speech to AAC.

And so, communication repair has become a huge target of ours. We are determined to empower her to become frustrated when people don't understand, to assert herself and say "No, that's wrong!", and then to draw on a variety of tools to help clarify and re-communicate her point.

Step One: Provide the Tools

I started by creating a page in Maya's talker (she uses the Speak for Yourself app) that can be easily used for communication repair. The ideas for the words and phrases on this page came from a variety of SLPs and AAC families, gathered primarily in a few FB groups. (A lot of these came from a great draft in the SFY user group.)

If you're an AAC person, there are two things to note. First, this page uses a fair number of phrases and sentences. In general, I like having one button per word, but I think that in times of communication breakdown an AAC user should be able to protest/redirect very quickly. Second, I have maximized the motor planning of a SFY user by stacking the buttons in the same location as things that they are related to on the primary page. For example, the phrase "slow down" is located in the same area (right column, fourth button down) as the word "down" on the primary page.

The information presented below, including the list of repair phrase and the color coding, can be downloaded and printed here.

Here is a master list of the phrases included on this page--since the buttons can only hold a certain number of characters, it's difficult to guess what they all mean. (The word in parentheses shows which location the word is under, when they are related.)

Top Row:
I don’t understand (I)
I understand.
okay (OKAY)
Ask me a yes or no question (ASK)
Put that word in my talker. (PUT)
I need help to find the word I want. (HELP)

Second Row:
You don’t understand (YOU)
Do you understand?
Are you listening to me? (ARE)
What do you mean? (WHAT)
I have no button for that. (NO)

Third Row:
Something from the past.
Something from today. (TIME)
Something in the future.
I have a question. (HAVE)
I give up. (UP)

Fourth Row:
That’s not what I said. (NOT)
the opposite of
Slow down. (DOWN)

Fifth Row:
It starts with
I will spell it
I will give you a clue (THINK)
This person is a clue
This place is a clue
You aren’t close
You’re getting closer
You’re very close
You got it!
Start over

Sixth Row:
It rhymes with
I changed my mind (KNOW)
I’m talking about (TALK)
That’s not right (RIGHT)
I’ll tell you how close you are.
Try to guess (TRY)
Can you say it again? (AGAIN)
Seventh Row:
It sounds like
This is frustrating (FEEL)
Listen to me! (HEAR)
I want to tell you something (TELL)
A question
An idea (SLEEP)
A place (THAT)
A thing (THIS)
A person (FRIEND)
An action (WALK)
A feeling
An event (WHICH)

Bottom Row:
It’s important
It’s not important
Never mind
I need a new word (NEED)
Wait! I have something to tell you. (STOP)
Be patient with me (BE)

The color coding is as follows: 
Orange= the most important buttons I want her to use (kind of assertive buttons)
Blue = questions
Bright yellow = strategies
Greyish purple = hints 
Peach= things that I wanted to look like a clump
White = everything else

Step Two: Teach the skill
This is clearly the more difficult step. How do we get her invested? We've learned that she is much more likely to use a new communication skill if she's had the opportunity to practice it . . . but it's difficult to practice repair. If you're the listener, it's hard to model how she should give clues (and sometimes it's hard to realize you've misunderstood in the first place). If you try to create fake misunderstanding scenarios, it's a gamble whether the AAC user will play along. And the idea has to be explained, too . . . "hey, if I don't understand you you should tell me to stop, ok?"

Enter one of our awesome speech therapists, who created a fantastic social story to introduce the idea of communication repair. The book starts by giving voice to the frustration of a communication breakdown, then moves on to lay out the two important parts of communication repair: stop the listener and let them know a breakdown has occurred, then try to use other tools to relay your point.

Here's what the book looks like:

Maya wanted to be dancing in this picture :)

The entire book can be downloaded here (as a PowerPoint file) and can be modified with your own photos or screenshots.

The book was introduced featuring one strategy from her communication repair page, "It starts with . . . ". This is a great technique for Maya, and one that she used spontaneously in the past, but she never had a button to basically say "now I'm going to tell you the first letter." New pages will be added to the book as different strategies are introduced and practiced during speech sessions. I'm going to send a copy into school and have shared it with our other therapists, so that they know what we are working on and can be mindful of potential communication breakdown and our repair strategies.

I hope that this page will help Maya become a more assertive communication partner. She has the right to be understood, and she has the right to say "Hey! You're not correct! Stop talking and listen to me!" Now it's our job to make sure that she has enough practice with it that it will jump to mind when a breakdown occurs, and that she feels like it's worth her time and effort to work through the repair process.


  1. Amazing! I'm truly impressed with how determined you and your team is to help Maya with her issues!Way to go,Dana!

  2. I don't know if this is feasible or not, but have you ever thought of you and your husband setting aside times to communicate exclusively by using Speak For Yourself on your iPods during Maya's waking hours? That would be the ultimate communication modeling for Maya!

    I just find myself wondering if the reason some SN kids don't really take off and fly with AAC is that they're the only one in their family who uses it. Even at school, adults use speech to communicate. Thus kids view AAC as a toy and/or school assignment, not a serious vehicle for interpersonal communication beyond asking for snacks. Maybe some of the more neurotypical kiddos can make that cognitive leap for themselves, but it seems to me that kids like Schuyler and Maya instinctively want to use the Serious Adult means of communication-- speech-- in preference to the "kids' stuff" of ACC. Even though speech isn't working for them.

    I wonder if on some level they expect to die or become speaking by adulthood, like deaf kids raised by the Oral Method used to?

    Just a thought to consider. :-)

  3. We use AAC at home with her all the time, and her little brother has a talker as well.

    Speech is faster and easier than AAC, it's completely natural to use it instead of AAC. Maya will speak parts of sentences and use AAC to fill in the unintelligible parts as well.

    I definitely don't think she views speech as a more mature option than AAC.

  4. You an amazing Mother and family going above and beyond to help her become the best she can be. I actually was reading something the other day that you proabaly would identify with-
    Found your blog via Love That Max link up. Come and check out our blog if you get a chance Looking forward to reading more about your journey. Sarah

  5. It’s so inspiring to see how dedicated you are! Your system seems very well thought, I hope it really helps Maya and other kids to be understood.