Once an AAC user starts to grow their expressive language production, it's common for them to get "stuck" at the single word level. There's so much more to say than one word! So how can we help them grow their language for functional communication?
There are several strategies for language growth and development for AAC users. Two of those strategies? The use of extension and expansion. These are both strategies utilized in Enhanced Milieu Teaching (EMT). EMT is communication intervention that targets natural communication, modeling, and promoting spontaneous, functional communication (Kaiser & Wright, 2013). The use of EMT is supported by empirical work with studies documenting progress in communication skills for children with language delays (Hancock & Kaiser, 1996; Roberts & Kaiser, 2012), children with autism (Hancock & Kaiser, 2002) and children who are nonverbal (Kaiser, Ostrosky, & Alpert, 1993).
How do we expand and extend an AAC user's utterance for growing their language?
Expansions include adding a word to a child’s previous communication production (Roberts et al., 2016). To expand a phrase, you can add a descriptive to the word the AAC user produced. Expansions can help an AAC user learn new words, especially when they are interested in an activity (Kaiser & Wright, 2013).
If the user says “cat,” you could say “brown cat” or “little cat.” Adding the color or size introduces new language concepts to the utterance for the user to learn!
Other ideas: Sizes (big, little), color (red, blue, green), quantity concepts (many, few, some), and actions (running, eating, dancing, jumping).
Extensions include responding to the child’s utterance, but not imitating their production with additional information (Roberts et al., 2016). To extend a phrase, you can introduce new language concepts related to the word or phrase they produced and already know. In this case, we respond to the child's production in a conversational way providing new information related to their production.
If the user says “mommy,” you could say “yes mommy is eating soup!” Adding an action and an item provides the user with the opportunity to learn new language concepts in a natural way.
Other ideas: Locations (at the park, at school, at home), feelings (feeling tired, happy, hungry, mad), pronouns (mine, yours, his, hers) and activities (cooking, reading, playing).
There are several considerations for these strategies for maximizing language growth for AAC users.
Extension and expansion are great! But "too much" of each can be more detrimental than beneficial. Target just one or two words so the focus is on those language concepts!
Communication opportunities occur during shared engagement around an object, an activity, or a routine (Kaiser & Wright, 2013). Utilizing these strategies during communication opportunities that occur frequently throughout a user's day provides natural opportunities for language growth. Activities such as meal time or bedtime occur often making them great opportunities for language!
You can also extend and expand with modeling. Modeling means you point to words on the AAC device as you speak it.
Hancock, T. B., & Kaiser A. P. (1996). Siblings’ use of milieu teaching at home. Topics in Early Childhood Special Education, 16, 168–190. https://doi.org/10.1177/027112149601600204
Hancock, T. B., & Kaiser, A. P. (2002). The effects of trainer-implemented Enhanced Milieu Teaching on the social communication of children with autism. Topics in Early Childhood Special Education, 22(1), 39–54. https://doi.org/10.1177/027112140202200104
Hancock, T. B., & Kaiser, A. P. (2006) Enhanced milieu teaching. In R. J. McCauley & M. E. Fey, Treatment of language disorders in children (pp. 203–236). Paul H Brookes.
Kaiser, A. P., Ostrosky, M. M., & Alpert, C. L. (1993). Training teachers to use environmental arrangement and milieu teaching with nonvocal preschool children. The Journal of the Association for Persons with Severe Handicaps, 18(3), 188–199. https://doi.org/10.1177/154079699301800305
Kaiser, A., & Wright, C. (2013). Enhanced milieu teaching: Incorporating AAC into naturalistic teaching with young children and their partners. Perspectives on Augmentative and Alternative Communication, 22(1), 37-50. https://doi.org/10.1044/aac22.1.37
Roberts, M. Y., & Kaiser, A. P. (2012). Assessing the effects of a parent-implemented language intervention for children with language impairments using empirical benchmarks: A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1655–1670. https://doi.org/10.1044/1092-4388(2012/11-0236)
Roberts, M. Y., Hensle, T., & Brooks, M. K. (2016). More than “try this at home”—Including parents in early intervention. Perspectives of the ASHA Special Interest Groups, 1(4), 130–143. https://doi.org/10.1044/persp1.SIG1.130
Katie Threlkeld, M.S., CCC-SLP is a Doctoral Candidate at the University of Missouri and the Educational Program Developer at Forbes AAC. She has over 8 years of experience in AT and AAC assessment and treatment across the lifespan. Her goal is to provide all AAC users and those around them with evidence-based information for best practice in AAC.