From the start of my career as a Speech-Language Pathologist, I have worked with many children who use high-tech speech generating device systems (SGDs) or augmentative communication. While many speech-language pathologists worried that SGDs would slow down speech, I found the opposite to be true: using SGDs helped the children I worked with create an effective communication system much sooner than expected. I began getting lots of speech therapy referrals for babies with complex disorders of various genetic etiologies, many of which had delayed or a need for a different approach for total communication (Lawthers et al., 2003; Perry et al., 2004).
My work up to that point had taught me that the earlier you introduce a child to an augmentative system the better, especially if the child is missing early expressive and receptive milestones. So I began incorporating SGDs with children as young as 6 months old to assist them in total communication at home during mealtime, toys and games, and social interactions. I started by using a speech-generating device to build language in and model vocabulary. I also modeled and demonstrated various types of communication on the SGD so that the families see the importance of using a SGD as a two-way messaging system, not just a “press and request system”. This way the children could learn early on how to use the drive as a two way communication system with their parents and caretakers. Being able to communicate at home is an important building block in a child’s early development, and I strive to set the children I work with up for success in school and their future goals through helping them access the world through communication.
Since each child is different, I try out many different devices with the child and family before writing up a report to see which one is best for their long term goals. I also work with the parents at home to train them on how to incorporate the device into their daily lives and develop goals to guarantee it is not abandoned. Giving a child a SGD with no training would be like talking without allowing them to speak—it’s one-sided and ineffective. SGDs are not meant to replace speech, but to empower a child to learn to use alternative strategies until verbal speech appears. To do this properly, we must help children understand that communication is a two-way street—and we must train their parents and caretakers to use this communication tool.
Oftentimes parents ask me to wait until they are sure the child is ready before writing a report and offering funding. While sooner is better than later when it comes to using SGDs, it’s also incredibly important to have parents and caretakers on board as you seek to help the child learn an effective communication system. It’s not possible to predict what the child’s speech development will turn into, so using the strengths of the child’s diagnosis and developmental checklists as a guide can be beneficial in creating mini milestones in communication. Continual treatment and revelation not only helps the child but also helps me monitor and understand the development of the child’s use of the technology. (Fried-Oken et al., 2015).
Aside from a well thought out evaluation, monitoring device use is one of the most important factors when working with babies and young children in early adoption of a SGD. Through properly monitoring a child’s use of the SGD, I can determine if any changes or modifications need to be made to ensure the best possible outcome. It’s important to remember that this might not be their forever device or language system; speech-language pathologists must be mindful of the changing needs of the child and family. While the device might eventually be phased out or replaced with another version that works better for the individual’s needs, it’s still vital to create long-term goals. I try to take into account how big the device will be, how the child will access it, and what they will see.
I then confer with the other medical professionals working with the child to make sure what I’m suggesting makes sense for him or her. Popular wisdom says it takes a village to raise a child, and that’s also true when it comes to speech pathology. It’s important to get different perspectives, read research from other therapists to learn new methods and best practices, and work with the OT/PT/TVI to come up with micro goals for the child. I also build relationships with device representatives in my area so I can reach out to them with questions about troubleshooting during trial periods.
My goal is to prevent learned helplessness in language by providing training that will develop throughout a child’s lifetime. Social engagement decreases over time for children who are not presenting developmental changes, so I aim to prevent that learned helplessness by providing access to self-advocacy and two-way communication. By creating a communication system that a family can model and use at home, I empower children to find a voice earlier and succeed in developing and understanding a communication system.
Rebecca Taskin, MS, CCC-SLP, ATP founder and owner of Speech in The City New York, New York, has been in private practice since 2019 rebecca@speechinthecity.com
