Step 4: Set Up the Environment to Support Communication

Once you have selected motivating contexts for intervention and you have ensured that your child has effective means and vocabulary to communicate, the next step is to set up the environment to support your child's communication.

There are three things to remember when you set up the environment:

• position your child to maximize vision, hearing, and motor skills
• position yourself to maximize interaction
• incorporate AAC appropriately

How do I position my child to maximize vision, hearing and motor skills?

Your child will be able to participate more effectively in social interactions if he or she can see, hear, reach and touch the related items (for example, the picture symbols, the toy, the computer or SGD), to the greatest extent possible.   

Many children with complex communication needs are also at risk for difficulties with vision, hearing, or motor skills.

• Be sure that your child is assessed for difficulties in these areas.
• Seek knowledgeable, qualified professionals who have experience with children with special needs.
• Ask these professionals for practical recommendations to maximize your child’s visual, hearing, or motor performance.
  • For example, what is the best size for photos or other visual materials? Where should their toys and books be positioned – at midline, to the right or to the left? How far away should items be from your child?
  • For further information on positioning to maximize motor skills, click the link to watch the free webcast, "Seating and Positioning for Individuals who use AT" by certified occupational therapist, Aileen Costigan, MSc-OT.
     

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How do I position myself to maximize interaction with my child?

In order to communicate and learn language, your child needs to learn to attend to his or her partner. 

It is difficult for some children with special needs to shift their attention between their partner and the ongoing activity.  They need to learn what is known as "joint attention."

You can help your child learn joint attention by:

• sitting directly in front of him or her
• positioning yourself at his or her eye level
• holding activities and materials in front of you in your child’s line of sight
• using lots of expression and intonation in your voice
• minimizing competing distractions (such as the TV)

 Note -- if your child requires special accommodations for vision, your child's vision specialist may have recommendations about how you can position yourself and the related materials to maximize his or her ability to see and perceive the interaction.  Check with your child's vision specialist for recommendations.

Janice has positioned herself so that Jackson can easily see and reach everything he needs.  She holds his computer at his eye level and under her face so he can easily shift his attention during their interaction.

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How do I incorporate AAC appropriately?

It is important that your child has access to AAC throughout the day during play and other interactions.

Model the use of AAC every time you play, read books, sing songs, talk to your child or engage in other daily activities such as mealtime or dressing.

• Use signs as you talk to your child.
  • Make sure that your child is positioned securely and has his or her hands free to sign.
  • Remember, children's signs tend to be approximations -- much like their spoken words can be.  Their signs are likely to become more refined with time and practice.

• Make sure that you have your child’s communication board or speech generating device (SGD) available when you play or interact.

• Hold it directly in front of your child and just under your face so that it is easy for your child to look at you and the communication board or computer.

• Make sure that your child can reach it easily.

• As you talk to your child, point to the appropriate pictures on the communication board or SGD.  When you are introducing a new picture or symbol to your child, say the word and pair it directly with the toy, person or action.
  • This will make it easier for your child to understand what the picture or symbol means.

• Help your child find the appropriate page/symbols in his or her AAC system.
  • Do not worry if your child cannot immediately navigate through his or her communication book or SGD.
    • Help your child locate the appropriate page.
    • Show your child how to navigate to the page.
      

Lili is signing "dad" with her parents and Janice.

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Example

For example, Gareth, his mom and Janice are playing with the school bus in this photograph.

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Gareth is 2 years old and has cerebral palsy. He has a tracheostomy. He points to photos and symbols to communicate; he also uses a speech generating device (SGD).

Janice and Gareth’s mom have set up the environment to support his communication.

• Gareth’s mom is following directions from his occupational therapist to position him appropriately to maximize his skills.
• Janice is sitting in front of Gareth so that he can see what she is doing.
• Janice is holding the toys in front of her and close to her face so that Gareth can easily attend to the activity and to her.
• Gareth’s mom has his communication book available. He has lots of photos and symbols in this book.  The picture symbols are covered in contact paper and mounted on Velcro.
  • Click here to see a photograph of Gareth's communication book.
• Janice is introducing a new symbol to represent the bus driver. She introduces the symbol in a meaningful situation while they play with the toys together.
• She says “bus driver” and shows Gareth the picture symbol with the actual toy so that he can easily understand what the symbol represents.
• She provides lots of opportunities for Gareth to use the symbol to communicate in a variety of ways.
  • To tell his mom who is going to drive the bus
  • To ask to sing a song about the bus driver
  • To tell his mom who is silly, and so on

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Pointers

At first it may seem awkward to try to incorporate AAC when you play and interact.

As you practice incorporating AAC into your interactions,

• it will become easier and easier
• your child will benefit significantly as he or she will have many more opportunities to learn language and communication skills 

Janice has set up the environment so that she and Lili can interact easily.
 

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