Over the past several years, we have been engaging with several AAC professionals, therapists and parents who interact with children with complex communication needs. One of the growing concerns was that the exposure to AAC for most children (with CCN), was limited to the 1-2 hours per week of therapy time, and there was pretty much very limited or no exposure to AAC for the rest of the week, which limited the child’s progress significantly. This is because it limits the child’s exposure to receptive language, which has a direct bearing on language development. While a typical child is exposed to 30 million words by age 3, a child with CCN is exposed to far far fewer words by the same age due to lack of similar exposure. 

Our discussions and interviews with several parents helped us understand that some parents are extremely motivated to participate in their child’s communication development at home, but are vexed at their lack of “therapy” knowledge to guide their child in the “correct” manner. On the other hand, therapists have expressed their deep desire to get the parent to supplement their therapy at home, to speed up progress, but have also, in the same breath, expressed their inability to support and educate the parent, due to lack of time - a chicken and egg story. And thus began our quest to find a way to bridge that gap. This led us to think about how we could play a critical role in pushing towards more consistent AAC adoption at home during the remainder of the week, with the aim to dramatically increase the child’s exposure to receptive language. 

As we delved deeper into the problem, we were inspired by the research of Teaching partners to communicate - by Jennifer Kent-Walsch and Cathy Binger that backed our thoughts to parent empowerment. Our own research, coupled with detailed discussions with our panel of researchers and thought leaders, guided us along the track to adopt Assisted Language Input (ALI), the most effective parent-driven approach to teaching a child to communicate. We decided to pursue a model that would equip the parent with communication strategies on how to guide the child at home using ALI. 

Our focus then shifted towards building a deeper understanding of the parent, to help us towards building an app that supports their needs and their busy lifestyle. We wanted to make an app that made things easier for them, keeping the task of ‘learning’ less pedagogic / tedious and making it more fun-filled and a way by which they would be motivated for more consistent usage, which would in turn result in accelerated progress of the child. We also wanted app to be easy and adaptive for the child’s use as he progresses from a beginner to a more advanced user of AAC. 

With the parent’s needs, child’s needs and ALI at the heart of the app, we designed features to support these from all fronts. This led us to find innovative and interesting ways to design elements for the following needs, which got refined over a series of prototypes and beta versions:

    • Train the parent with communication strategies 

The Comm Adventures is a series of fun and interactive games to teach the parent communication strategies rather than a pedagogic approach. 

    • a database of practical tips and conversation ideas for various activities 

    • a database of reference URLs that include research papers, blogs, and articles by thought leaders and researchers

    • Make the parent fluent with the app

This led us to the develop the Practice mode which 

    • Helps the parent learn the vocabulary and word layout through hints

    • Gives them sufficient practice with vocabulary

    • Keep it simple to use

The parent can easily get overwhelmed trying to learn all the vocabulary available on the app. So how can we start byte-sized and grow gradually? We came up with the idea of making it Activity-based. The parent focuses on one activity at a time and ensure learning all aspects about it .. the vocabulary, the strategies, tweaking the vocabulary, practice sentences and conversations ideas. 

    • Personalize the app for the child

Avaz can be most effective if the app is personalized based on the child’s interests so that it can serve as a reinforcement and motivation, when he finds pictures of his favorite and familiar objects. 

    • Help them use it on a daily basis and under all settings using modeling 

This led us to the development of a robust pragmatic vocabulary for daily use, at home and under all environments. The vocabulary is a graded 3-level vocabulary and supports consistent motor planning across all levels. 

    • Measure the child’s progress

We included the Analytics section which provides the child’s progress through visual charts. 


Research and References:

“Pragmatic organization … provides strategies to support communication systems that enable genuine communication for a variety of functions in all daily environments.”

by Porter and Cafiero (Dec 2009), doi:10.1044/aac18.4.121

“90-95% of everything an AAC user says is core vocabulary. 5-10% is extended vocabulary. And in less than 10% of instances are pre-stored sentences able to accurately represent what an AAC user is trying to say.” Hill and Dollaghan (ASHA, Nov 1999)

Augmented language input (ALI) is the most effective approach we’ve seen.

Aided language input is effective in increasing spontaneous speech and augmented communication & decreasing aberrant behaviors

Cafiero, 1995, 2001, 2005; Dexter, 1998, Acheson, 2006,Romski & Sevcik, 2008