Input–output symmetry: why it matters for AAC users, and a word list to help

Child output = speech

Adult input = speech

Child output = AAC

Adult input = speech……. Whoops!? See how that might be a problem for learning?

How about:

Child output = AAC

Adult input = aided input (pointing to graphic symbols during speech)

“Among children with complex communication needs, vocabulary selection for aided AAC has almost exclusively been driven by consideration of expressive language needs. However, receptive language is critical to expres.png

No matter a child’s mode(s) of expressive communication, it’s our job to help ensure that they are getting receptive examples that match their expressive output, as often as possible. How? Encourage parents to use aided input, right? Simple!

Not simple. Consider this—are the words the family uses most frequently on the child’s device? Often times children’s AAC is programmed only for the child’s lexicon. But shouldn’t it also be set up for the words s/he is learning?

To help tackle the input–output asymmetry issue, this paper provides a list of words you may want to consider for programming young clients’ communication systems. The list is a compilation and comparison of data from three large sets, identifying words mothers use most frequently when speaking to their toddlers, as well as words most commonly spoken by toddlers and preschoolers.

They found that just over 250 words comprise most of mothers’ child-directed speech, with considerable overlap between mothers’ most frequent words and the words used by children (and this includes children unrelated to the mothers!… but arguably from similar cultural backgrounds). Another interesting finding: some mothers talk more than others (like, four times more), but the difference in lexical diversity among mothers (that is, number of different words) isn’t so high.

Though limitations include the fact that this research was done on typically-developing children, and it’s a new analysis of a ton of old data (from the late 80s forward), it “…provides a beginning place for guiding vocabulary selection.” So, basically, this list could be very useful as long as you take generational and cultural considerations in mind. So maybe add words like “tablet”? And please just ignore the fact that the data is on “mothers”, not parents in general—the world wasn’t as woke 20 years ago. 

This review is published in both the Early Intervention & Preschool & School-Age sections. 

Quick, N., Erickson, K., Mccright, J. (2019). The most frequently used words: Comparing child-directed speech and young children's speech to inform vocabulary selection for aided input. Augmentative and Alternative Communication. doi: 10.1080/07434618.201

Note: You can also find a link to this research at the author’s institutional repository, here.

Integrating therapists into the research: a how-to

Have you ever heard of Triadic Gaze Intervention? No? Me neither. Unless you went to the University of Washington for grad school, you probably don’t know that TGI is an evidence-based protocol with 20 years of research behind it. But hey, we have to give these researchers credit—they acknowledge this common research-to-practice gap, and are invested in working to fix it.

In this study, Feuerstein et al. sought to include early intervention practitioners in their research. Specifically, they used qualitative methods to assess practitioner’s perceptions of Triadic Gaze Intervention, in terms of acceptability and feasibility for implementation. Their overarching goal was to highlight the unique contribution of practitioners in implementing research to practice. #shoutout


Triadic Gaze Intervention is a technique used to teach toddlers with physical disabilities to use gaze as a form of intentional communication. During play activities, therapists recognize a child’s potential communicative behavior, and shape that behavior toward a three-point triadic gaze. To read more about this method, see Olswang et al. (2014).

So what did SLPs have to say about implementing this highly researched technique in everyday practice? They felt that it closely aligned with their intervention priorities for this population. They found it easy to learn and implement into their current practice. They also thought it was an extremely acceptable and feasible intervention method.

SLPs also listed some potential barriers. They wanted TGI to be taught to a broad range of EI team members, not just SLPs. PTs and OTs are often the first service providers to see toddlers with disabilities, and TGI may align with the motor and social engagement goals targeted by these clinicians. SLPs also brought up the idea that most EI models use a parent training/coaching model. They wanted support from researchers for how to train parents to use this intervention.

So there you have it, folks! Collaboration between researchers and practitioners is not only useful, but necessary for implementing evidence-based protocols into everyday practice. Practitioners should not just be consulted, but integrated into research programs. When we collaborate with each other, everybody wins, including the children.

Feuerstein, J. L., Olswang, L. B., Greenslade, K. J., Dowden, P., Pinder, G.L., & Madden, J. (2018). Implementation research: Embracing practitioner’s views. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2017_JSLHR-L-17-0154