Normal Language Acquisition & Children using AAC Systems

by Gail M. Van Tatenhove, PA, MS, CCC-SLP

November 2016

How should a normal language acquisition (NLA) model be used when

working with children who use AAC systems?

That question has been addressed repeatedly in the AAC literature, starting in 1992, when Sima
Gerber and Arlene Kraat outlined a range of issues regarding the use of a developmental model
of language acquisition with children using AAC systems. Jan Bedrosian, in 1997, continued the
discussion, exploring questions about the language development of young children with severe
speech impairments. Ann Sutton (2008) expanded the conversation with a discussion of
language acquisition theories with AAC implementation applications. Finally, Martine Smith
(2015) reflected on the state of the science and future research directions in understanding the
language development of individuals who required AAC systems.

REFERENCES
Sima Gerber & Arlene Kraat. (1992). Use of a developmental model of language acquisition: Applications to
children using AAC systems, Augmentative and Alternative Communication, Vol. 8, No. 1.

Jan Bedrosian. (1997). Language acquisition in young AAC system users: Issues and directions for future
research, Augmentative and Alternative Communication, Vol. 13, No. 3.

Ann Sutton (2008). Language acquisition theory and AAC intervention, SIG 12 Perspectives on Augmentative
and Alternative Communication, Vol. 17, 55-61.

Martine Smith (2015). Language development of individuals who require aided communication: Reflections on
state of the science and future research directions. Augmentative and Alternative Communication, Vol. 31, No.
1.

Much of the discussion about using normal language acquisition information with children with
no or low speech is differentiated by whether or not normal language acquisition (NLA) is used
as a judge of a child’s language skills or as a guide to AAC intervention.

Most authors express caution about judging a child by NLA standards for a variety of reasons:
“Late” Introduction to AAC: Most children using AAC systems are introduced to AAC later than
the age of three. This puts the child using AAC at a disadvantage in demonstrating key
language skills by the “normal” age milestones.
Expressive-Receptive Language Disparity: A NLA model evaluates a child’s stage of language
development based on expressive language, not receptive language. However, there is
often a huge disparity between expressive language production and receptive language skills

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 Normal Language Acquisition & Children using AAC Systems

among children using AAC systems. This is another way in which the child using AAC is at a
disadvantage demonstrating language milestones.
Externally Selected Vocabulary: Children using AAC systems have externally selected
vocabularies. Other people are choosing the words to include on the AAC system. They can
only practice word combinations based on the words that others have provided to them. If
the AAC system is noun-based and/or provides a limited range of words from all word
groups, the child can produce a limited amount of generative language. In addition, if the
externally selected vocabulary does not include any morphological markers (e.g., verb
endings, etc.), the child is limited in his/her ability to practice morphology.
Modeling & Modality Mismatch: The normal language acquisition model assumes a “typical”
situation of a child hearing verbal language models and then practicing spoken language. In
the absence of consistent, intensive modeling on the AAC system, a child receives no clear
model of how to communicate using the AAC system. The child using an AAC system
experiences a mismatch between language input (spoken language) and expected language
output (AAC system).

There are many external variables that affect the path of language acquisition for children who
use AAC systems. However, there is no research that definitely shows that children who require
use of AAC systems do or do not follow the normal path of language acquisition. Therefore, it is
recommended that, in the absence of clear research, to use the principle of the least dangerous
assumption: Use Normal Language Acquisition information as your GUIDE in designing an
AAC system and implementing AAC intervention. Normal Language Acquisition (NLA) can
guide intervention in all areas of communication and language development.
 Semantics: What words do typically developing children use?
 Pragmatics: Why do typically developing children use those words? What are their
reasons for using them?
 Syntax: What word combinations do typically developing children make?
 Morphology: What endings do typically developing children put on words?

Semantics: The WORDS on the AAC system

The family, teacher, or therapist working with the child who uses an AAC system needs to have a
vision of where they are going in terms of AAC and language development. Without this vision,
development of an AAC system is too often drive by "immediate needs," with the support team
continually scrambling to make yet another board or to program yet more vocabulary for yet
another activity or event in the child's life. What you often end up with is (1) an AAC system
full of nouns, but deficit of language and/or (2) an AAC system that lacks a systematic
organization of words. Plus, this cycle of board making and vocabulary programming is never

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 Normal Language Acquisition & Children using AAC Systems

ending, with most of these boards and new vocabulary used for a day, or week, or month. It
does not build long-term, life-long language skills.

However, when the focus is on providing a planned set of high

frequency, re-usable vocabulary, then you can concentrate on
teaching language that provides the child with real
communicative power. These kinds of words are called core
vocabulary words and they are the words that are useful across a
broad number of events or activities. They are words you need
your entire life.

The long-range plan is to end up with a useful vocabulary of approximately 300+/- core
vocabulary words on the child’s communication device. From this solid basis of vocabulary,
additional words can be added based on the child's continued language development, as well as
the child and family's interests, needs, and activities. These words will serve the child well
throughout his/her school years and remaining life. They are a worthwhile investment of time
and learning experiences.
At the end of this handout, there are references on selecting core vocabulary, as well as a list of
recommended vocabulary. For children with severe cognitive and/or multiple disabilities, the
list of recommended vocabulary can guide you in selecting an appropriate, albeit reduced, core
vocabulary.

Pragmatics: The JOBS done by the words on the AAC system

Imagine you own a company called “Language Development, Inc.” The purpose of this company
is to development language. As you set up your company, you decide (1) what jobs need to be
done and (2) who’s going to do those jobs. If the job that needs to be done is to evaluation
choices, then you want to hire the words “good” or “bad.” If the job is to repeat an action or
increase the amount of an object, then you want to hire the words “again” or “more.”

The chart below shows some of the jobs (called “functions”) that need to be done and example
words, used by typically developing children, which do the jobs. A well-selected AAC core
vocabulary will fulfill most of these functions of language. This well-balanced vocabulary
ensures that the child using an AAC system has the opportunity to learn how to communicate
for a variety of reasons, experiencing the power of language to meet a range of his/her
communication needs.

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 Normal Language Acquisition & Children using AAC Systems
When Talking with Mostly One Word
Functions Form
Greet hi, hello, names of people
Part bye bye, goodbye
Request Assistance help, do
Recurrence more, another, again
Naming-Labeling toy, drink, (names of things)
Existence this, that, there, look, see
Nonexistence no, away, gone
Disappearance away, all gone, gone
Rejection no, stop
Cessation stop, different
Comments like, dirty, big, naughty (other adjectives)
Vocatives mama, dada, baby
Directive go, help, stop, different
Associative big, hot, pretty, up

When Starting to Put Together Two or Three Words

Functions Form (vocabulary examples)
Greet hi + person, hello + person
Part bye bye + person
Request Object or Action (want, get, find) + substantive word, want that, get more
Request Information why, what's that, where go, what doing
Request Assistance (help) + another word
Recurrence (more, another) + substantive word, do again
Existence (this, a, the, that, it, there) + substantive word
Nonexistence (no, away, all gone) + substantive word
Disappearance (no, away, all gone) + substantive word
Rejection no + substantive word
Cessation no + substantive word, different + thing
Comment like that, that mine, you funny
Directive get that, help me, stop it, do different
Associative (big, hot, pretty) + substantive word
Agent-Action daddy hit, me read
Action-Object get that, read it, get some, want one,
Agent-Object mommy book, me that
Possessive mommy book, my book, that mine
Locative that thing, go store, on chair, get up
Attributive big one, red thing
Experiencer-State me read, me love, me want
Agent-Action daddy hit, me read
Action-Object get that, read it, get some, want one,
Agent-Object mommy book, me that
Possessive mommy book, my book, that mine
Locative that thing, go store, on chair, get up
Attributive big one, red thing
Experiencer-State me read, me love, me want

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 Normal Language Acquisition & Children using AAC Systems

Syntax & Morphology

The typically developing child doesn’t talk with one word for years and years and years. By the
age of 3, most typically developing children are becoming quite proficient at combining words
into phrases and short sentences. They are learning the rules of their language for the correct
order of words, which is called syntax. They are also learning how to change the endings of
words, turning the word “eat” into “eating,” the word “big” into “biggest” and the word “one”
into “ones.” Learning how individual words “morph” or change is called “morphology.”

Typically developing children learn the rules of syntax and morphology without formal
instruction. The theory is that they learn the rules through exposure, trial and error, modeling,
correction from others, and more and more and more modeling of the spoken language.

Specific information on the details of syntax and morphology development, including the
“stages” in which typically developing children progress, is typically drawn from research
conducted by Roger Brown and when discussed, is referred to as “Brown’s Stages.” The
references below can be reviewed for more information on Brown’s Stages.

REFERENCES
Brown, R.; 1973. A first language: The early stages. London: George Allen & Unwin Ltd.).
AAC Language Lab. Charts and applications can be retrieved from:
https://aaclanguagelab.com/slp/stages
Bowen, Caroline. (1998). Brown’s Stages of Syntactic and Morphological Development. Charts can
be retrieved from: http://www.speech-language-therapy.com/index.php?
option=com_content&view=article&id=33

BIG IDEA: Pragmatic and syntactical development is made possible

ONLY when a child is given access to core vocabulary words.

Ground Zero for language development for typically developing children and for people who
use AAC systems is access to core vocabulary. On the next couple of pages of this
handout are vocabulary lists to reference in your work with people who use AAC systems, plus
a form to help you plan how you will use core vocabulary in classroom activities.

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 Normal Language Acquisition & Children using AAC Systems

Top Words Used by Toddlers

In Banajee, M., DiCarlo, C., & Buras-Stricklin, S. (2003). Core Vocabulary Determination for
Toddlers, Augmentative and Alternative Communication, 2, 67 – 73
1. all done-finished 9. mine 17. that
2. go 10. more 18. the
3. help 11. my 19. want
4. here 12. no 20. what
5. I 13. off 21. yes-yeah
6. in 14. on 22. you
7. is 15. out
8. it 16. some

Not all of these words might be the “first words” you put on a child’s AAC system
(e.g., the, is); however, most of them should be included on initial vocabulary sets.

Expression of this initial vocabulary could be “said” through a variety of

modalities. For example, if the child has a reliable way to say “yes” and “no”
through gestures, body language, or facial expressions, the words “yes” and “no”
might not be included on an aided AAC system, such as a manual communication
board or simple voice output device with limited keys or memory.

©Van Tatenhove, 2005, Revised November 2016 6

 Gail Van Tatenhove’s Clinical List of Core Vocabulary (Based on AAC Research and Clinical Practice)

First 10 Words: 10. get 17. get

1. all done 11. go 18. give Adding More Words
2. different 12. good 19. go 1. afraid
3. help 13. help 20. good 2. after
4. mine 14. here 21. happy 3. afternoon
5. more 15. I 22. he-him-his 4. am-is-are-be
6. not-don’t 16. in 23. help 5. and
7. stop 17. it 24. here 6. ask
8. that 18. like 25. I 7. because
9. want 19. little 26. in 8. before
10. what 20. mine 27. it 9. body
21. more 28. like 10. bore(d)
First 20 Words: 22. my 29. little 11. boy-man
1. again 23. not 30. make 12. bring
2. all done 24. off 31. me 13. buy
3. all gone 25. on 32. mine 14. call
4. away 26. out 33. more 15. can
5. different 27. put 34. my 16. change
6. do 28. some 35. not 17. cold
7. go 29. stop 36. now 18. color
8. help 30. that 37. off 19. confused
9. here 31. there 38. on 20. count
10. I 32. up 39. out 21. day
11. it 33. want 40. play 22. dress
12. like 34. what 41. put 23. dumb
13. mine-my 35. you 42. question 24. easy
14. more 43. read 25. fall
15. not First 60 Words 44. sad 26. family
16. stop 1. again 45. she-her-hers 27. fast
17. that 2. all 46. some 28. father-dad
18. want 3. all done 47. stop 29. favorite
19. what 4. all gone 48. tell 30. find
20. you-your 5. away 49. that 31. friend
6. bad 50. there 32. full
First 35 Words: 7. big 51. thing 33. fun
1. again 8. busy 52. this 34. girl-woman
2. all done 9. come 53. turn 35. goodbye
3. all gone 10. different 54. up 36. guess
4. away 11. do 55. want 37. hard
5. bad 12. don't 56. what 38. have
6. big 13. down 57. where 39. hear
7. do 14. drink 58. who 40. hold
8. different 15. eat 59. why 41. home
9. down 16. feel 60. you 42. hot
 43. how 65. need 88. sing 111. together
44. hungry 66. nice 89. sit 112. tomorrow
45. hurt 67. night 90. sleep 113. town
46. idea 68. one 91. slow 114. try
47. job 69. other 92. soft 115. under
48. know 70. over 93. sorry 116. use
49. later 71. person 94. start 117. very
50. leave 72. pet 95. stinky 118. wait
51. let-let’s 73. place 96. stuff 119. walk
52. listen 74. please 97. surprise 120. wash
53. live 75. pretty 98. swim 121. watch
54. look 76. problem 99. take 122. way
55. lose 77. ready 100. talk 123. we
56. love 78. ride 101. teacher 124. when
57. mad 79. right 102. thank you 125. win
58. maybe 80. same 103. these 126. work
59. mean 81. say 104. they 127. write
60. medium 82. scary 105. think 128. wrong
61. morning 83. school 106. thirsty 129. yesterday
62. mother- 84. see 107. those 130. your
mom 85. share 108. time
63. myself 86. sick 109. tired
64. name 87. silly 110. today

CONTINUE TO ADD MORE VERBS, ADJECTIVES, ADVERBS, PREPOSITIONS, CONJUNCTIONS

Other People/Living Things Words

1. aide School Words
2. baby 1. activities
3. babysitter 2. alphabet
4. brother 3. classes
5. bus driver 4. colors
6. children 5. days
7. class 6. months
8. grandfather 7. numbers
9. grandmother 8. seasons
10. neighbor 9. shapes
11. OT 10. weather
12. pet
13. PT
14. sister
15. SLP
 Vocabulary Reference List for Selecting Core Vocabulary
 Adamson, L., Romski, M., Deffebach, K., & Sevcik, R. (1992a). Symbol vocabulary and the focus of
conversations: Augmenting language development for youth with mental retardation. Journal of
Speech and Hearing Research, 35, 1333-1343.
 Banajee, M., DiCarlo, C., & Buras-Stricklin, S. (2003). Core Vocabulary Determination for Toddlers,
Augmentative and Alternative Communication, 2, 67 – 73.
 Beukelman, D., McGinnis, J., & Morrow, D. (1991). Vocabulary selection in augmentative and
alternative communication. Augmentative and Alternative Communication, 7, 1-15.
 Beukelman, D. R., Yorkston, K. M., Naranjo, C., & Poblete, M. (1984). Analysis of communication
samples produced by adult communication aid users. Journal of Speech and Hearing Disorders, 49,
360-367.
 Fried-Oken, M. M., L. (1992). An initial vocabulary for nonspeaking preschool children based on
developmental and environmental language sources. Augmentative and Alternative Communication,
8(March), 41-56.
 Fristoe, M., & Lloyd, L. L. (1980). Planning an initial expressive sign lexicon for persons with severe
communication impairment. Journal of Speech and Hearing Disorders, 45, 170-180.
 King, J., Spoeneman, T., Stuart, S., & Beukelman, D. (1995). Small talk in adult conversations:
Implications for AAC vocabulary selection. Augmentative and Alternative Communication, 11(4), 260-
264.
 Light, J., Fallon, K., & Paige, T.K. (1999). Vocabulary selection tool for preschoolers who require AAC.
American Speech-Language-Hearing (ASHA) Convention. San Francisco, CA.
 Marvin, C. A., Beukelman, D. R., & Bilyeu, D. (1994). Vocabulary-use patterns in preschool children:
Effects of context and time sampling. Augmentative and Alternative Communication, 10(4), 224-236.
 Morrow, D., Mirenda, P., Beukelman, D., & Yorkston, K. (1993). Vocabulary selection for
augmentative communication systems: A comparison of three techniques. ASHA, 2(2), 19-30.
 Stuart, S. (1991). Topic and vocabulary use patterns of elderly men and women in two age cohorts.
Unpublished doctoral dissertation, University of Nebraska-Lincoln.
 Stuart, S., Vanderhoof, D., & Beukelman, D. (1993). Topic and vocabulary use patterns of elderly
women. AAC, 9(June), 95-110.
 Van Tatenhove, G. (1986). Vocabulary versatility for the person who is nonspeaking. Communicating
Together, 4, 19-20.
 Van Tatenhove, G. M. Considering vocabulary versatility as a measure of effective use of a symbol
set. In Augmentative Communication: Implementation Strategies (pp. 3-113-133).
 Van Tatenhove, G. M. Training caregivers and facilitators to select vocabulary. In Augmentative
Communication: Implementation Strategies (pp. 6-30-42).
 Yorkston, K. M., Dowden, P. A., Honsinger, M. J., Marriner, N., & Smith, K. (1988a). A comparison of
standard and user vocabulary lists. Augmentative and Alternative Communication, 4, 189-210.
 Yorkston, K. M., Smith, K., & Beukelman, D. (1990). Extended communication samples of augmented
communicators I: A comparison of individualized versus standard single-word vocabularies. Journal
of Speech and Hearing Disorders, 55, 217-224.
 Yorkston, K. M., Beukelman, D. R., Smith, K., & Tice, R. (1990). Extended communication samples of
augmented communicators II: Analysis of Multi-Word Sequences. Journal of Speech and Hearing
Disorders, 55(2), 225-230.
PRACTICAL SUGGESTIONS FOR APPLYING THIS INFORMATION
1. When you are starting with a device with a limited number of keys (either because that's all
the device has or all the child can handle), put words for broad language functions on the
device and extended vocabulary (names of people, places, & things) on a manual
communication board. In order to have words with MAXIMUM value across the most
number of activities and communication settings, start by focusing on words that are used
to MEDIATE or REGULATE activities (e.g., more, again, help, all gone, all done, different).
Then add words that are used to COMMENT and RELATE (e.g., fun, good, bad, like).
2. If a child has a reliable way to say "yes" and "no," (or "hello" and "goodbye"), don't select
these words as the first words on the AAC device.
3. While little children use "the" and "a" with high frequency, these are not high content or
function words and don't need to be on an AAC device or board that has limited keys. This
principle may apply to many other high frequency, but low content words, like “of,” “to,”
“with,” “by,” “for,” etc.
4. Begin to build a manual communication board, keeping motor planning and automaticity in
mind. Always try to have a board with keys for at least 50 core words. For nouns, use a
section that can be flipped or changed so that no matter what the activity, the same 50 core
words are always available. There is a FREE board available at the Minspeak.com website
which is designed with 50 core vocabulary words and a flip section for nouns. Download
this 50-location board from: http://minspeak.com/teachers/InterventionPlanningArchives.php?
PixonCommunicationBoards=1#.WA5W_jKZN0I.
5. After the first 50 words, the AAC system should grow in keeping with normal language
development principles.
 Make sure you continue to include words from a variety of word classes.
o Do you have key pronouns (I, me, you, mine, he, she); verbs (do, put, make,
let, get); negation (not, don't); prepositions (on, off, over, under); key question words
(what, where); modifiers (gone, more, some, all); generic locations (here, there,
away).
 Verb phrase development depends on having access to main verbs, "little" verbs, and
verb endings. You need main verbs with the widest range of function (e.g., do, put, get,
give, make, let, try, like) and more specific function (e.g., eat, read, drink, read, color).
o Some verbs cannot stand alone (e.g., "put'). They are combined with another
word (e.g., preposition = put on, adjective = put more, adverb = put away, pronoun =
you put it, determiner = put that). You have to have a variety of words available to
combine with these verbs.
  Noun phrase development requires more than names of things. Many times, the more
generic nouns have more usefulness in the context of the situation. Consider how you
can use these words: this, that, these, those, other, more, one, thing, any, etc.
 Make a plan for expanding the language available to the child on the AAC board or
device.
o How are you going to add more pronouns?
o How will you give the child access to verb forms?
o How important is it for the child to practice helper verbs like "am," "is," "are," "be,”
"can," "will," or "should?"
o How are you going to help the child practice using plurals?
o How are you going to help the child use modifiers (both adverbs and adjectives)
when building noun and verb phrases (e.g., I go now, that big one.)
o How will you expand prepositions?
6. Add words for PERSONAL needs. You are focusing on core vocabulary, but that doesn’t
mean that you ignore or avoid personal, fringe/extended vocabulary words.
a. Do you have words that represent things, activities or people that are motivating to
the child?
b. Do you have words that are important to the child’s personal needs, especially key
people, health and/or safety concerns, and personal care vocabulary?
7. Use language modeling during activities with the child. The ideal way to model is directly on
the child’s AAC system. When the child says 1 or 2 words (e.g., “in”), use the child’s AAC
system to expand upon what the child said but adding a word to the beginning (“put in”) or
end (“in there”). Make sure you are verbally saying a short, complete sentence as you
model key words for the child. And don’t require the child to repeat what you modeled.
You are exposing the child to language, not dictating what they are supposed to say.
8. Make visual supports that you can also use to model language and which the child can
reference as a way to encourage two, three, and four word utterances. Consider purchase
of a Natural Aided Language Board for students who have robust AAC systems
(http://www.vantatenhove.com/naturalaidedlanguageboards.shtml) or download a free Pixon-based
vocabulary wall chart from the Minspeak.com website for students using Pixon-based
communication systems. (http://minspeak.com/teachers/InterventionPlanningArchives.php?
PixonCurriculumSupports=1#.WA5ZSzKZN0I)
9. Implement a prompt hierarchy to encourage the use of core vocabulary. Starting with
modeling as your first prompt. If the child is not attending to your visual model, add a light
or sound prompt to alert them to LOOK at what you are modeling. Consider the use of
masking or highlighting as another way to help the child LOOK at and LOCATE the target
word.
10. Develop intervention plans that encourage the use of core vocabulary across a wide variety
of practical activities with a range of communication partners. One useful way to do this is
to write simple "scripts." A script helps communication partners think about their role in
the communication exchange and also how to organize and engineer an activity to promote
the use of core vocabulary and generative language. This handout includes scripting
instructions, a blank scripting worksheet, and a completed worksheet example.

SCRIPTING INSTRUCTIONS
1. Select your activity and list your language learning goal(s) and the vocabulary that helps
meet that goal(s).
2. When gathering your materials for the activity, decide what core words might be used as a
“referent” for the object(s) of the activity. For example, if making a pita pizza, the pita bread
could be referenced with the word “soft” and the toppings with other descriptive words,
such as shape, color, size, or texture.
3. When planning the flow of the activity, decide what you will say and do to engineer the
activity in order to encourage use of the target vocabulary. For example, you might limit the
amount of an item given to the student to encourage him/her to ask for “more.”
4. List any additional vocabulary you will model during the activity. These words are not your
specific target vocabulary that you hope your students will express during the activity. They
are simply additional words to which you want to them to experience.
5. Note whether or not you will be using highlighting or masking as a scaffold to success.
6. List any additional teaching props or materials you might be using to help your students
understand the language concepts and the symbols used for the target vocabulary.
7. Note anything else that you think is important to remember during the activity.
 SCRIPTING WORKSHEET
Activity:

Language Learning
Goals:

Target Student
Vocabulary to Meet
Goals:

Referents Core Words for Referents

Materials Needed:

How I will engineer the activity in order to …..

Tentative “Flow” of
the Activity:

Additional Vocabulary
(to model and/or
mediate interaction):

Highlighting/Masking
of Target Words:

Picture
Teaching/Props:

Other:

Scripting Worksheet Example

Activity: Make a Smoothie

Learning Goals: 1. Initiate communication (interaction)

2. Request recurrence of something (reason to communicate)
3. Say the word “more” appropriately (vocabulary)
4. Say the word “again” appropriately (vocabulary)

Target Student more

Vocabulary to Meet again
Goals:

Referents Core Words for Referents

Materials Needed:
1. almond milk 1. sweet, white
2. strawberry 2. little, red
3. banana 3. long, yellow
4. ice 4. cold, hard
5. blender 5. loud, fast

Tentative “Flow” of the How I will engineer the activity in order to …..
Activity: 1. wait (timing) 1. encourage student to initiate
2. withhold amount (sabotage) 2. encourage student to request more or
: again

put in
Additional Vocabulary (to
go – stop
model and/or mediate
drink
interaction):
Highlight words on Teacher Board of core vocabulary
Highlighting/Masking of
Use masking on each individual Student Board.
Target Words:
Use “more” notes when put in each ingredient.
Picture Teaching/Props:
Use “again” prompt when blending it around and around.

Video and send link home for parents to see and replicate at home.
Other: