While in graduate school I began working with children and adults with complex communication needs, and thereafter spent the next several years working with the same population in various settings, such as therapeutic day schools, educational life skills programs, and privately in residential facilities and in private practice. While some of my clients had a high tech or low-tech communication system in place, many lacked access to a communication system altogether or were on waiting lists to trial devices. For those who lacked a communication system, I began using static core vocabulary boards and mid-tech systems to attempt to provide a robust vocabulary. For several individuals on my caseload, a static board or mid-tech system worked, but I continued to have a large population of students who did not learn reciprocal and intentional two-way communication using these systems. Many children with autism spectrum disorder were able to access a static board and could point to multiple icons on a page, but it became difficult for a communication partner to determine what was intentional communication and discriminate which icons were being used to formulate a message.
While working with children in a life skills classroom, I found many of my students to have a wide range of low-tech communication books and make-shift AAC systems with removable icons, or there were multiple pages accessed by direct selection (i.e.pointing to phrases on a page). As a therapist, I liked the aspect of these systems being low-tech, as I saw great growth in areas such as joint attention and orienting to communication partner when making requests; however, at the same time these systems lacked access to single core words and had no organizational systems. They were often full of nouns, phrase-based icons, and pre-determined sentences. If core words existed in these systems, they could be accessed on multiple pages and had no real motor plan for each word. Overall, there was decreased efficiency in accessing items that a child wanted to say. Additionally, I found these communication books limited my students’ ability to compose novel utterances at their language level, as phrase-based pages and nouns did not allow them to use varying syntax across communicative intents. There are many different ways to use individual words to communicate a variety of functional intents, and I knew my students were capable of that. As a speech-language pathologist, my training told me that I needed to work on language!
For the next year, I continued my own research and incorporated evidence based principles into the creation of the Core Vocabulary Exchange System™ (CVES™). CVES™ is a low-tech, exchange based communication system consisting of a Communication Binder, Core Vocabulary Foldout, Binder Inserts, and Communication Card.
There are a total of 9 different core vocabulary foldouts which have been designed to meet the needs of a range of communicators and fine motor abilities. Please see the diagram below which shows each series. The 9 foldouts have been organized into 3 language sequences, including Emergent, Intermediate, and Advanced. Within each series is a set of 3 core vocabulary foldouts, and the physical size of these foldouts are either Single Fold, Gate Fold, or Trifold. The terminology “Single Fold, Gate Fold, and Trifold” refers to the physical size of the core vocabulary foldout, with “Single Fold” being the smallest, and “Trifold” being the largest foldout.
On each core vocabulary foldout comes a full set of core vocabulary icons. The number of icons changes depending upon the size of the foldout. The larger the foldout, the more language that’s available. A Trifold will always have the most language available within a series, while the Single Fold has the least number of icons. It is important to note that the size of the icon remains the same throughout each series, and what changes is the physical size of the fold out. The larger the foldout, the more icons available for the user. One of the most important concepts relating to the icons is that they are removable and returnable to the same location, keeping a consistent motor plan for each word.
In the Emergent series, all icon sizes are large. Emergent (Large Icons), includes the Single Fold (2o icons), Gate Fold (36 icons), and Trifold (60 icons). This series is great if a child has difficulty accessing smaller icons or may have difficulty with visual motor integration.
The second series is Intermediate (Medium Icons), which includes the Single Fold (35 icons), Gate Fold (65 icons), and Trifold (105 icons). This is a great go to series for a child who can access medium sized icons, but who still might still have some difficulty with fine motor dexterity and accessing an icon from the Advanced series.
The 3rd and final series is Advanced (Small Icons), which includes the Single Fold (63 icons), Gate Fold (119 icons), and Trifold (189 icons). This series contains the most number of icons within each fold out, and allows for more extensive vocabulary modeling and use. A child who uses this series has the ability to access an icon that is slightly less than 1 inch in size.
If a child is already using a communication binder, the core vocabulary foldout can be attached to the back of the binder with hook and loop. Alternatively, the core vocabulary foldouts can attach to the back existing communication binders or to CVES™ communication binders.
The use of a core communication card allows for different words to be exchanged at the single word level or multi-word level, which allows the individual to build sentences of increasing complexity. The communication partner can then respond back to the user in a two-way exchange and create a communication loop. For example, after an individual has communicated a message (i.e. “want ball”), the communication partner removes icons from the core vocabulary foldout and places them onto the communication card and speaks back to the individual (i.e. “here you go”). This approach pairs speech with each individual icon to increase the association between verbal speech and each symbol. This two-way exchange may facilitate multiple conversational exchanges on a topic, where core vocabulary icons may be exchanged multiple times onto the communication card between the user and communication partner.
The Binder Inserts contain pre-selected frequently used fringe vocabulary words which are color coded into 8 different categories (Favorite Things, People, Food/Drink, Social Phrases, Sensorimotor, Feelings, Art/Colors, Miscellaneous). There is also blank space provided on each insert to allow for additional fringe vocabulary words/pictures to be added. The Binder Inserts are a great place to store pictures of favorite toys, sensory tools, and other items an individual may need on a daily basis.
The Core Vocabulary Foldout and/or Binder Inserts can be used in a variety of ways. An emergent communicator may take core vocabulary icons directly off of the Core Vocabulary Foldout or Binder Insert to communicate at the single word level with a communication partner (use icons without the communication card). If an individual is working on two-word or multi-word phrases, the user can remove icons from the Core Vocabulary Foldout and Binder Insert, sequence them onto the core communication card, and exchange the message to a communication partner. Additionally, the communication partner can respond back to the individual by removing core/fringe vocabulary words from their position on the foldout or inserts, and visually demonstrate these icons to the user, and then return the icons to their original location. Individual manipulation of icon pieces allows for a practitioner or other communication partner to model language receptively and expressively by removing icon pieces from a consistent predetermined location and returning icon pieces to the same location after use.
One of our primary areas of focus has been on reciprocity of language and two-way interactions using CVES™. We hope that you’ll join us each month and check in to see how we are targeting reciprocity, joint attention, data collection, success stories, and other tips for a variety of individuals!