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An SLP Offers AAC Intervention at 30,000 Feet

by Rachel Romeo
written by
Woman looking at boy next to her on airplane.

When I boarded an 8-hour international flight home from a language neurobiology conference a this past August, I anticipated getting some major work done. If I was lucky, I could also catch a nap. But my plans quickly changed when assigned seating fates intervened.

Thanks to a technical snafu, I got the last remaining seat on the plane. As I walked down the aisle, a flight attendant stopped me. She warned that my seatmate—a young boy with nonverbal autism prone to disruptive behaviors—might make the flight difficult, but that there were no more available seats.

When I sat down, the boy’s father preemptively apologized. I told him not to worry, because, as a speech-language pathologist, I understood.

Before the plane left the ground, the boy started screaming, grabbing my things, and self-stimming in potentially dangerous ways in such a small space. His behavior clearly seemed reactionary to anxiety and frustration.

I asked the father if and how his son communicated, recognizing that English was likely not the father’s first language. I thought if I could in some way introduce myself and seem less of a stranger, it might provide some relief for the son. The father seemed confused by my question, repeating, “He doesn’t talk.” I asked if anyone tried pictures, but the father said no.

Now I knew what I had to do, and our language barrier became irrelevant.

But how to introduce augmentative and alternative communication (AAC) on a plane? I used my laptop to pull up standard picture communication symbols for things the boy seemed most interested in, specifically the lemon in my cup and a stuffed penguin toy he held. He immediately seemed bothered by the screen, so I tried to think of a plan B.

I didn’t have any paper (who has paper anymore?!), so I took out the air-sickness bag and started drawing. I am by no means an artist. Pure luck allowed the boy to interpret my crude pictures.  I find the beauty of symbols transcends drawing skill, however. Symbols or images don’t need to be exact representations, as long as the communicators agree on meaning.

I retrieved my lemon—at this point just a piece of peel—pointed to the picture and then handed him the bag. I did the same with the penguin, going back and forth between the two pictures. After just a few exchanges, my seatmate started to get it—the symbol stood for the object. I could almost see the gears turning in the boy’s head.

His father started paying close attention, realizing his child was responding to another person and in some cases even initiating interaction. The frequency of his challenging behaviors lessened. The boy seemed to feel less frustrated. His father looked overcome with emotion. We all came together through the power of communication.

Being literally strapped in together and not knowing when, if ever, the child might learn more communication techniques, I introduced several more symbols than I typically do at one time. I tried to choose pictures most relevant to our situation and his life. We worked on symbols for plane, dad, food, water, and several different feelings. I taught him afraid and mad by using pantomime, so he could potentially communicate meaningful ideas to help him avoid his disruptive actions.

As we neared the end of the flight, I gave the father the ignoble “board” and made sure he knew how to use it. I encouraged him to grow the symbol repertoire, slowly and deliberately, and it was OK for him to change or take away symbols that weren’t working.

And then the plane landed and we went our separate ways. I’ll likely never see my fated client again, or know how this AAC strategy continues to work or not. For at least one day, though, I was in the right place at the right time to help a family communicate.

As you prepare to endure often stressful holiday travel, keep in mind that getting the last seat on a crowded flight might change someone’s life.

Rachel R. Romeo, PhD, CCC-SLP, is a post-doctoral fellow in translational neurodevelopment at Boston Children’s Hospital & Massachusetts Institute of Technology. rromeo@mit.edu


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