A high school student arrives with no communication device, no verbal speech, and no manual signs. Parents report he’s never had an AAC system, and you wonder how any student could make it this far with almost no access to communication.
When you talk with his teacher, she’s concerned that he might not have the prerequisite skills for AAC. You turn to the site SLP, and she is exasperated. She already tried introducing a single-message voice output device in her sessions without success.
The team is stuck. And frankly, so is the student.
The Problem
When I got the team together, I asked a new question: What does he love? What motivates him?
The team knew immediately—a specific character doll from his favorite YouTube show. The student brings it to school every day and seeks it out often.
Here’s what changed everything: that doll has a button on its stomach that plays the character’s song when pressed. The student pushes that button consistently and clearly understands the cause-and-effect relationship: press button → voice output.
That’s the same operation required for the BigMack that hadn’t been working. Same button press. Similar voice output. Completely different result.
The difference? Context. Motivation. Familiarity.
The Plan
The team shifted their approach in three key ways:
Push-in over pull-out
Sessions moved into his classroom, at his desk, surrounded by familiar people and routines. Generalization becomes easier when you’re not asking a student to transfer skills across different environments.
Prioritize rapport over “readiness”
His BigMack was paired with his favorite toys and media. Access to the things he loved wasn’t contingent on performance. Trust would pave the way for progress.
Train the team, not just the student
Rather than putting him on the spot to use the BigMack, his aide learned to model using the system naturally throughout the day. She requested preferred items using the device. She demonstrated that this button—just like the one on his beloved doll—could make things happen.
The Results
Within two weeks, the student was using his BigMack to request a preferred item in his classroom.
He’s now working toward a three-button system with expanded communication functions. In the coming months, he will work on requesting different objects, requesting simple actions, and answering yes or no questions.
The trajectory has completely changed—not because his cognitive or communication skills drastically improved, but because the intervention finally aligned with what actually motivates him.
Lessons Learned
It’s never too late to try something new, especially in the world of AAC.
“Readiness” is a construct that keeps far too many students from accessing communication. Students don’t need to demonstrate a hierarchy of prerequisite skills before they’re “allowed” to use a voice output system. They often need a team willing to find what matters to them, meet them in contexts where they feel safe, and show them that communication can be powerful and worth the effort.
Sometimes the button works when it’s on a doll’s belly. Sometimes it works when it’s on a familiar desk instead of a therapy table. Sometimes it works when a trusted adult models it instead of demanding performance.
When AAC isn’t working, revise your approach, rally your team, and rely on your student’s interests to lead the way.
Author: Alex Redfern, M.S., CCC-SLP
