A few weeks ago, my nieces visited our home for their annual week of "Camp Rankin." We meet their family at the same park, halfway between our homes, each year to pick up and drop off the girls. Visiting a playground only once a year provides amazing insight into the changes in Nathaniel's physical abilities. In 2015, he kept his feet on solid ground. Walking on the uneven park surface carrying his tube feed in a backpack was challenging enough. In 2016, he was comfortable walking up a ramp to the lowest play area. His aunt and cousin were watchful spotters to his emerging climbing skills in 2017. This year it was hard for any of us to keep up.

I don't notice these changes at the playgrounds we go to regularly. Improvements in Nathaniel's gross motor skills are gradual and not as easily recognized in our day to day routine. Similar to the park visit, periodic visits with extended family gives us feedback on Nathaniel's communication skills.

We spent last week in Ohio with my brothers, sister-in-law, and nieces. It is an annual event, providing family a brief glimpse into our AAC world. My brother's first comment about Nathaniel's language use was after we had ordered ice cream cones and were standing as a group outside the ice cream shop. Nathaniel waved to get everyone's attention and said "Come lake" on his device. Our nightly habit was to walk on the dock once ice cream cones were in hand. He was eager to go and decided it was his job to get the group moving. "He didn't tell us what to do last year," my brother commented. In many ways, this feedback from family is more valuable to me than the clinical based AAC evaluations Nathaniel has received in therapy.

In their explanation of why The Pragmatics Profile of Everyday Communication Skills in Children was created, Dewart and Summers write, "In traditional approaches to assessment, such as standardised testing and observations of interactions in clinical settings, it is only possible to gain a very limited picture of how children make their needs and wishes known and how they deal with the range of different communicative situations and conversational partners that will be encountered in the course of a day. We believe that the ways the child communicates in situations outside the clinic are of paramount importance and should be the focus of intervention with children who have communication difficulties."

Growing Nathaniel's pragmatic language skills - his use of language in real life situations - is my motivation for working with him. I don't model on his AAC device or continually expose him to more vocabulary through reading so he scores better on his next evaluation; I want to equip him with language so that when he needs it, whether at home, at church, in learning co-op, or on vacation, he is a successful communicator.

Over the course of the week, family pointed out other changes they noticed in Nathaniel's communication skills. Observations included things like: Nathaniel is over all more settled and able to concentrate on his device. He is habitually putting multiple word phrases together. He turns to his device to solve his problems. Device use seems less adult driven and more Nathaniel driven.  He is physically stronger - more capable of and willing to carry the device.

This sort of feedback is valuable. In five years of speech therapy with a few different therapists, we have never received information of this sort. Rather than an assessment that compares Nathaniel to a standard, these annual family based AAC evaluations compare Nathaniel to himself. They offer insight into my role as a communication partner. They are based on tangible circumstances and include concrete reasons for communication and examples of communication. They help me understand where we've made progress and areas where more work is needed because the communication successes and breakdowns influenced our lives and time together.

Family vacation doesn't allow the time to ask a family member all the questions in the Pragmatic Profile. But these few questions come to mind as possible discussion points with observant family or friends who spend time with Nathaniel intermittently:
1. What changes did you notice in Nathaniel's communication skills?
2. Did your relationship with Nathaniel change in anyway since our last visit because of communication? How?
3. Describe a moment you experienced when Nathaniel needed more communication skills than he demonstrated? How did this resolve?
4. Describe a moment you experienced when Nathaniel's communication skills were sufficient for the situation and you had a good interaction.

A printable list of these questions can be downloaded here.