Assistive Technology, Augmentative Communication: Some Considerations

1. Assistive Technology, Augmentative Communication: Some Considerations Michael McSheehan University of New Hampshire mcms@unh.edu

2. Let’s Start Some Baseline • PRETEST questions taken from the content presented in Romski & Sevcik (2005).

3. The cognitive prerequisites of Piagetian Stage V or VI sensorimotor skills are necessary for successful use of AAC. … means/end behaviors (Stage V) are necessary but not sufficient for intentional communication … representational behaviors (Stage VI) are necessary prerequisites for symbolic communication. Children’s natural actions and behaviors are the only prerequisites to AAC. The child must demonstrate intent to communicate and motivation for a communication connection. There are no child prerequisites but there must be a CCC-SLP on the intervention team. What prerequisites are necessary in order to begin AAC?

4. MYTH FACT The use of AAC will interfere with a child’s vocal development.

5. AAC & Speech: • Published literature and clinical experience supports the assertion that AAC does not interfere with a child’s natural ability to develop vocal/verbal communication. … • Using augmentative communication is not an indication of giving up on vocal communication, and neither parents nor therapists should perceive it this way.

6. Is it necessary to understand specific concepts/ vocabulary before that vocabulary can be used for communication? • Yes • No

7. Understand Vocab. Before Use? • It is difficult to determine what concepts/vocabulary any child actually understands because judgments are made on the basis of her or his performance, which may or may not reflect underlying competence (Miller & Paul, 1995). • Information about comprehension and communicative intent is particularly limited for children who do not use speech (Romski & Sevcik, 1993). • Even judging comprehension in individuals who are skilled in the use of AAC is complicated by elements of partner input, voice output, or demands of language comprehension tasks (Sutton, Soto, & Blockberger, 2002). Waiting for children to fully demonstrate comprehension of a concept before using words for it would place too much emphasis on the interventionist’s limited ability to gauge the extent of a child’s comprehension of any given word.

8. Regarding Symbolic Words & Concepts Vocabulary Before Use • Use of symbolic words and concepts does not have to wait until children understand those concepts, even for typically developing children. • Waiting until a child demonstrates understanding of what is presented to him or her may promote passive interactions. • Downing (1988) reported that adult focused structure for children’s communication is prevalent in school-age Individualized Education Plan (IEP) goals, where children who do not use speech are systematically taught to respond to adult communication (such as choosing symbols to match an adult model) before they are provided with opportunities to use those symbols themselves for communicative exchanges. • …teach new concepts and words by using them, rather than by expecting a child to first demonstrate understanding of them.

9. There is a representational hierarchy of symbols from objects to written words (traditional orthography). • TrueorFalse. • The empirical evidence from literature on typical language development suggests that this myth is not based on evidence about how young children learn. In fact, during early phases of development, it may not matter if the child uses abstract or iconic symbols because to the child they all function the same. The choice of symbol set may be complicated by what adults perceive as appropriate.

10. Invented Knowledge:when a gap exists between “what we know” and “what we need to know,”we make it up.Rosenhan 1984

11. Points For AT/AC Consideration • Assistive Technology, including augmentative communication addresses needs of both INPUT and OUTPUT • AT/AC is selected based on student characteristics and communication need (instruction & assessment) • Barriers to AT/AC include perceptions of student competence and how we think about ‘symbols’

12. Augmenting INPUT & OUTPUT

13. www.lburkhart.com/hand_ALS_Aud_Scan.htm

14. www.lburkhart.com/hand_ALS_Aud_Scan.htm

15. Student Characteristics • Receptive/INPUT • How might the student take in information? • How might educators present information? • Visual, auditory, tactile, etc. • Expressive/OUTPUT • How might the student demonstrate learning? • Access (e.g., eye point, hand point, switch, manipulate objects) • Symbol set (representation of concepts) • How might educators monitor learning?

16. Student Characteristics Profiles Two Examples of Tools: • Learner Characteristics Inventory • (Kearns, et al., UKY & NAAC) • Sensory Access Profile • (Fedorchak, et al., NH Dept. of Ed.)

17. Barriers • Low Expectations • Perceptions of competence when the student does not have an effective and efficient means of communication • Mindset of modifications not accommodations • AT/AC must be complicated & special • Develop AT/AC for “today” not “tomorrow” • Developing a series of “one time” AT/AC supports • Students demonstrate mastery of symbols in a hierarchy from objects to letters, from abstract to concrete – AND that learning takes a long time or may not occur for some students

18. Strategies • High Expectations • Use the materials available first. If those work, do not introduce something artificial. • Develop AT/AC for “today” and “tomorrow” • Teach “presymbolic communicators” to become symbolic communicators, keeping in mind studies have shown it is possible and may only take a few months of thoughtful, consistent instruction • “You can’t make a withdrawal unless you make a deposit.” (Mirenda)

19. Research Rowland & Schweigert (2000) • In the beginning many of the students were “presymbolic” – they had not made the association between a *thing* and what it might represent. • Students in fact did make the associations. • Some didn’t move along as far as others. • The GOAL all along was to move students along the gradient from pre to symbolic.

20. Rowland & Schwiegert, cont. Usefulness of Tangible Symbols for Individuals with a Variety of Handicapping Conditions: • This project involved children with widely varying etiologies and handicapping conditions who had in common a lack of functional symbolic communication skills. … The instruction provided amounted to 15 to 20 minutes per school day for an average of 6.5 months. Of 41 participants, only 6 failed to acquire tangible symbols during direct intervention, demonstrating that tangible symbols are useful for children demonstrating a broad range of abilities. p. 73 • If we define fast mapping as the learning of novel symbols that occurs within the first three exposures to a new symbol, then 28 of our 35 participants who learned to use tangible symbols became fast mappers.p.73

21. Rowland & Schwiegert, cont. Bridging Function of Tangible Symbols: • …progress through different levels of representation did not occur in a predetermined sequence, nor did it require experience with every level of representation. p.73

22. Rowland & Schwiegert, cont. • “The current functional communication skills of a child are far more relevant to communication intervention than are decisions based solely on a child’s handicapping condition. • As a group, the 41 participants of this study appeared more alike than not, sharing a lack of symbolic communication and a wide range of multiple disabilities. • Indeed, there was no single handicapping condition among our participants that was exclusively associated with the outcome of intervention.”

23. Consider • How does our AA-AAS (and related professional development) reflect high expectations relative to AT/AC? • How does our AA-AAS (and related professional development) encourage educators to use “low” and “high” tech, as appropriate? • How does our AA-AAS (and related professional development) portray students as learners, with potential to become symbolic communicators?

24. Resource of EXAMPLES • See handout • Denham, A. (2004). Pathways to Learning for Students with Cognitive Challenges: Reading, Writing and Presenting. Interdisciplinary Human Development Institute, University of Kentucky. [Online] Available: http://www.ihdi.uky.edu/IEI/

25. Select References and Resources Used for this presentation • Beukelman, D., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children and adults with complex communication needs (3rd ed.)  Baltimore: Paul H. Brookes. • Romski, M.A. & Sevcik, R.A. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18:3, 174-185. • Rowland, C. & Schweigert, P. (2000). Tangible symbols, tangible outcomes. Augmentative and Alternative Communication, 16:2, 61 – 78. • Snell, M., Caves, K., McLean, L., Mineo Mollica, B., Mirenda, P., Paul-Brown, D., Romski, M.A., Rourk, J., Sevcik, R., & Yoder, D. (2003).  Concerns regarding the application of restrictive “eligibility” policies to individuals who need communication services and supports: A response by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities.  Research and Practice for Persons with Severe Disabilities, 28, 70-78. • AAC-RERC http://www.aac-rerc.com/

26. Select References and Resources Used for this presentation • Jorgensen, C.M., McSheehan, M., & Sonnenmeier, R. (2007). Presumed competence reflected in students’ educational programs before and after the Beyond Access professional development intervention.  Journal of Intellectual and Developmental Disabilities, 32(4), 248-262. • McSheehan, M., Sonnenmeier, R., Jorgensen, C.M., & Turner, K. (2006).  Beyond communication access: Promoting learning of the general education curriculum by students with significant disabilities.  Topics in Language Disorders, 26(3), p. 266-290. • Sonnenmeier, R., McSheehan, M., & Jorgensen, C.M. (2005). A case study of team supports for a student with autism’s communication and engagement within the general education curriculum: Preliminary report of the beyond access model. Augmentative and Alternative Communication, 21(2), 101-115.