Creating Successful Communication Opportunities!

1. Division of Accountability Office of Exceptional Children Assistive Technology Services Creating Successful Communication Opportunities! • Valeska Gioia Ed.S, ATACP • Assistive Technology Specialist Special Thanks to: Carol Page, PhD, CCC-SLP, ATP SCATP www.ed.sc.gov

2. Why Use AAC? • Provides a purpose and intent for learning - Through play and active participation • Self-concept, self-esteem, self-competence – improves ability to learn • Means of expressive & improving receptive language • Provides a means for self-talk and cognitive processing Linda Burkhart www.lburkhart.com

3. Why Use AAC? • Communication – may lead to speech, may use AAC as a means indefinitely • Reduces frustration and behavior problems • Makes language less transient - VISUAL • Makes language more concrete • Social interacting with peers • Provides support for accessing other emergent skills (i.e. literacy) Linda Burkhart www.lburkhart.com

4. Successful Communication • Focus on Communication - Not the technology • Assessment is an On-Going, Dynamic Team Process • Multiple Systems & Multiple Modalities • Active Learning • Learn Language through Natural Immersion in Language • Input before Output • The ‘Juggling Act’ for Children who Have Significant Multiple Challenges • Motivation is Key Linda Burkhart www.lburkhart.com

5. Multimodality AAC • More than one form of communication is needed to meet needs and social expectations. • Typically many of us use two or more forms of AAC or visual supports as we talk. • Children learn multiple symbol systems. Carol Page, PhD., CCC-SLP, ATP SCATP

6. Difference between Communication & Visual Schedules • Visual Schedule Communication • Visual support used to • Understand routine • Understand expectations • Follow directions • Decrease anxiety • Symbols used to • Allow individual to communication messages that are important to him/her • Teach higher level communication skills by using motivating messages Carol Page, PhD., CCC-SLP, ATP SCATP

7. Picture or Visual Schedulefor Free Play • The routine should be the act of checking the schedule. • The routine should not be memorizing the actual items on the schedule. Carol Page, PhD., CCC-SLP, ATP SCATP

8. Active Participation • Children with significant challenges, may become passive learners when they have difficulty communicating, interacting and/or understanding what is going on around them. • Passive Role = Less Learning • Providing opportunities for control • Choice Making • Child-directed activities • Following Child’s Lead Linda Burkhart www.lburkhart.com

9. Opportunities for Active Participation Linda Burkhart www.lburkhart.com

10. Opportunities for Active Participation Communication Activities/Games – Carpet Play Square

11. Errorless Choice-Making • Opportunities for making choices - enable the child to feel "In Control" • Provide choices that matter • Who (to sit next to, take turn) • What (song lines) • When (order of events) • Where (to put things, places) • How (to sing fast/slow; loud/soft) • Order of events (books, songs) • Song lines Linda Burkhart www.lburkhart.com

12. Errorless Choice-Making All children can participate in the song… “This is the way we wash our___________.” Carol Page, PhD., CCC-SLP, ATP SCATP

13. Errorless Choice-Making Linda Burkhart www.lburkhart.com

14. Choice-Making using Labels as Symbols Choice Board on Mat Board Using Product Labels

15. Motivation • Motivation for Learning • Nobody does anything without a reason that makes sense to them at the time - including young children • Motivation for learning comes from within a person - Inborn Drives: • 1. To Understand • 2. For Independence and Sense of Self • 3. To Connect Socially with Others Linda Burkhart www.lburkhart.com

16. Beyond Choice Making • Communication is not ‘choice making’ • ‘COMMUNICATION’ means that we don’t already know what the person wants to say • Some children are most interested in the social process, not the message Linda Burkhart www.lburkhart.com

17. Providing Communication Opportunities • Assert independence • Ask questions • Share information • Relate events • Call attention to how things are related - similar and different • Talk about past and future • Negotiate and bargain • State opinions • Tease • Make up stories • Initiate or call attention • Greet • Accept • Reject • Protest • Request objects • Share and show objects • Request information • Name • Acknowledge • Answer • Comment on action/object • Express feelings

18. Current Strategy – ‘Testing’ • Children are often asked direct questions with a right or wrong answer or given limited choices that don’t go anywhere • “What is the weather?” Linda Burkhart www.lburkhart.com

19. Single Message Voice Output Big Mack by AbleNet Chipper by Adaptivation Partner/One by AMDi

20. Ideas for Single Message Devices(i.e. BigMack) • During an activity to indicate “more” or “finished” • To initiate gain attention “you can’t catch me,” “tickle me,” or “brush my hair.” • Use to sing a song, part or whole song • Use with a story with a repetitive line • Use during story time, “Turn the page” • Allow the child to “report” the weather during circle time. • Mount next to door with recorded message “Bye.” • Mount next to door with recorded message “Hi, how are you?” • Mount device next to inside of door with recorded message “May I go outside?”

21. Ideas for Single Message Devices(continued) • Record message on device related to switch-adapted activity (e.g. fan, light, bubble machine, dinosaur) and connect activity into the device. • Send student to another location with a request/statement/question, “I would like to borrow___,” “Here’s the attendance, everyone is here today” • Allow individual to notify others when they need a break with device with recorded message “I need a break.” • Use for communication between home/school. Teachers can record a message for the child to relay once at home (“We had apples for snack.”) and parent may record a message about an event at home (“We read the book about lions”) for the child to relay to the teacher • Use device with recorded message (“I want that.”) for individual to select when communication partner scans through choices (“book, computer, snack”). Carol Page, PhD., CCC-SLP, ATP SCATP

22. Sequential Message Voice Output Little Step-by-Step by Able Net Partner One/Stepper by AMDI Sequencer by Adaptivation

23. Ideas for Sequential Message Devices • Use it to spell a name. For example, “A-L-I-C-E – spells Alice – that’s my name Alice”. You can vary the length of this spelling activity depending on the switching ability of the user. • Use it for counting. You can record the numbers from one to ten • The easiest activity is just to see how many switch presses the user can do “Wow you got up to 8 today I wonder how many you will do tomorrow?” • Using the device to count things in the room is a bit harder. “Let’s count how many people are here today” • Giving directions to draw a silly picture “How many legs?” 1-2-3-4 – “Oh you want 4 legs hey? • Use it to participate in book reading. For example, record the pages from a small book, e.g. “That’s not my lion”. The user can then “read” the page by pushing the switch when each page is turned. • Use it to be funny. Record some jokes or riddles, e.g. “Knock knock – Police – Police to meet you – Want to hear another?”, etc. (4 switch presses).

24. Ideas for Sequential Message Devices (continued) • Use it in cooking. Record the steps of a recipe to remind the rest of the class during cooking. “Break 2 eggs into a bowl – Add one cup of sugar – Beat until pale and frothy”, etc. • Use it in class. Record all the students’ names. The device can now be used to do the roll call or to choose a partner for class activities. • Use it to get to know people. Program in a chat script to make friends and get news from people. “My name is Sue what is yours?” – “I live in Springwood where do you live?” – “My star sign is Scorpio what is yours?” – “My favorite color is pink what is yours?” – etc. • Use it to be social. Record some messages and compliments to be used anytime anywhere to make contact with people. “You look nice today” – “How are you doing?” – “What’s new?” – “Have you got time for a chat?” • Use it for social scripts between 2 people to tell a story, engage in conversation, etc.

25. Current Strategy – ‘Here now, Gone Later’ • Vocabulary flies in out of thin air and then poofs back into oblivion at the end of the activity. Linda Burkhart www.lburkhart.com

26. Vocabulary Always Available:Environmental Embedded Supports Linda Burkhart www.lburkhart.com

27. Vocabulary Always Available: Individual AAC Carol Page, PhD., CCC-SLP, ATP SCATP

28. Natural Immersion inLanguage -Input before Output • Children most effectively learn to use augmentative communication through the SAME methods that they learn to use verbal communication - through modeling in natural and functional contexts!!! • Drill and practice, rote learning is not very effective for learning language • Learning in functional situations facilitates generalization Linda Burkhart www.lburkhart.com

29. Input Before Output • Aided Language Stimulation (Goosens', Crain and Elder) • Children can not be expected to know how to use something until they are given an opportunity to learn how to use it in natural contexts • Multi-Modal Language Stimulation - information needs to go in before it comes back out • Modeling! • Just-right challenge – modeling one step beyond current level Linda Burkhart www.lburkhart.com

30. Strategies/Examples • To support transitioning from picture exchange system to a pointing system, model the use of pointing to communication boards • Model and encourage self-talk using multi-modality supports • Song books and Song Boards • Use conversational language instead of just questioning the child ("You like that,“ "Your car is crashing", "That's big", "I'm going to throw the ball", etc.) • Avoid asking too many questions, use more comments and social expressions ("that's silly", "uh oh!". "we need to clean it up.") • When asking a question, provide a concrete way for student to respond ("Do you want chocolate or regular milk" - showing both containers or pictures for child to select from) Linda Burkhart www.lburkhart.com

31. Providing Input through Songs Linda Burkhart www.lburkhart.com

32. Juggling & “Inconsistency” • Cognitive attention focuses on anything that is not automatic. • Children with significant physical challenges, have not yet developed reliable control of movements at an automatic level, and therefore, even simple movements can be unreliable and require a great deal of cognitive energy to perform. • Juggling means that the child may only have some of the ‘components in the air’ at any given time, and having all the ‘components in the air’ will be rare. This explains why performance is so inconsistent and can not always be predictably repeated! Linda Burkhart www.lburkhart.com

33. Success? • We need to take successes and move on, as opposed to requiring repetition of the task over a given number of trials – Meaningless repetition produces boredom and habituation and thus produces inconsistent test results • For example – the habituation of single message devices and single switch activities Linda Burkhart www.lburkhart.com

34. Natural Contexts • Relate what they already know to new information –increasing motivation and retention. • Provides meaningful opportunities for practice with natural variability to maintain interest. • Augmentative systems need to be seen by the child as a natural means for communication. This is another reason that the systems must be used by others, while communicating to the child. • A variety of communicative functions need to be modeled • Children’s attempts to communicate also need to be responded to and expanded upon using the same systems that the child is using. • Provide activity-specific vocabulary on voice-output devices. • Teaching vs. Testing! Linda Burkhart www.lburkhart.com

35. Engineering the Environment • Identify and prioritize communication activities that occur throughout the day. • Develop message sets for each activity. • Depict message sets on communication boards appropriate for the target student. • Place communication boards in the environments where they will be used. • Implement a systematic approach to cueing and teaching the students to use the boards. Carol Goossens', Ph.D., CCC-SLP, Sharon Sapp Crain, M.S., CCC-SLP and Pamela S. Elder, M.A., CCC-SLP

36. Engineering the Environment • Consistent systems across children and environments, when possible • Place picture symbols at your finger tips - throughout the environment • Aided language stimulation • Model repair strategies and use of alternative forms of communication • Sabotage and engineer activities for communicative opportunities Carol Goossens', Ph.D., CCC-SLP, Sharon Sapp Crain, M.S., CCC-SLP and Pamela S. Elder, M.A., CCC-SLP

37. Aided Language Stimulation Research • 3 week long aided language stimulation program on vocabulary acquisition skills of children with little or no functional speech (LNFS); 4 children single subject, multiple-probe study across activities • 3 activities: arts and crafts, food preparation, and story time activity. Each activity was repeated over the duration of 5 subsequent sessions. Eight target vocabulary items were taught within each activity. • RESULTS: • The intervention met the criterion of being used 70% of the time & providing aided language stimulation with 80:20 ratio of statements to questions • All 4 children acquired the target vocabulary items. • The 3-week intervention program in aided language stimulation was sufficient to facilitate the comprehension of at least 24 vocabulary items in 4 children with LNFS. Dada, S., & Alant, E. (2009). The Effect of Aided Language Stimulation on Vocabulary Acquisition in Children With Little or No Functional Speech. American Journal of Speech-Language Pathology, 18, 50–64.

38. Article/Research on Aided Language Stimulation • Study to determine impact on aided language stimulation on children with moderate cognitive disabilities. • 3 preschool children with moderate cognitive disabilities who were functionally nonspeaking; 12 target vocabulary • Aided language stimulation during a scripted routine designed for a preferred activity. Before beginning the scripted routine, the experimenter placed a communication board in front of the child. The experimenter referred to each object/symbol four times during each session. The position of the symbols displayed was randomized before each session. • Results indicated that all 3 children displayed increased symbol comprehension and production following the implementation of aided language stimulation. Dada, S., & Alant, E. (2004). The Impact of Aided Language Stimulation on Symbol Comprehension and Production in Children With Moderate Cognitive Disabilities. American Journal of Speech-Language Pathology, 13, 155–167.

39. Engineering the Environment Carol Goossens', Ph.D., CCC-SLP, Sharon Sapp Crain, M.S., CCC-SLP and Pamela S. Elder, M.A., CCC-SLP

40. Environmental AAC Supports Communication placemat Carol Page, PhD., CCC-SLP, ATP SCATP

41. Environmental AAC Supports Communication CD Case Carol Page, PhD., CCC-SLP, ATP SCATP

42. Environmental AAC Supports Communication Photo Album Carol Page, PhD., CCC-SLP, ATP SCATP

43. Environmental AAC Supports Add Communication Symbols to Play Toys Carol Page, PhD., CCC-SLP, ATP SCATP

44. Environmental AAC Supports Add Communication Symbols to School Items Carol Page, PhD., CCC-SLP, ATP SCATP

45. AAC Symbols • 95 teachers rated their students’ symbolic communication level: • - abstract • - concrete • - pre-symbolic • - awareness • Statistically significant difference between teacher rating and student actual performance on 10 tasks • (Brower, D. Flowers, C. & Wakeman, S.Y., 2006) Check out: http://www.osepideasthatwork.org/toolkit/index.asp

46. Continuum of AAC Symbols • Continuum: • objects (easiest) • objects with pictures and text • photos, pictures and text (photographs are often easiest for children with ASD) • text (most difficult) Carol Page, PhD., CCC-SLP, ATP SCATP

47. Using Objects to Communicate • May need to use the actual object at first. • Use a duplicate object (symbol) as soon as possible. • Begin exchange system. • Mount object on board or voice output device. • Change color, size or texture of object. • Introduce second, but very different object symbol. • Elizabeth Rush, MA, CCC-SLP, CPM • Mary Joan McClure, MS, CCC-SLP

48. Why Objects Work • Concrete (low cognitive demand) • Static or permanent (low memory demand) • Iconic (close obvious relationship to referent) • Easy to manipulate • Allow tactile discrimination • Support expressive and receptive communication Elizabeth Rush, MA, CCC-SLP, CPM Mary Joan McClure, MS, CCC-SLP

49. When Objects Don’t Work • Object identification is not communication. • Miniature objects are not understood well by some (individuals who have visual impairments or autism). • Non-motivating objects used. • Difficult to find objects to represent verbs, adjectives, modifiers, etc. (core vocabulary) Carol Page, PhD., CCC-SLP, ATP SCATP

50. Object Choice Board Choice Board Using Clear Plastic Zip Drive Cases