AAC and Apraxia: One Teacher, One Parent, One SLP

AAC and Apraxia: One Teacher, One Parent, One SLP July 8, 2011 Session 305 1-2:30 p.m. Part A 3-4:30 p.m. Part B Daigle, Rogers, Rausch

AAC and Apraxia: One Teacher, One Parent, One SLP Agenda 1:00 - 2:30 p.m. Part A 1:00 – 1:15 Introductions 1:15 – 1:40 A Teacher’s Perspective: Intro to AAC - Dr. Sharon Rogers 1:40 – 2:30 A Parent’s Perspective: One Family’s Journey – Kathy Daigle 3:00 – 4:30 p.m. Part B 3:00 – 3:20A Teacher’s Perspective: 8 principles of AAC- Dr. Sharon Rogers 3:20 – 4:05 An SLP’s Perspective : Assessment and Instruction – Kathy Rausch 4:05 – 4:30 Summary and Questions

AAC and Apraxia: One Teacher, One Parent, One SLP PART B

Rogers’ 8:Principles of AAC Developed by: listening to children and parents analyzing and writing about real children teaching graduate students in speech language pathology teaching special educators

# 1: Children Are As Different as Their Finger Prints Knowledge of how to use language, operate AAC Strategies for being communication partners Positive affect/attitude—become attentive and feel less frustration “Each child is going to be different, and each new child means they are new to you… The teachers need to figure out those differences”, an educator said.

# 1: Children Are As Different as Their Fingerprints Favorite topics: Cinderella Pinkalicious chocolate Favorite tone: Serious Teasing Favorite music: Hannah Montana Celtic Brazilian jazz.

# 2: Children are Social Beings Place primary emphasis upon children’s participation socially with peers and adults More important to work with other children instead of stickers

# 2: Children are Social Beings With peers Motivating Instructive Children accepting • “He lights up for the kids in the classroom,” • a parent told me.

# 3: Communication Develops in Families Parents/caregivers interpret accurately and sensitively about their child’s non-verbal communication. This needs to be shared with child’s communication partners May use “Hearing Them Into Voice” protocol Parents augment and use alternative communication at home and in the community.

# 3: Communication Develops in Families Provide Models Become Interpreters Set priorities Teach Follow through Instruction Coordinate “Education starts at home and isn’t something that parents send their child off to get.”

# 4: Communication is More than Speaking Listen/watch, speak, read, write Nonverbal Word Approximations Words-written and spoken Augmentative and Alternative Communication--light and high technology

# 4: Communication is More than Speaking Writing is his “valley” Speaking is a “raging river” that he cannot cross “He used pantomime to tell complete stories to anyone who would listen.”

# 5: Children Can Learn to Read and Write Before Speaking Take time to teach reading and writing Use AAC for clarification, repair, and expanding communication Resource: www.aac-rerc.com Webcast Janice Light, Penn State, on “Maximizing the Literacy Skills of Children who use AAC”

# 5: Children Can Learn to Read and Write Before Speaking Mom, Your love can make us confident, Can make us struggle Can make us brilliant Can make us success.. Your love is enough for us, More than enough Jefferson, age 6 • “Even if you cannot speak, at least you can write to tell us.”

# 6: Intrinsic Motivation Best Stimulates Learning Satisfaction from seeking/getting results Not extrinsic rewards others decide on In preferred activities that children value and use multiple places Learning lasts longer

# 6: Intrinsic Motivation Best Stimulates Learning “Completion of a task is more a question of interest than ability,” an occupational therapist described one child. “School dumbed our daughter down,” her parent told me.

# 7: Environment Determines Children’s Level of Participation Find the AAC tools Develop a team of persons with different expertise Believe that AAC can develop child’s potential Have written policies that encourage AAC use Make speech and language services available for problem solving in assessing and teaching, and facilitate AAC use.

# 7: Environment Determines Participation Danbury Elementary, Claremont, CA Technology for every student Curriculum support “Disbelief and low expectations are reflected onto A.D. who has no control over what people say or think about him,”one educator reported. Learning with AAC

# 8: Children Give to Others Expect novel and generative ideas Appreciate humor and questions Participates in “dance of life”

# 8: Children Give to Others “She taught me to ask the right questions,”an educator commented. “I could go around the world 6 times, take every university course and not learn as much about life as I have from J,”a child’s nurse described.

SOOOO! Don’t DelayDo Not Pass Go: Do Not Collect $200 Two speech language pathologists wrote: “Simply put, delayed language and conversational development are high prices to pay while either waiting for speech to develop normally or while devoting 99% of the available therapy time to speech intervention.” Cumley and Jones, 1992

AAC and Apraxia- Perspectives from an SLP Let’s use modern technology to assist our children with Apraxia Augment- to increase or strengthen Early intervention is the key! What are we waiting for? Kathy Rausch, M.S., CCC-SLP

AAC and Apraxia- Perspectives from an SLP • AAC Assessment • Trials • Training is critical • Teach, Teach, Teach, Teach • AAC in the educational setting • AAC for communication and literacy • Kourtney’s journey • Don’t forget….. • Summary of AAC and Apraxia

AAC Assessment Background Information- developmental history Current level of functioning Formal evaluations- psychoeducational, speech and language, educational Interventions previously and currently used Vision and hearing Physical status- fine motor skills

AAC Assessment (cont.) Attention and Behavior- distractibility, alertness, response rate, cooperation Receptive and expressive language skills Current level of speech Other means of communication used-facial expression, gestures, body language, speech approximations Social emotional development- Social Networks Communication Inventory-Blackstone and Berg

AAC Assessment –Assistive Technology Eval Can the child use direct selection (use of fingers) as an access method? How many symbols on a page can they handle and what size? Use of the Test of Aided Communication Symbol Performance (TASP)- Joan Bruno, SLP (MayerJohnson.com) Visual skills Does the child need adapted equipment? ( use of a switch, stylus, or trackball?) If a child is using a switch, what type of scanning is appropriate?

AAC Assessment –Assistive Technology Eval • What type of symbol system is appropriate? • Photographs? Icons? Line drawings? Abstract symbols? Words? Words paired with symbols? • Use of color coding- Caroline Musselwhite (1999), Goosen’s, Crain and Elder (1992)- allows the AAC user and facilitator to quickly identify and locate their symbols on the display • For visual impairments consideration may be given to changes in size, figure-ground contrasts and complexity of pictures. • Level of intelligibility- Apraxia is not static but fluctuating

AAC Assessment –Assistive Technology Eval A feature match is completed. • Features of the device (symbol system, size, color, complexity, etc.) must meet each child’s communication needs, match the AAC user, and provide for future growth and development (5 year) This is not an exact science. • Feature match drives whether you select lite tech vs. dynamic display communication device - you may start a lite tech option and build selection skills - Bottom up or top down approach? Most children with Apraxia benefit from a top down approach

An AAC device is selected now what? • A device should always be trialed prior to purchase to make a final determination as to the appropriateness of the device. • Janice Light( 1989) discussed four critical areas of competency when working with a child that has an AAC system- 1) Operational, 2) Linguistic, 3) Social, 4) Strategic • Article “AAC is more than requesting” • This is what we look at during a trial to determine if it is successful • Parents need to be involved in this step • Customization of vocabulary is critical! (Use of language scripts targeting key areas of communication.)

Successful trial- Go to Funding Funding sources- private pay, medical insurance, Medi-cal, CCS, school districts and Regional Center Funding can be challenging and is a process AAC devices can range from being “relatively reasonable” (< $1,000) to expensive ($8500.00) Unsuccessful trial?- other alternatives are available- use of a second trial

Training is critical Who should be involved? EVERYONE: Child, family, educational support system, therapists Successful use of an AAC system is dependent upon acceptance, training and implementing the system into the child’s environment using naturalistic teaching methods In naturalistic settings, communication is meaningful, motivating, used for control and social

Teach, Teach, Teach, Teach, Teach! AAC devices increase motor planning skills Teaching allows for repetition of language in different contexts Go beyond simple requesting and choice making- teach language i.e.. questioning, commenting, describing Use motivating child preferences

AAC in the educational setting AAC use allows for development of literacy skills when words are paired with icons Children with significant communication impairments are at risk for acquiring reading skills – non-verbal children can read and write We need to build the bridge between how language sounds and how language looks Key areas that need to be incorporated into the use of an AAC device for reading instruction 1) Phonemic awareness, 2) Phonics, 3) Fluency, 4) Vocabulary and 5) Comprehension skills (Torgesen 2002)

AAC for communication and Literacy Build reading with the AAC device by careful book selection Read to your child Use “adapted books” and books on the device Point out letters and sounds Develop a sight vocabulary-place it on the device Ask those “wh” questions about the story to develop comprehension skills Make it fun and interactive

Kourtney’s Journey Use of the Vantage Lite Communication Device by Prentke Romich Company Progression from Unity 60 single hit to Unity 84 sequenced language which provides much more language use. Language is not categorically based but self generating and based upon experiences at hand. Core vocabulary is developed. Sight words have been added to literacy pages also the use of phonic pages to develop phonics and phonemic awareness.

Kourtney’s Journey The ability to produce speech continues to improve. Kourtney will at times still converse with a range of 20 to 80% intelligibility, “good days and bad days”. Her “talk” bridges her communication with individuals who do not understand her When frustrated, Kourtney will go to her device using it for a conversational repair strategy video

Kourtney’s Journey Sight word vocabulary continues to improve Phonics and phonemic awareness skills, reading and spelling continue to be stressed but are challenging A laptop computer is recommended for use in the classroom for written activities due to fine motor skills

Don’t Forget………. • AAC devices have shown to not only improve a child’s ability to communicate but also decreases a child’s level of frustration when attempting to communicate with others. • AAC assists the child with the ability to use language even when they have difficulty producing speech • Don’t limit language because they can’t produce speech sounds

Summary of AAC and Apraxia Each child is unique The child must be paired with an appropriate communication device. The communication device must provide for communication growth and requires proper training and programming For our children who are struggling with their ability to produce speech why wait? Use technology that is available now!

Summary of AAC and Apraxia Children are social beings so encourage participation with AAC . Integrate family values into therapies. Communication is more than speech. Teach children to read and write with AAC. Communicate with AAC to get intrinsically motivating jobs done—expanding social interaction, sharing information, expressing unique identity. Provide supports for children with apraxia using AAC across environments--at home, at school, in community. Expect that children will give to others using AAC.

Summary of AAC and Apraxia • Take a holistic approach to each client • Let the child drive the selection of AAC/AT • Be open to different types and levels of technology • Get your whole team on board with the AAC/AT – it’s all about collaboration! • The family and IEP team need to be educated • Keep it exciting so it will be adopted!

AAC and Apraxia: One Teacher, One Parent, One SLP