“LITTLE’s” CAN have a VOICE Too!

1. “LITTLE’s” CAN have a VOICE Too! Michelle Moorehead, MA, SLP Amanda Ream, MA, CCC-SLP March 22, 2013 MSHA Annual Conference 2013

2. It started with a survey….. March 25, 2011 Dear Parent, Your CHILD is learning touse a communication device (Augmentative Alternative Communication-AAC) & we would like to have your input! If we had a summer AAC camp, would your child attend? _____ YES ______NO If the camp is held on July 20-August 11 would your child be able to attend? _____ YES ______ NO If your child could attend, would you or another caregiver be able to attend some of the sessions with your child? _____ YES _____NO If your child attends an AAC summer camp, will someone be able to transport? _____YES _____NO The purpose of this camp would be to teach new skills, practice new vocabulary, interact with other AAC users, and educate family/caregivers about the importance of AAC use in all environments. Thank you for your input!! Please return by April 15, 2011 MORE TO COME……………..  MSHA Annual Conference 2013

3. Year 1 NEED based Determine age level of group 4 students registered-3 attended + peer mentor Goals: Students will be responsible for carrying devices They will use voice to interact with building staff Vocabulary based on theme-Pirates Parent Education MSHA Annual Conference 2013

4. Students: • Brayden is a 4 year old with a special education eligibility of Physically Impaired. He has been receiving special education services since he was an infant. Exploration of AAC began for Brayden as a toddler. • Kendra is a 3 year old and has received special education services since infancy. She has a special education eligibility of Early Childhood Developmental Delay supported by a medical diagnosis of Down’s Syndrome. • Jacob is 3 year old that has received special education services since infancy. He is a child with a medical diagnosis of Down’s Syndrome and has significant motor planning issues. MSHA Annual Conference 2013

5. Mentoring Program • Caitlin • Current AAC user • Using the Vantage • Going into 3rd. Grade • Looking for leadership opportunities for her • Alec • Current AAC user • Going from the Dynavox to ECHO w/eye scan • Uses eye gaze to access device • Great role model!! MSHA Annual Conference 2013

6. ArRgh!! • ALL Aboard Ship Porter Education Center • Sailing on Thursdays, 9:00—11:30 a.m. • Room 320 • July 21 • July 28 • August 4 • August 11+ PARENTS EDUCATIONAL TIME • August 18 + PARENTS COME & SEE!! MSHA Annual Conference 2013

7. “Schedule” • 9:00: Arrival • 9-9:15: Openings/Greetings • 9:15-9:30: Calendar time • 9:30-9:50: Story time • 9:50-10: Bathroom • 9:50-10:20: Scavenger Hunt • 10:20-10:30: Bathroom • 10:30-10:45: Snack • 10:30-11: Craft • 11-11:20: Games • (11-11:10 Optional Bathroom break) • 11:20-11:30: Treasure Box, Rhyme, Closing • Parents are invited the last 2 weeks • Last Day: Caitlin orders lunch. MSHA Annual Conference 2013

8. Our Focus MSHA Annual Conference 2013

9. A learning opportunity…. MSHA Annual Conference 2013

10. Amanda’s AHA moments!!! • Changing focus from curriculum vocabulary to core • Motor planning • AAC teaming • Language Stealers YouTube MSHA Annual Conference 2013

11. Language Stealers YouTube http://www.youtube.com/watch?v=iOVm8q0mCYA MSHA Annual Conference 2013

12. “AHAAAA” MOMENT -Michelle All the children that I work with begin with language such as: me, mine, I want, up, down, in, out, all done, ……. With all of my years of experience, why am I thinking that children that need a voice output device should learn the name of items to interact ….. MSHA Annual Conference 2013

13. Brown’s Five Stages Stage I -- Semantic Roles and Syntactic Relationships MLU 1.75 Earliest 18 months; latest 27 months See mommy. See daddy. Find it. Hide it. Fix it. Mine. All gone. Up here/Over there. Stage II -- Grammatical Morphemes and the Modulation of Meaning MLU 2.25 Earliest 21 months; latest 30 months That's daddy's nose. Stage III -- Modalities of the Simple Sentence (Yes/no questions, WH questions, negatives, & imperatives) MLU 2.75 Earliest 23 months; latest 37 months Who is this? What is this? I can't swim. Stage IV -- Imbedding of One Sentence within Another MLU 3.50 Earliest 26 months, latest 44 months Now, where's a pencil I can use? That's a box that they put it in. Stage V -- Coordination of Simple Sentences and Propositional Relations MLU 4.00 Earliest 27 months, latest 48 months You snap and he comes. I did this and I did that. We went up to Foxboro and there were slides. MSHA Annual Conference 2013

14. Toddler Vocabulary Arranged by Frequency Words Percentage I 9.5 No 8.5 Yes/yea 7.6 my 5.8 the 5.2 want 5.0 is 4.9 it 4.9 that 4.9 a 4.6 go 4.4 mine 3.8 you 3.2 what 3.1 on 2.8 in 2.7 here 2.7 more 2.6 out 2.4 off 2.3 some 2.3 help 2.1 all done/finished 1.0 96.3% 26 core words shown at left comprise 96.3 percent of the total words used by toddlers in this study Are any of these words picture producers? Which of these words commonly seen on language boards? Banajeeet al. MSHA Annual Conference 2013

15. In the Course of Development the Banajee Core Vocabulary is Nested Within the Marvin Sampling black blue both box boy bugs but buy by bye call came can can't candy car catch cause chair come comes cookie corn could couldn't cup cut day did didn't different do does doctor doesn't dog doing don't done door down drink duck eat eating else even everybody everything face fall find finger fire first five fixed fly foot for from found get gets getting girl girls give go goes going gonna good great green guys had hair hand hands has have haven't he he's her head hear hello help here here's hi high hill him his hold home horse hot house how huh hum I I'll I'm if in inside is isn't it it's juice jump jumped jumping just kind know last leaves let let's lift like little long look looking lot lunch made make man many may maybe me mean messy middle mine mom mommy more most move much must my myself Name name named need never new next nice no not of off oh other ok old on one only open or our ours out over paint people pet name pick piece play please push put ready really red remember ride right room run said same saw say see she she's show shut side sit so still some somebody someone something sometimes somewhere stop stuff swing tape tell than that that's the their them then there there's these they they'll they're thing things this those three threw through time to today together too top toys trees try trying turn turtles two um up us use used very wait want wanted was wasn't watch water way we we'll we're well went were what what's when where where's which while who whole why with won't would ya yes yet you you'll you're your yours a about after again all almost already also an and another ant any are aren't around as at away baby back bad ball bathroom be bean because before being bet better big bird birds bite Christine A. Marvin, David R. Beukelman, Denise Bilyeu AAC, Vol. 10, Dec., 1994 15 MSHA Annual Conference 2013

16. Year 2 • Focus Core Vocabulary • Literacy • Parent participation MSHA Annual Conference 2013

17. AAC for summer ESY servicesDaily Schedule Year 2 8:30-8:35/10:30-10:35 Book/puzzle time 8:35-8:40/10:35-10:40 Introductions/hello song 8:40-9:00/10:40-11:00 Book time 9:00-9:20/11:00-11:20 Request time 9:20-9:25/11:20-11:25 Bathroom/wash hands 9:25-9:55/11:25-11:55 Snack 9:55-10:00/11:55-12:00 Good bye song MSHA Annual Conference 2013

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19. Books for Summer Camp # 2 I Want….. I Like…. MSHA Annual Conference 2013

20. I want popcorn. Do you want it? I want it! I don’t want it. MSHA Annual Conference 2013

21. I want asparagus. Do you want it? I want it! I don’t want it. MSHA Annual Conference 2013

22. I like m & m’s. I like it! I don’t like it! MSHA Annual Conference 2013

23. I like red m & m’s. MSHA Annual Conference 2013

24. Background -Brayden Brayden is 5 yo with a special education eligibility of Physically Impaired. He has been receiving special education services since he was an infant. Exploration of AAC began for Brayden as a toddler, but caregivers have waivered in their focus-voice output support or Brayden voice. *Year 2 of camp attendance. Summer Progress and Suggestions Student: Brayden Device used this summer: Vantage Fall teacher:XXXX Sessions attended: 4 out of 5 Strengths:This is Brayden’s second year in our summer AAC camp. Brayden is very bright but often does not work up to potential. He is very happy and enjoys his social role with others. Brayden has some word approximations and an excellent use of his gestures to interact. Weaknesses:Brayden needed max cues to use device.  He often refused to use device and would turn it off/move it away. It appears that Brayden does not see the need for communication, other than what he currently uses. This is a difficult place for Brayden and his family, a transition with no true decisions or commitment. **This weakness can be turned into a strength as a commitment to consistency (home & school) of a strategy is determined and used-Brayden knows that all the adults are not on the same page and he is “playing the game”. Recommendations:Braydenhas been using the LISD Vantage for over a year. Teacher, therapist, and family need to make a decision to trial other devices or move forward to purchase a device for Brayden. Update • Early Childhood Special Education Program • Currently using iPad with Touch Chat app MSHA Annual Conference 2013

25. Background-Kendra Kendra is 4yo and has received special education services since infancy. She has a special education eligibility of Early Childhood Developmental Delay supported by a medical diagnosis of Down’s Syndrome. Kendra has some “pop out” language, but communication support began early with sign language, pictures, and voice output devices. *Year 2 of camp attendance. Summer Progress and Suggestions Student: Kendra Device used this summer: Springboard Fall teacher:XXXX Sessions attended: 4 out of 5 Strengths: This is Kendra’s second year in our camp. She was very eager to learn and participate in activities during summer group. Kendra needs cues and models to use the Springboard. Mom has now seen Kendra using the device and sees the need.  Weaknesses: Kendra needs continues support in the area of independence with using the Springboard. She is distracted, but understands the benefit of communication this year! Kendra is a “swiper” due to her use of an Ipad. When using a device, she will need a keyguard to support direct selection. High expectations are key for Kendra because she CAN do it! Recommendations:Werecommend continued trial of the Springboard. Current AAC use • Early Childhood Special Education Classroom • Currently using iPad with Proloquo only at school MSHA Annual Conference 2013

26. Background- Jesse • Jesse is 5 yo with a special education eligibility of Early Childhood Developmental Delay. He has been receiving special education services as a toddler and was non verbal. Jesse has been involved in using PECS, sign, Go Talk, & apraxia programs. Minimal progress was noted. • *Year 1 of camp attended. Summer Progress and Suggestions Student: Jesse Device used this summer: Springboard Fall teacher:XXXXX Sessions attended: 5 out of 5 Strengths: Jesse enjoys interacting with people. He can vocalize/verbalize, but is “stuck” in the “I want” stage. It is exciting that he is able to verbalize, but due to his Weaknesses: Jesse needs handover hand assistance to use device. He was not able to locate pictures independently even with model. Jesse’s focus interferes with his independence-as well as follow through of activities at home. **a device was sent home with home practice. Recommendations:Werecommend continued trial of the Springboard. Update • Early Childhood Moderately Cognitively Impaired Classroom • Currently using Go Talk-(& has communication book available), according to classroom teacher  MSHA Annual Conference 2013

27. Background-Daniel Daniel is 6yo and has received special education services since age 24 months. He was originally given The eligibility of Early Childhood Developmental Delay, but that was changed to Autism Spectrum Disorder @ age 40 months. Daniel has been exposed to visuals paired with many low tech voice output Beginning as a toddler. He is driven to be independent & use his behavior to get his needs met. Daniel’s motivation is extremely selective. He is one of 6 other children in his family, with one sister Who is also ASD. *Year 1 of camp attendance. Summer Progress and Suggestions Student: Daniel Device used this summer: Springboard/Vantage Fall teacher:XXXXX Sessions attended: 5 out of 5 Strengths: Daniel benefits from a model. After a few trials he is able to be independent. He prefers the freedom to do things independently, but will not try new things if he is not guided. Weaknesses: Daniel has many protesting behaviors. He needs many prompts and cues to use communication device. Daniel resists new learning, but when he GETS something he likes-he is VERY capable!! Daniel will benefit from strong adult persistence, consistency, and the understanding that he can do it! Recommendations:Werecommend continued trial of the Vantage. Update • Early Childhood Moderately Cognitively Impaired Classroom • Currently using communication notebook  MSHA Annual Conference 2013

28. Background-Rebekah Rebekah is 4 yo and has received special education services since 20 months of age. Her initial Eligibility was Early Childhood Developmental Delay until 2/2012 when the MET changed it to Autism Spectrum Disorder. Rebekah is one of 6 children. She has a twin sister with significant language delays, a brother w/ASD, and mom is a person with a hearing impairment. *Year 1 of camp attendance. Summer Progress and Suggestions Student: Rebekah Device used this summer: Springboard Fall Pre-school teacher:XXXX Sessions attended: 5 out of 5 Strengths: Rebekah benefits from sensory activities (swinging, squishies, and joint compressions) before group work. She is able to match colors and numbers with the device. Rebekah is able to use two to three word utterances with prompts and some hand over hand guidance. She enjoys using the device once she sees the intent/purpose it serves. Weaknesses: Rebekah has many protesting behaviors. She needs structures activities to use communication device. Rebekah will resist the use of something new, until she sees a purpose. She is very capable and persistence & consistence of adults will support her learning. Recommendations: We recommend continued trial of the Springboard/Vantage. **a device was sent home with practice homework, so the family was also exposed to an AAC device. Update • Early Childhood Special Education Classroom • Currently using iPad with Proloquo only at school MSHA Annual Conference 2013

29. Background-Katelyn Katelyn is 4 yo. She has a medical diagnosis of Rett’s and has received special education services since a toddler as a child with the eligibility of Otherwise Health Impaired. Katelyn has been exposed to alternative communication strategies since a toddler including pictures, switches, Go-Talk 9, & Springboard. *Year 1 of camp attendance. Summer Progress and Suggestions Student: Katelyn Device used this summer: Vantage Fall teacher:XXXXX Sessions attended: 5 out of 5 Strengths: Kate is able to match objects to device. She benefits from limited vocabulary/highlight key words for her to access. Weaknesses: Needs a way to access device from walker; distractable-hand over hand assist with waiting for “focus” (put m&mover color to get Kate to look at color icon); device needs keyguard for direct access; used thumb on left hand for access Recommendations:Recommendcontinued use of AAC devices and parent trainings. Update • Early Childhood Special Education Classroom • Currently using Go Talk at calendar time; Springboard Lite; some low tech; and trialing other devices from MiTs. • Parents have AAC evaluation scheduled at U of M MSHA Annual Conference 2013

30. Background-Max Max just turned 4 and has received special education services since age 2 ½. He is eligible for services As a child with an Early Childhood Developmental Delay. Max is a twin and at this time, his sister is not Eligible for service. He is developing expressive language of an “echolalic” nature. Max has been Exposed to visual supports for language comprehension and other expressive opportunities since toddler services. Use of AAC may facilitate the organization of Max’s ideas into words. *Year 1 of camp attendance. Summer Progress and Suggestions Student: Max Device used this summer: Vanguard Fall teacher:XXXX Sessions attended: 4 out of 5 Strengths: Max is a very bright young man. He was able to change settings on device (always have a copy of your customization & lock the tool box). Max’s speech output increased during summer therapy with the use of the Vanguard device. He imitates phrases, sentences, questions, jokes, etc. Max is using more un-prompted communication  The device has been assisting with sentence structure and grammar. Weaknesses: **not really weakness-Max’s desire to learn and explore the information in the device is hard to keep up with!! Structured learning opportunities will assist with his ability to learn and address goals. Recommendations:Recommendcontinued use of AAC devices to facilitate expressive language development, grammar, and comprehension. Current AAC use • Early Childhood Special Education Classroom • Currently using low tech pictures and sentence strips; at home also using sentence strips and pictures • Trial Dynavox MSHA Annual Conference 2013

31. What’s NEXT?? • Meeting with Supervisors • Meeting with other SLP’s • Bridging gaps in support • Continues professional development around AAC devices & users • Providing additional resources for parents • Continuing to advocate for preschoolers MSHA Annual Conference 2013

32. References & Resources AAC Language Lab http://www.aaclanguagelab.com/resources Balandin, S., Iacono, T. (1999). Adult Vocabulary Usage, English, Australia, AAC, Vol. 14. Banajee, M., Dicarlo, C., & Stricklin, S. B. (2003). Core Vocabulary Determination for toddlers, AAC, 19, 67-73. Beukelman, D., Jones, R., & Rowan, M. (1989). Frequency of word usage by nondisabled peers in integrated preschool classrooms. Augmentative and Alternative Communication, 5, 243-248. Brown, R. (1973). A First Language: The early stages. Hill, K. (2001). The Development of a Model for Automated Performance Measurements, Doctoral Dissertation, Speech-Language Pathology, University of Pittsburgh. Marvin, C., Beukelman, D. & Bilyeu, D., (1994). Vocabulary-use patterns in pre-school children: Effects of context and time sampling. Stuart, S. and Beukelman, D. (1997). Most Frequently Occurring Words of Older Adults, AAC, Vol. 13. PrentkeRomich Companyhttp://prentrom.com