AAC success story blog posts

In my last blog, I introduced the idea of using eBooks to provide independent access to books for students with significant disabilities.  eBooks are an electronic version of a printed book which can be read on a personal computer or hand-held device designed specifically for this purpose (Oxford Dictionary of English). eBooks can also be read on dedicated hardware devices such as Tobii Dynavox T-Series, eBook readers, personal computers and some cell phones.  eBooks allow students with physical disabilities (e.g., cerebral palsy) to independently turn pages.  eBooks can also be read out loud for students who are emergent readers.

While reading books is certainly a leisure activity that should be supported for students with special needs, there are many classroom applications as well. 

4 Tips for using eBooks in the classroom

  1. Load a dictionary and with the speak features of your device; you can create a “talking dictionary” for your students.
  2. Use eBooks during guided reading activities. This is one component of a four-block reading program, developed by Pat Cunningham and Dottie Hall.
  3. Download national or local newspapers to read about and discuss current events. 
  4. Provide visual and auditory feedback by using the Highlight as you Speak feature. This feature will speak the current eBook page and highlight each word as it is spoken.  This feature can be turned on by going into the Message Window tab in the Interface Features menu.

I was in a workshop recently when I heard someone say, “He can’t learn to use his AAC device for anything but requesting because he has autism.”

Could that be true?

I don’t think so.

I think we often introduce AAC equipment and strategies in activities that involve requesting.  Why?  Because it is motivating and often instantly successful.   Because it works!  We then often expand opportunities for requesting to additional activities throughout the day, so the AAC user can request snack foods, center time activities, music, break time, and even which classmate to sit with.   Many opportunities, but only opportunities for requesting.  Is that all there is?

We know that the ability to use AAC to request may not automatically transfer to other functions of language without teaching.  That is what the research suggests.  So what that means for us is that we need to introduce AAC use for other functions of language and then use our communication partner strategies to teach it!

How do we do it?

We can model and teach AAC use for commenting, protesting, and sharing information in virtually any setting.

I can show commenting at its most simple by saying and touching the AAC device to indicate “this is good” or “this stinks,” while we are having a snack.   “This is funny,” while reading a book or “This makes me mad,” when having difficulty with something.

I can show protesting by modeling the use of the AAC device to say, “I don’t want to,” or “No” after presenting items or activities that I know the AAC user does not like.  “Stop it,” when a classmate is being a bother.  I can use sabotage to create situations that lend themselves to protest and then assist the AAC user to do so with his or her device.

I can teach information sharing by using photographs of the AAC user engaged in fun activities or with his or her family members, and messages that tell about the people and events depicted.  “This is my dog.”  “This is me at Christmas with my presents.”  “Look at me on a bike!”

Have a look at the AAC users that you support.  Are they using their AAC device for a variety of language purposes?

I recently had a conversation with a man who had a stroke about two years ago.  He is able to use his speech to communicate but does experience some difficulty with memory and word finding.  He has always been an independent person and one of the ways he has maintained his independence since his stroke is to give his communication partners directions when he wants to remember or find the right word on his own.  Instead of waiting for his communication partner to finish his thought, he says, “Now wait a minute” and holds up one finger.  This prompt to his communication partner generally gives him enough time to recall what he wanted to say or find the necessary words in the sentence.  It allows him to be independent—something he wants very much.

This kind of strategy would work in an augmentative communication system too.  Messages such as

  • “Please wait.”
  • “Don’t interrupt.”
  • “I’m still thinking.”
  • “I can remember, just give me a minute.”
  • “Hold on, I’ve got it.”

could be programmed in and used when a thought or word isn’t immediately spoken and the speaker would like a minute to two to remember or find them.  Accompanying gestures could be taught in conjunction with the words to make the point even more clear.

When communicating with new partners, it can be useful to have an introduction that explains a little about how and why the individual is communicating as he is.  For example,

  • “I had a stroke and sometimes I forget what I am trying to say.  I’m very independent and want to find the word myself.  Please be patient with me.”
  • “When I have trouble thinking of a word or remembering something it is frustrating.  I will ask for extra time to think when I want to remember.  Please be patient with me.

Using these strategies will help both you and your communication partners feel more comfortable in a potentially uncomfortable situation.

 

 

The town where I live has a number of statues in front of and around public buildings.  They depict people mostly but one of them is a statue of a bear lying on its back.  It stands (or lies, more accurately) in front of our park district’s main building.  This particular statue sparked my interest because of the consistent reaction children have when they see it.  Child after child approaches the bear and rests his or her hand on its head, grabs its hand then sits on it.  This is true of toddlers to kids in early elementary school.  Rarely does a child walk by without approaching the bear unless being pulled by his or her parent into the building or back to the car. (I’ve even seen older children and adults eyeing the bear.  I have a feeling that if they weren’t so “cool” or “mature” they would be touching and sitting on the bear as well.) When these children think about the park district building, what picture do you suppose pops into their minds?  Probably the bear!

What bearing (insert groaning and head shaking here) does this have on AAC in the classroom?

There are times when we as adults become so task-oriented that we miss what is important to the child.  This is especially true when we are adding stories and news to devices.

I remember a trip to New York City with my Girl Scout troop.  We saw so many wonderful and interesting things including the Empire State Building, Central Park and the Museum of Natural History. We also toured backstage at Radio City Music Hall and attended the Radio City Christmas Show!  What did my fellow Scouts and I tell our families about when we got home?  The men in the dining car on the train who were singing, “You are My Sunshine”, loudly and off-key throughout much of the return trip.  I must say that this was very disappointing to my mother (our troop leader) who was hoping that the trip had some more significant impact.  If I had a communication device, I can guarantee you that the men singing, “You are My Sunshine”, would not have been programmed into my news page.

When we customize a student’s device with stories or news, let’s consider what they find interesting.  How do we do that?

  • Ask them.  They may be able to tell us using their devices, gestures or even eye gaze.
  • Pay attention.  Notice what makes them excited, angry or pay increased attention.
  • Watch or ask other students.  Listen to what other students are talking about or ask what news they plan to share when they get home.
  • Tap into your inner child.  Ask yourself, “When I was ___ years old, what would I have found worthy of talking about today?”

Let’s bear in mind (sorry!), that the communication device should reflect the user primarily, not the programmer.

 

The Assistive Technology Industry Association (ATIA) has just released the results of a 2011 survey of speech-language pathologists (SLPs) that was conducted to explore attitudes and use of assistive technology (AT) and augmentative and alternative communication (AAC).  549 SLPs participated in the survey, all of whom were part of either the Schools special interest group or AAC special interest group divisions of ASHA.

Some of the results of the survey are of particular interest to those of us in the school setting.

  • Most respondents felt that their undergraduate and graduate education did not prepare them to competently provide AAC services within their practice.
  • 86% of respondents would like to know more about AT and AAC services and equipment.
  • Only a tenth of respondents believe that there are “sufficient ranks of SLPs with AT and AAC knowledge to meet the needs of consumers.”
  • Many respondents reported that AAC services were inconsistently delivered in their setting due at least in part to lack of expertise.

Oh, dear!  But I think these problems come as no surprise.  While we all know gifted professionals in our field who are providing exemplary AAC services in the schools, the survey reminds us that many SLPs would like more training in AAC to improve their knowledge and skills.   If you are one of them, you are not alone! We all want to provide our students with the best possible services!   ASHA reports that greater than 50% of school-based speech-language pathologists serve students who are in need of AAC,  (ASHA, 2010), yet we know that school-based SLPs often rate themselves as having low levels of AAC expertise.  (Fallon, 2008)

ATIA makes the following recommendations:

  • Pre-service educationat both the undergraduate and graduate level should provide more coursework in AAC and AT.
    • That will be helpful in the long term, but doesn’t help those of us in the field today!
    • Maybe this is something that we can all be working towards in our state organizations for the SLPs of the future.
  • Continuing educationand conference opportunities must be more robust, including on-line offerings.
    • This is the key, in my opinion.  And I think we can recognize that continuing education may take a variety of forms for those of us working in the schools, including:
      • Local in-service opportunities, both intra and inter-school district.  Let’s share the knowledge and expertise as much as possible in our geographical areas.  Could you or someone you know offer in-service training?   Consider interdisciplinary training, and training that includes parents and families.
      • Greater focus on AAC tracts in state and national conferences.  We may have to do a better job of informing conference organizers that we need more AAC!
      • Maybe everyone can’t go to everything, but sending an ambassador from your district to worthy training opportunities and conferences to “train-the-trainer” can be very cost-effective.
      • We have to do a better job of educating our school administrators about our need for continuing education in the area of AAC!  Advocate for your students and yourself by demanding (politely, of course) the time needed to attend worthwhile training events.

Coinciding with diminishing school district funds for conference attendance is a dramatic increase in on-line training opportunities in the field of AAC.  Many current on-line offerings in AAC are of very high quality, and generally allow you to invest your time in small “bites.”  One hour courses or serialized courses offered one hour at a time over a number of weeks are common.  While some are “live,” most are archived and so are available at any time.  There is a list of on-line classes on our website at http://www.tobiidynavox.com.

  • Mentoring as a path to proficiency.  In many school districts or educational co-ops you find one or two SLPs who are more knowledgeable and comfortable with particular areas of practice, like AAC.  Often these SLPs informally advise and assist their colleagues as needed.  I have found a more formal mentor-mentee arrangement to be effective, with clear guidelines established to address the goals, timelines, and expected outcomes of the collaboration.    One objective of the mentorship may be that the current mentee becomes a mentor to others in the future!

ATIA’s survey says that we need greater knowledge and skills in AAC, and we want greater knowledge and skills in AAC.  Maybe we should all make an action plan for how we personally are going to get it in the coming school year. What is your plan?

References

American Speech-Language-Hearing Association (2010). 2010 Schools Survey report: SLP caseload characteristics. Accessed from:  www.asha.org/research/memberdata/SchoolsSurvey.htm on October 12, 2011.

Assistive Technology Industry Association (2012).  The critical need for knowledge and usage of AT and AAC among speech-language pathologists, Survey white paper. Accessed from: http://www.atia.org/i4a/pages/index.cfm?pageID=4327 on June 18, 2012

Fallon, K.A. (2008). AAC in the schools: Current issues and future directions.  Perspectives on Augmentative and Alternative Communication, 17, 6-12.

 

I initially wrote this blog post during the last winter Olympic games.  But I thought that I’d present it here because it still provides valuable advice on how to increase communication and communication opportunities using something unifying – like the 2012 Olympic games!

So many of us were riveted by the inspiring performances and dramatic contests taking place on the Olympic stage recently!   It was fun to watch the games and talk about the events with friends!

In a therapy session that took place while the Olympic games were in progress, I watched a clinician (Jenna) develop an entire language lesson and activity around the Olympic theme.  She asked her student (Brian) to share what he knows about the Olympics, and then provided a literacy activity that gave him a chance to read and learn even more than he already knew. As they talked through the various events and stars of the winter Olympics, I noticed how easily she breezed through content that was already on his AAC system and in some cases updated it to include vocabulary lists or common constructions relative to this conversation.  Brian was instantly exposed to and using content that was relative to this timely topic.

Instead of building a new page about the Olympics, Jenna encouraged Brian to use his games page and sports pages to talk about the sports. When talking about where the Olympics take place, they were able to access appropriate vocabulary in vocabulary lists.  By providing both a model via partner augmented input, as well as support in navigation and customization of these pages, Jenna empowered Brian to be able to go to school the next day and talk about just what his friends were talking about – the Olympics!

I love to hear people laugh.  My extended family and friends include some people with BIG laughs.  You know the kind I mean.  It comes from their very toes and sort of bursts out.  Laughter, for my family and friends, is usually a result of some unexpected situation, a wry comment or a crazy story.  These moments of laughter result in us feeling closer because we have shared and often become fodder for future tales and times of uproarious hilarity.

When introducing AAC to students, many of us consider the role humor plays in encouraging social relationships by utilizing jokes already in the devices or programming our own.  Some people even integrate this with academic goals (e.g., reading, spelling, computer skills) and encourage the student to find a joke-of-the-day on the Internet.  We know that, for some children and teens, the response from their peers is highly motivating and increases desire to interact.

Humor, however, is more than a good joke.  As I described above, it is found in those unexpected situations and comments – purposeful or accidental.

Just like other language and social skills, the humor of children develops over time.  At a certain age, they make up jokes that don’t make sense, produce strings of rhymes using words that do not exist, assign names to people and things with words that do not relate to each other (e.g., “It’s a leafy blanket.”, “It’s a carpet blanket.”) and make up silly phrases (“Too tass cuckoo clock”).   All of which cause them to dissolve in fits of giggles while we shake our heads.

Much to our dismay, children of a certain age find bodily functions really funny (sometimes extending to an age much older than we’d like).  Production of these during class is certainly inappropriate and there are consequences for doing so.  However, we must not be naïve enough to think that they are not produced to a chorus of chuckles and guffaws elsewhere in the school.  Before we remove these from the device, consider (based on the student’s needs and goals) the opportunities that this humor provides for sharing silliness with peers, as well as the teaching of social appropriateness and experiencing consequences.

Augmented communicators may have more limited opportunities to practice and use their humor.  This could be a result of the rather structured nature of the school day.  However, students who speak still have time to practice their humor when not engaged in academic activities (and sometimes during).  Could it be that augmented communicators often spend more time communicating with adults who do not share their sense of what is funny?  Could it be that more of their communication is directed by adults or that they don’t have access to the language they need to produce humor?

How do we encourage development of this socially important skill?  Here are some very basic ideas.

  • Provide time with and encourage the peers to use the device to produce their messages (Partner Augmented Input/Aided Language Stimulation).  Funny things will happen given time.
  • Produce age-appropriate humor ourselves using their device.
  • If students produce humor that is inappropriate for the setting, respond as you would for any other student.  Rather than just squelching the student’s developing attempts at humor, setup opportunities for the student to use that humor when it is appropriate so that they learn the difference.
  • As adults, let’s consider our response to student’s production of irrelevant messages or, what appears to be, playing with the device.  If the production is funny and at an appropriate moment, laugh as you would at any other student’s funny comment.  If it is not, respond as you would to any other student.

Let us recognize and encourage humor in students using AAC for our mutual enjoyment and for their future benefit.  As E.E. Cummings wrote, “The most wasted of all days is one without laughter.”

Article by Stephanie Ekis, MS, CCC-SLP

Supporting social skills development for individuals with autism can be a challenging task for service providers and caregivers.  Children and adults with autism (depending on severity) may have difficulty communicating with others and may have very few friends and shy away from the conversation or interaction.  Children with autism may avoid contact with their peers in school and in turn, classmates may not make an effort to build a relationship or friendship because they do not understand his/her “stand-offish” behaviors (Spivey, 2009).

Possible obstacles to social success…

  • Limited or no opportunity to participate in meaningful social interactions with peers
  • Limited life experiences
  • Low expectations of communication partners
  • Limited access to appropriate communication tools
  • Anticipation of needs/wants by caregivers and educational staff
  • Communication environments that do not support learning and practicing new skills

It has become very clear to me that many children and adults with autism have limited access to meaningful social experiences.  Many of the obstacles listed above could easily be removed by creating a positive communication environment.  Spending a few minutes every day to select activities and set up situations where children and adults with autism have access to meaningful social interaction can make a world of difference.  This small step can provide opportunities to build and practice social and communication skills.

Social participation Quiz…

One quick way to know if you are giving ample opportunities to practice social skills would be to answer the following yes/no questions:

  1. I give the child/adult many opportunities to initiate interaction with others.
  2. I ask a lot of questions that elicit a yes or no answer.
  3. I give the child/adult daily opportunities to practice skills in social situations.
  4. I give the child/adult enough time to answer/comment when we are talking.
  5. I encourage the child/adult to express their opinions.

If you answered “no” to any of these questions, a social opportunities intervention plan is warranted.  Start by creating a list of 5 opportunities each day when the individual will participate in a meaningful interaction.  Make sure to provide them with the tools they need in order to be successful (e.g. communication board/device, script, etc.).  Also, make sure that you vary the communication partners (e.g., peers, adults, familiar, unfamiliar, etc.).

Resources:

Article by Elizabeth Bahr, MA, CCC-SLP

I recently met a person with severe expressive aphasia who was visiting my area from Mississippi.  He was wearing at least 3 pieces of Ole Miss paraphernalia at the time.  College football season was just beginning and his wife informed me they were season ticket holders for Ole Miss Football.   I couldn’t resist… as a Florida Gator I know there is nothing like some good old fashioned SEC banter!

This gentleman had his Tobii Dynavox Maestro with him when we met.  When asked if he used it a lot, he and his wife reported it was a definite learning-curve to work it into their daily lives, but once they did, it’s become a fixture in most of their interactions.   As soon as I mentioned my SEC team of choice, the multimodal communication began including facial expressions and gestures.  My favorite one was his dramatic pinching of the nose (a.k.a. “they stink”).  I asked him why he didn’t like my beloved Florida Gators and he used his ‘what I think’ page under My Phrases folder to illustrate his point a bit clearer!  A family member had added more vocabulary to this page.  The page comes with general terms, (terrible, awful, bad), but he also had more sport-specific words, (winless, weak, over-rated).  On this page he also had terms he used to give his opinions on the stock market.  He worked in finance most of his life and his wife stated that after SEC football, he loved to talk about the market and their stocks.  I thought this was a wonderful idea.  Instead of just making a page of ‘stocks’ and a page for ‘football’, which he had, they incorporated vocabulary he would use within those favorite topics throughout his device.  This gave him more vocabulary with a more natural flow throughout the system.

I was quickly losing this SEC debate.  I pulled out the big guns; I asked him how many SEC championships his team won lately, knowing the answer would be 3 less than my Gators! He minimized his Series 5 software and opened a PDF document that was linked to his desktop.  That document was what I feared he would bring up, the 2008 Ole Miss Season schedule recap.  He quickly pointed to the big win over the Gators and the facial expressions and gestures began again.  He then went back to his Series 5 software and used his numbers page to type ‘600’ and then picked ‘win’ off his football page.  Sure enough, he was correct, that victory was also Ole Miss Rebel’s 600th victory of all time, making it that much sweeter.  Uh oh.

He then opened his monthly calendar in his Series 5 software and pointed to December 1, 2012.  He had “SEC Championship Game” written in. He pointed to himself and to me with a nod.  I replied “yes, it would be nice to have a Gator vs. Rebel SEC game this year!”  If that did happen, hopefully my team would fare better than I had; my new friend used total communication to clearly win this match-up!

Last week I was visiting a local school where several students use Tobii Dynavox devices.  I had a chance to talk with one teacher who was so excited about the progress one of her students is making using the device to communicate.

Janet, Annie’s teacher, was thrilled to share this great story about her student using her Tobii Dynavox in a creative way to share a message. A few months ago Annie was invited to a birthday party for her friend Molly.  Janet said that the time leading up to this party was like Christmas- she was so excited about it and wanted to talk about it all the time. It was a bowling party so they got the content in that topic page customized and ready, and also had the birthday page programmed with things like “I can’t wait for your party, Molly” and “What do you want for your birthday?”  Molly gave her some hints and Annie and her mom bought the gift. It was at home in the living room waiting for the big day.

For a couple days, Annie kept navigating to the Doctor topic page and selecting “wrap it up” (with the symbol of the ace bandage). When she would say it to her mom and Janet, they both asked her questions trying to co-construct some sort of pain or issue that she was talking about.  Then on a Saturday at home, Annie went to the page and said, “wrap it up” to her mom.  “Oh, Annie,” said her mom.  “I just don’t know what you mean!”  Annie was not in her wheelchair at that moment, so she crawled across the living room floor to get to the gift. Then she selected “wrap it up” again. Finally her mom got it!  Annie needed a way to express her desire to wrap that present- and she creatively found a way to say it.

This was like a light bulb going off for Annie’s parents and teachers.  She had been using a page set that was created for an emergent user, but she demonstrated some skills that showed she really was a context dependent user and needed access to more messages.  As her skills grow, she will learn that she can use other tools in her device to create novel messages, too- like keyboarding and use of core words.  It was an exciting day for Annie and she’s now enjoying opportunities to communicate in even more topics with more messages.

Have you ever had a user communicate in a topic using a message in a different sense than originally intended? Tell us about it!