By Patti Murphy

If there are masters of the teachable moment, Diane is one. A school nurse, Diane had many such moments several years ago while working one-on-one for an extended period of time with a teenager who had complex communication needs (CCN) and was medically fragile. She talked with me recently about that assignment. Providing daily health care for and assisting a student in learning is rare in her profession, Diane said. There were enduring lessons for all involved.

All day long, the student used a Tobii Dynavox augmentative and alternative communication (AAC) device for self-expression, using one finger to type whatever was on her mind. At home, she reverted to vocalizations for YES and NO, hand signs and a low-tech word board because her family did not encourage use of the device. This puzzled Diane. She believed in using “whatever works at the time or whatever is appropriate” when some form of AAC is in order and honored the other methods her student used. Yet she saw real value and potential in the technology for communication and made sure her student used it thoroughly at school—for academics, classroom and social communication, taking tests—whether opportunities for self-expression were obvious or not.  She taught teachers strategies that encouraged the student to communicate. These included sabotage, a technique conversation partners use to create opportunities for communication (through device use) by putting up roadblocks or purposefully misunderstanding something that the person tries to say without using their device. Sometimes they asked the student to use the device instead of the word board. When the student wrote and told stories with the aid of the device, others saw her imagination, personality and intelligence, Diane said.

The school speech-language pathologist (SLP) was completely on board, constantly updating content on the device to reflect the student’s changing needs and interests. Diane recalled that the SLP played games like “Jeopardy!” with the student as a way of keeping language skills fresh.

From the start, Diane wanted her student to recognize that communication meant more than making requests. “I would encourage her to use the device to communicate her feelings,” she said. “Not just, ‘I need to go to the bathroom,’ but ’I’m upset with my mother because of what she said last night.’” If the student had a crying jag, they’d talk about it immediately after. Sometimes the student’s friends joined in.

As time went on, the student communicated in more challenging environments. She socialized at school dances using the device. In an extended school year program, she shared her storytelling and writing abilities with preschoolers with disabilities. A work experience at a movie theater required her to use the device to say, “Thank you for your ticket. Please go to the left” as patrons arrived. Diane went along on all of these ventures. She said the theater job took the student far from her communication comfort zone. “She assumed that people understand her or would be patient enough to wait for her to use the device to convey a message,” Diane said. That didn’t always happen. Nonetheless, it was a good learning experience.

It makes sense that Diane always considered it part of her job to be attuned to students with CCN and help make colleagues aware. She raised a son with developmental apraxia and worked in rehabilitation hospitals. The years Diane spent with the student who used an AAC device brought forth a revelation.

“I thought I had a tremendous amount of patience,” she said. “It made me even better.”

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