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Assistive Technology/AAC Archive 2011

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Betsy A. Caporale, M.S. CCC-SLP-.
Speech-Language Pathologist
AAC/AT Specialist

Betsy has been working in the field of speech-language pathology for over 18 years, specializing in autism, augmentative communication and assistive technology. She has worked in a variety of settings, including public schools, private clinics, and hospitals. She received her certification as an Assistive Technology Specialist, Communication Services, from the University of South Florida, and earned a Certificate of Competency in Communication Assistive Technology Applications from the National Association of State Directors of Special Education.

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  • Should I be using an IPad as an AAC Device?

Question:

Our district is being inundated with students whose parents have purchased an iPad with various AAC apps and are now expecting the school to use this as an “AAC Device”. Many of the students need extensive training before they are ready to use an iPad in this manner, and I feel some of them may never develop the skills to use the iPad efficiently. Our director is encouraging us to “do the best we can” with the tool and try to make it work. Any suggestions?

Thanks in advance,

Frustrated SLP in Northern California


Answer:

Dear “Frustrated”:

You are not alone! I am hearing this same concern voiced by speech-language pathologists all over the country. In fact, this very topic was discussed in the most recent issue of ASHA’s PERSPECTIVES on Augmentative and Alternative Communication (Vol. 20, No. 1 pp. 1-37). It’s certainly worth reading to gain more insight about mobile AAC technologies from a variety of perspectives, included those of AAC users, implementers and developers.

I will share with you my thoughts on this topic based on many years of experience with AAC, including assessment, implementation, field-based observations, and personal involvement in the development of an AAC App.

The best piece of advice I can give to anyone working in the field of AAC is this: AAC is a process, not a tool! Far too often I see clinicians and IEP teams ignoring the process, and focusing just on a device. Intervention becomes an attempt to fit a student to a particular AAC device, rather than providing functional communication strategies that will best match the child’s unique skills and needs. Unfortunately, this problem has proliferated since the introduction of AAC Apps for the iPad and other mobile devices. The following factors are likely contributing to this phenomenon:

  • Accessibility: Almost anyone can download an AAC app. It’s quick and easy.
  • Affordability: The cost of creating an AAC device using mobile technology is significantly less than purchasing a device from one of the major AAC vendors.
  • The “Cool Factor”: Who doesn’t want an iPad?
  • Multi-functional: These are primarily entertainment systems; the fact that they can function as AAC devices is an added bonus.
  • Lack of Professional Support: most mobile AAC apps do not come with instructional support or manuals. Support services are primarily technical in nature. Little or no guidance is given as to how to implement the software as a communication tool.

In short, mobile technology has opened up the world of computerized devices to practically anyone who needs AAC. It seems like such a simple solution; just download an app, and you’ve created a voice. If only it were that simple! The reality is that AAC users are complex individuals. Most are not just speech impaired, but also exhibit significant impairments in language, cognition and/or mobility. In all of the excitement surrounding the onset of this new brand of AAC, there seems to be an abandonment of common sense procedures. Mobile AAC systems are being acquired before carefully assessing an individual’s skill levels or considering barriers which may interfere with his or her ability to use the device. Eager parents who purchase these systems without first consulting with a professional are “putting the cart before the horse”. As a result, they become disappointed or angry if the system is rejected by their child or not successfully implemented as a communication device. And what about the student who is expected to communicate with a tool he doesn’t have the skills to use? I’ve heard numerous reports of mobile devices being destroyed by AAC users out of aggravation and frustration.

So what’s an SLP to do in the face of this AAC dilemma? I suggest that you rely on your own professional judgment, and follow the best practice guidelines set forth by ASHA. These include:

  • Conduct a comprehensive, collaborative assessment before making AAC recommendations.
  • Consider communication needs across all environments.
  • Set realistic, attainable goals.
  • Provide intervention within functional, meaningful contexts.
  • Involve all significant individuals in the AAC implementation process, including school staff, community helpers, friends and family members.
  • Use a multi-modality approach to communication.

In addition to the above best practices, I offer the following words of advice:

  • Provide a variety of communication options across settings - don’t rely solely on one system.
  • Create a detailed AAC Implementation Plan which clearly defines what communication strategies will be used across settings, and who will facilitate.
  • Provide systematic training and practice with any AAC device.
  • Don’t expect too much too soon. Learning a new system takes patience and perseverance!
  • Have realistic expectations about what AAC can and cannot do. It will never replace natural, verbal speech.
  • ALWAYS KEEP IN MIND: AAC IS A PROCESS, NOT A TOOL!!!

Best of luck to you and your fellow SLPs. I look forward to hearing from you in the future with updates!

Betsy


  • Do you know of any research that supports the use of PECS or pictures for students with autism?

Question:

I work with students on the Autism Spectrum, many of whom are non-verbal.  When I recommend PECS or pictures for these students as a communication strategy, I am often challenged by parents who feel that this will inhibit their child from learning to speak.  I’m not quite sure how to respond to this.  Do you know of any research that supports the use of PECS or pictures for students with autism?


Answer:

I completely understand the reservations some of your parents may feel about you introducing an alternative form of communication to their child who isn’t a functional verbal communicator. It may seem to them that you are giving up hope that their child’s speech will ever improve. This is a very common fear among parents. At the same time, you are attempting to provide a practical way for the child to communicate, and must be frustrated by the resistance you are getting. 

Fortunately, there is now sufficient research to dispel the notion that providing a symbol based communication system will hinder further speech and language development. In fact, research indicates that just the opposite may be true. The best evidence indicates that Augmentative and Alternative Communication (AAC) interventions do not have a negative impact on speech production, and may actually enhance speech and language development. I would highly recommend reading the literature review entitled: Effects of Augmentative and Alternative Communication Intervention on Speech Production in Children with Autism:  A Systematic Review, by Ralf W. Schlosser and Oliver Wendt (American Journal of Speech-Language Vol. 17,  212-230, August 2008). The authors conducted a very comprehensive review of the research, and concluded that AAC interventions do not appear to impede speech production in children with autism or PDD-NOS. They also concluded that AAC interventions may result in increased speech production, and may even be viewed as a bonus of AAC intervention for some children. In a review conducted in 2006, Millar, Light and Schlosser made similar conclusions regarding AAC and children with developmental disabilities (The Impact of Augmentative and Alternative Communication on the Speech Production of Individuals With Developmental Disabilities:  A Research Review. Journal of Speech, Language, and Hearing Research, Vol. 29, 248-264).   According to the authors, this review “provides empirical evidence to support the conterargument that AAC intervention facilitates the production of natural speech” and concurs with existing evidence that “AAC interventions support the development of communicative competence and language skills.” 

I advise you to share this research with the families of students using AAC, as well as the professionals with whom they work. You may also be interested in looking at these related articles:

 

  • Kent-Walsh, Binger, Hasham (June 2010), Effects of Parent Instruction on the Symbolic Communication of Children Using Augmentative and Alternative Communication During Storybook Reading , http://ajslp.asha.org/cgi/reprint/19/2/97

 

 

  • Romski, et al (April 2010), Randomized Comparison of Augmented and Nonaugmented Language Interventions for Toddlers With Developmental Delays and Their Parents (April 2010)  ), http://jslhr.asha.org/cgi/reprint/53/2/350

 

Betsy


  • Can an assistive technical device such as a Classmate Reader help my son who is dyslexic and is diagnosed with ADHD? Also, what about using the Barton Reading System?

Question:

Hello,

My dear son is nine years and in the 4th grade. He has had an IEP since second grade for specific learning disabilities, has been diagnosed with ADHD and more recently dyslexia. In our most recent IEP team meeting I suggested the assessment for and implementation of assistive technology i.e the Classmate Reader. I am convinced that using this tool in class and home will help him in reading and completing assignments because in my opinion he is very dyslexic.

Of course, there was opposition and hesitation from almost everyone else on the team. I was not surprised. They continually suggest medication and placement in a special day class as the appropriate interventions. I am not sure how to convince them that the use of assistive technology would be of great value. I know that they have to consider it, but under what circumstances will they legitimately be able to refuse it? I am convinced that the opposition is primarily due to budget restraints. Why is this my son’s fault?

Also, do you have any input on the use of the Barton Reading System and how this may be incorporated into his IEP plan?  Your input and feedback would be most greatly appreciated.

Best regards,
Amber


Answer:

Hi Amber,

Thank you for sharing your concerns.  To best address your questions, two of us have collaborated to provide answers from our respective areas of expertise.  Betsy Caporale, Assistive Technology Specialist, will address your question regarding the Classmate Reader and Shari Gent, Education Specialist, will offer information about the Barton Reading System.

Assistive Technology

The Classmate Reader is one of several text readers available on the market today.  Other options include the iPad, Nook, and Kindle, to name a few.  Classmate Reader offers many unique features that make it particularly useful for students who are struggling readers, including capability to access a variety of file formats, speed adjustment for MP3 files, highlighting, bookmarks, note-taking support and an on-board dictionary. 

In order to determine if a text reader such as the Classmate Reader will be a useful tool for your son, his IEP team will need to conduct an Assistive Technology  (AT) assessment.  Most districts have an AT Specialist who will spearhead this process. The AT assessment should be a collaborative effort involving your son’s teacher, service providers and, most importantly, your son himself.  The team will want to evaluate how the Classmate Reader might help your son meet his IEP goals.  They should also explore other AT tools and strategies (both low and high tech) that might be appropriate.

 To determine the most appropriate AT tools and strategies, the team will want to conduct a feature match which clearly identifies your son’s specific skill levels and needs,  as well as the features of  the AT tools being considered.  For exampe, when considering a tool such as a text reader, the team needs to confirm that the student has the fine motor skills, visual acuity, and mental aptitude to operate the device independently.  Members of the AT assessment team will need to spend time observing your son across all academic environments, and conduct numerous trials with the AT tools and strategies being considered.  It is also crucial to determine whether your son is motivated to use a particular AT device.  Many students refuse to use AT because they don’t want to stand out or look “different” than their peers.  Unfortunately this issue is often overlooked, resulting in AT devices being rejected or abandoned after a short time.

Once the assessment has been completed and AT solutions have been determined, the team will need to address the following questions:

  • How and when will AT be implemented across the school day?
  • Who will be responsible for the implementation of AT?
  • How will instruction and assignments be modified using AT?
  • Who will be responsible for making these modifications?
  • Who will provide the necessary AT training for the student and staff?
  • Who will be responsible for the maintenance of any electronic AT devices?
  • Will an AT device be needed to complete homework assignments?

As you can see, AT “consideration” is a lengthy, complex, procedure which requires the input and expertise of many different specialists.    Keep in mind that as a student’s skill levels and academic environments change, so will his or her AT needs, therefore, the  AT assessment and consideration process is ongoing, and will continue throughout a student’s academic career.

I hope this information will help guide you and your son’s IEP team in selecting appropriate assistive technology!

Education

The Barton Reading and Spelling System is a program designed by Susan Barton to teach decoding and spelling skills.  The program is designed to primarily use tutors and is most effectively implemented in a 1:1 setting.  There are ten levels covering these topics: phonemic awareness, consonants and short vowels, closed and unit syllables, multisyllable words and vowel combinations, prefixes and suffixes, silent “e” words, vowel-r combinations, vowel digraphs, the influence of foreign languages, and Latin and Greek roots.  The program purports to address decoding and spelling skills from pre-reading through the ninth grade level.  Influenced by the well-researched Orton-Gillingham multisensory system, the Barton System uses attractive and appealing color-coded letter tiles to teach students to recognize sound patterns and sound out and spell words. 

A personal review of the Barton program indicated a program that is readily accessible to parents, tutors and teachers.  The user-friendly website includes detailed video clips of the developer modeling implementation so potential users can judge the program for themselves.  Interested parties can order DVDs that explicitly demonstrate the program so the user can practice and review each teaching strategy.  Because of this video training component, a volunteer with no background in reading instruction could conceivably use the tutoring strategies. 

The developer suggests that optimum results are achieved with 1:1 tutoring that takes place at least twice weekly.  Progress through the program depends on the student, the setting, and the frequency of instruction.  She states that optimum progress can be made when students are tutored daily for 45 minutes to one hour and claims that the student with “average” dyslexia can progress through the entire program in two to three years given instruction at least twice weekly.  By the end of the program, the developer claims that the student should be reading at the mid-ninth grade level.  She states that results will be slower if the student is distractible, if the program is offered in a small group setting, or if the child has severe learning problems.  Since your son has been diagnosed with ADHD, I would suggest that you would heed this caution.

The website cites testimonials and research articles that support the efficacy of the program.  The sheer number of citations would seem to prove the efficacy of the system.  Some of the studies do seem to show significant gains in decoding skills.  However, the fact that the research exists is not enough to prove that the program works.  The research done must be well-designed to prove anything.  Unfortunately, most agencies that review research and recommend programs have concluded that not enough well-designed research has been done to prove that Barton program is, in fact effective. 

For example, the Florida Center for Reading Research cited on the Barton website discusses the primary research done on Barton Reading in Pleasanton, California.  The conclusion of the Florida Center was, “because of the design of the study (i.e. lack of control group, pre/post-test design), it cannot be determined that the gains reported are the direct result of the Barton Reading & Spelling System.  The study also did not report average amount of improvement on the GORT-4 across all students, or how many students made significant progress on this test.” 

The United States Department of Education Institute of Education Sciences (IES) provides compilations of research and recommendations for intervention programs proven to be effective.  When reviewing reading programs to recommend for students that I serve, I like to check U.S. Department’s website, “What Works Clearinghouse” at http://ies.ed.gov/ncee/wwc/  The Barton System was reviewed by the IES in July, 2010.  Under the topic of effectiveness, the IES review states:

No studies of the Barton Reading & Spelling System that fall within the scope o the Students with Learning Disabilities review protocol meet What Works Clearinghouse (WWC) evidence standards.  The lack of studies meeting WWC evidence standards means that, at this time, the WWC is unable to draw any conclusions based on research about the effectiveness or ineffectiveness of the Barton Reading & Spelling System on students with learning disabilities.

The WWC reviewed thirteen studies released between 1989 and 2009.  None of the studies met the rigorous standards of the WWC for appropriate research design.

Another concern is the somewhat misleading claim by the Barton developers that the program is approved by the California Department of Education.  True, the Department has cleared the program for “social content.”  According to the California Department of Education website, this approval does not constitute adoption by the State Board of Education, but indicates that the instructional material meets the following statutes:

  • Portray accurately and equitably the cultural and racial diversity of American society;
  • Demonstrate the contribution of minority groups and males and females to the development of California and the United States;
  • Emphasize people in varied, positive, and contributing roles in order to influence students' school experiences constructively; and
  • Do not contain inappropriate references to commercial brand names, products, and corporate or company logos.

Being cleared for social content does not constitute an endorsement for reading intervention.  A number of reading intervention programs have been approved for adoption by the California State Board of Education. If your child attends a California school district, you might be interested in checking out this list of fully researched and approved programs for students “two or more grade levels below grade level” is located at:

http://www.cde.ca.gov/pd/ca/ma/mardsbeprvdrread.asp

Finally, when working with your school district to choose a reading intervention for your son, I would urge you to keep in mind that decoding and spelling are not the only reading skills that should be taught.  In 1997, Congress asked the National Institute of Child Health and Development (NICHD) to work with the U.S. Department of Education in establishing a National Reading Panel that would evaluate existing research and evidence to find the best ways of teaching children to read.  This panel found that effective reading instruction includes a combination of these techniques:

  • Phonemic awareness
  • Fluency
  • Guided oral reading
  • Vocabulary study
  • Reading comprehension

Most children benefit from a well-rounded reading program that targets all areas of the reading process. For more information, please visit http://www.nationalreadingpanel.org.

Good luck in your search for the right program for your son.  I hope this information will assist you.


  • What can you tell me about Kurzweil?

Question:

What can you tell me about Kurzweil?  The person working here before me purchased it but it has never been installed.  Do you advise updating it and having it installed?  Can you also provide me with information about BookShare and RFB&D.

Judith Spicker
Resource


Answer:

Hi Judith,

Kurzweil 3000, Version 11, is the newest of this software line.  If you don’t have the most recent version I would recommend contacting the vendor to see how much it would be to update it. Kurzweil 3000 is a software program designed for individuals who have learning difficulties related to reading, writing, or both.   Below are some of the key features:

Reading tools:

  • Text to speech (selected text is read aloud)
  • Colored highlighting of text as it is read
  • Sticky notes (student or teacher can create)
  • Voice notes (notes are spoken aloud and recorded )
  • Bookmarks (created by highlighting text)

Writing tools:

  • Self-editing (letters and words are spoken so that spelling errors can be quickly recognized)
  • Spell check (visual and audible)
  • Word prediction

Study Skills tools:

  • Scan worksheets to create e-text documents.  Answers can be typed directly onto the scanned image.
  • Highlighting
  • Easily create:
    • Study guides
    • Outlines
    • Word lists
    • Annotations

Test Taking tools:

  • Create modified test forms such as
    • Fill-in-the-blank
    • Multiple choice
    • Short answer
    • True/false
    • Essay
  • Scan documents to create e-text test forms which can be completed independently by the student.

You can visit the Kurzweil 3000 website at  www.kurzweiledu.com/kurz3000.html  to learn more about the software, and determine if it might be appropriate for the students you serve.

You also asked about Bookshare (www.bookshare.org)  and Recording for the Blind and Dyslexic; (www.rfbd.org ).    These sites offer digital textbooks and literature titles for students with disabilities.  Bookshare offers audio and e-text formats, as well as digital Braille.   RBF&D offers audio format only.  Both have extensive libraries, which you can browse by visiting their websites.

I hope this information is helpful. 

Betsy


  • Do you know of any computer programs that can provide practice of higher level reading comprehension (‘wh’ questions)?

We all know that many students with the diagnosis of autism can have strong rote reading and literal comprehension skills. I have been researching computer assisted instruction for students with autism and the benefits they gain learning via the computer.

Question:

Do you know of any computer programs that can provide practice of higher level reading comprehension (‘wh’ questions)?

Thank you in advance for any support you can provide

Risë Revis
Preschool and Elementary Program Specialist
VUSD Special Education


Answer:

Hi Risë,

Yes, those of us that work with students on the autism spectrum can certainly attest to the fact that they are typically visual learners, and that many of them learn to read rotely before they start putting sentences together verbally. In fact, the use of visuals (including, photos, pictures, icons and text) is often a good way to teach the structure of language to students with autism. Given these facts, a computer with adapted software can be a powerful learning tool for these students.   

There are many adapted software applications that provide alternative instruction and practice activities for students with special needs. Since you are particularly interested in reading comprehension, you may want to start by subscribing to a digital text website for students with disabilities. E-text is a wonderful way for special needs students to independently access reading material! Try visiting Bookshare (www.bookshare.org ) or Accessible Book Collection (www.accessiblebookcollection.org ). Bookshare  provides a searchable online library offering thousands of  digital books, textbooks and periodicals for all ages, while Accessible Book Collection offers primarily high interest books at lower reading levels. 

After deciding on an e-text provider, your next step will be to select appropriate software to create reading comprehension activities for your students. Below is a brief description of three software programs with which I am familiar. 

 

Fairly new to the scene, this Mayer-Johnson product is designed to be a creative, fun and timesaving educational tool. The program offers an array of features which allow educators to create customized materials and interactive computer activities (including videos) for students of all ages and abilities. Two clever features are Studio Reward Animations and the Studio Sound Library. Both provide amusing, entertaining feedback to keep students interested and motivated. A library of 150 starter templates is included, many of which can be used to enhance reading skills. In addition, you can access thousands of pre-made activities at www.boardmakershare.com, a community sharing site.

 

This program offers several features which support reading at many different levels.  For independent reading, you can use Clicker 5 to create talking books using text and pictures downloaded from websites such as Bookshare or Accessible Book Collection. Students can listen to these books as they are read aloud, while the text is being highlighted on the computer screen   In addition, students can record their own voices as they read aloud, providing useful feedback for the student as well as the teacher. Students may also choose to read independently, without the speaker option, and click only on the words with which they are unfamiliar, allowing them to hear the pronunciation. As a follow- up to a reading assignment, comprehension activities and worksheets can easily be created using Clicker 5 premade templates.   Or, you can download premade curriculum-based activities for all grade levels (K-12)  from Cricksoft’s Learning Grids website, (www.learninggrids.com).

 

Classroom Suite 4 is a comprehensive educational intervention program designed for students in grades pre-K through five. Pre-made activities are provided, as well as templates that can be customized for instruction, practice and assessment. Expanded Reading Instruction features activities for phonemic awareness, phonics, vocabulary development, reading comprehension and fluency. All reading instruction is aligned with national standards. Teachers can create activities to match specific IEP goals and objectives, and collect data to track an individual student’s progress. Intellitools also has an exchange website ( http://aex.intellitools.com/ ) from which hundreds of premade activities can be downloaded.
    
Please visit the websites to learn more about these adaptive software programs, or to download a free 30 day trial. You will want to carefully investigate the features of each one to determine which would be the most appropriate for your particular students. I also recommend checking with your district to see if they might already have a license for one or more of these programs.   

Happy exploring!

Betsy