CA Dept. of Education

Home

Assistive Technology/AAC Archive 2012

bc  

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.

Submit A Question

Click a topic below to expand the full question and answer.

  • Removing AAC Goals from an IEP

Question:

Can you tell me what to do if a speech therapist takes away a child’s AAC goals because she states that he is “adept”?

Darell B.


Answer:

Hi Darell:

I’m so glad you asked this question, because it gives me the opportunity to provide some “best practice” guidelines regarding the assessment and implementation of Augmentative and Alternative Communication (AAC) services.

Let me start by stating that AAC is an ongoing process which continues throughout a user’s lifetime. As an AAC user’s skills and environments change, so do his or her AAC needs. And, as I’m sure you know, new AAC technologies are being developed at a rapid pace, especially in this age of iPads, tablet computers and smart phones, which means options are always changing and improving. Also keep in mind that the term “AAC device” is not synonymous with “high-tech” device. An AAC device can be something as simple as a picture communication board. And those who do use high-tech speech-generating devices (SGDs) rely on other modes of communication as well, such as yes/no responses, eye-gaze, or symbol-based communication books. AAC users require multi-modality systems, allowing for the easiest and most efficient means of communication for a given task or environment. For example, if a user wanted to choose between chicken or pasta for dinner, it would be much simpler to make a selection by pointing to or looking at a choice, rather than using a sophisticated device. An AAC user should never be expected to use a highly sophisticated communication device to meet all of their communication needs.

I’m concerned that your child’s speech-language pathologist (SLP) would state that he is “adept” at using AAC, and therefore discontinue services. Perhaps your child has become very skilled at using a particular AAC device, which is wonderful. But how are other AAC tools and strategies being implemented in the classroom? Specifically, I would want to know how AAC is being used to:

  • Enhance social interaction
  • Help your child participate in structured learning activities
  • Provide access to the curriculum
  • Promote independence

Many SLPs become overwhelmed trying to accommodate the needs of students who rely on AAC. They are often expected to create communication boards or pages, develop vocabulary, program devices, trouble shoot technical problems and train staff. This simply cannot be done by one person. In fact, best practice calls for a collaborative, multi-disciplinary approach to AAC assessment and implementation. This means the entire IEP team, including teachers, paraeducators, and designated service providers, should all be a part of this process. The IEP should include specific curriculum-based goals which include the use of AAC across environments, and clearly designate all of the people responsible for helping the student achieve those goals. SLPs will often play a lead role in this process, especially during the beginning, but they are only one member of a collective, cooperative team with shared responsibilities.

I advise you to work with your child’s IEP team to develop IEP goals and objectives which include the use of AAC to meet the unique needs of your child.

Thank you again for writing, and please keep me updated on your child’s progress!

Betsy


  • Assessing Reading Skills for AAC Users

Question:

Hi Betsy,

What are you recommending for reading assessment for students who are non-verbal and use SGDs?

Diane Russell


Answer:

Hi Diane,

I’m glad you asked this question! In my experience, the reading level of non-verbal students who use Speech Generating Devices (SGDs) is rarely assessed. Instead, assumptions or “guesstimates” are made by teachers, paraprofessionals and other service providers who work with these students. Most often, SGD users rely heavily on adult support and prompting to access reading activities. Determining whether the student understands what they are reading, or what is being read to them, can be tricky, as the student may have no reliable means of independently communicating what they know.

I frequently see these students being assessed using standardized tests, with alternative response modes such as “yes/no” or “multiple choice”. Responses can be made using a SGD, or via low tech means, such as eye-gaze, choice boards or partner assisted scanning. This can be a slow, tedious process for both the student and the examiner, and as you know, standard scores cannot be reported because the testing procedure has been altered.

When I assess a student’s reading ability, I prefer to use informal and/or alternative methods which are highly individualized according to the student’s unique needs. Factors which I always consider include:

  • Motor skills
  • Visual acuity
  • Cognition
  • Language skills
  • Endurance (many of these students fatigue quickly)
  • Medical issues
  • Motivation/interests

Because of the complex needs of most SGD users, I always implement a collaborative approach, and include appropriate related service providers in the assessment process (i.e. Occupational Therapist, Resource Teacher, Speech Therapist, Vision Specialist, Reading Specialist).

In terms of assessment tools, I find it helpful to use adapted software to create activities which the student can access as independently as possible using a touch-screen or switch. For example, the student can listen to a story read aloud, while the text appears on the screen and is highlighted as the words are read. This can be followed by a comprehension activity, using formats such as “fill in the blank”, multiple choice, or word banks to create responses to questions. When conducting such assessments, I like to start at a level where I’m confident the student will experience success, and then gradually increase the difficulty of the task until a frustration level is reached. I also make every effort to create reading activities that are of high interest to the student to keep him engaged and motivated. By using this assessment method, I’m usually able to get a good sense of the student’s reading abilities. In addition, I can determine which access methods and response formats work best to allow independent access to other curriculum related activities.

Thanks for writing Diane!

Betsy


  • Bullying and Students with Special Needs

Dear Ask A Specialist Readers,

Did you know that children with disabilities are at an increased risk of being bullied?  Any number of factors:  physical vulnerability, social skill challenges, or intolerant environments, may increase the risk. Research suggests that some children with disabilities may even bully others as well.

On April 3, 2012 the U.S. Education Secretary, Arne Duncan, and Health and Human Services (HHS) Secretary, Kathleen Sebelius, unveiled the revitalized Stop Bullying website: www.stopbullying.gov.

The Stop Bullying Website:

“The site encourages children, parents, educators, and communities to take action to stop and prevent bullying, and provides a map with detailed information on state laws and policies, interactive webisodes and videos for young people, practical strategies for schools and communities to ensure safe environments, and suggestions on how parents can talk about this sensitive subject with their children. The site also explores the dangers of cyberbullying and steps youngsters and parents can take to fight it.”

Special Resources to Help Children with Disabilities:

This website also provides special resources to help children with disabilities who are bullied or who bully others. The website illustrates how IEPs or Section 504 plans can be useful in designing specialized approaches for preventing and responding to bullying.  Additionally, the website discusses how civil rights laws protect students with disabilities against harassment. That is, when bullying is directed at a child because of his or her disability and it creates a hostile environment at school, bullying behavior may cross the line and become “disability harassment.”  Under Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990, the school must address the harassment.

Act Now!

We know that bullying can negatively impact a student’s ability to learn and threaten their physical and emotional safety at school. We know, too, that the best way to address bullying is to stop it before it starts. The Stop Bullying website and the other websites listed in the Resources provide a number of actions school staff can take to make schools safer and prevent bullying.

We here at Ask A Specialist encourage you to do your part to help all students be safe at school.

Submitted by Ann England, Assistant Director, Diagnostic Center, Northern California on behalf of all the Ask A Specialist Contributors

RESOURCES:

  • Positive Behavioral Interventions and Supports

  • Can you please explain to me how an iPad with AAC software differs from other high tech AAC devices?

Question:

Can you please explain to me how an iPad with AAC software differs from other high tech AAC devices? Don’t they all operate pretty much the same way? It seems the iPad would be the most logical way to go, considering the substantial savings.

Curious SLP in California


Answer:

I am going to focus only on sophisticated high tech AAC devices in response to this question, meaning devices that have a robust vocabulary and a dynamic screen display (a screen that links or opens to other screens). Proloquo2Go was the first AAC app on the scene, debuting in April of 2009. Originally designed for the iPhone or iPod Touch, it provided an easily accessible speech generating device (SGD) for a fraction of the cost of other commercially sold SGDs with similar features. Other software developers soon followed suit, setting off an AAC app craze, especially after the launching of the iPad! Currently there are several AAC apps which rival Proloquo2Go in terms of features and pricing.

You are right on about the savings, however; you aren’t exactly comparing apples to apples when you look closely at what the iPad offers compared to other “dedicated” SGDs. By definition, a “dedicated” device is one which functions only as a communication tool. Even though the device is typically built on a PC or tablet platform, many of the features are disabled, so that only the communication software is accessible. This is mandatory if the device is to be funded by Medicare, and many private insurers abide by this policy as well. This means that an iPad running an AAC app will not be funded as a SGD, since there is no way of disabling the other features of the system. Keep in mind also, that it can be difficult to convince a student to use an iPad as a communication tool when they are accustomed to using it as an “entertainment system”. This can be especially difficult for students on the autism spectrum.

Most SGD vendors have invested significant time and money in the research and development of their systems, both hardware and software. Commercially sold SGDs are considerably more durable than an iPad, making them much more “kid friendly”. Consider also that SGDs are often mounted to wheelchairs and must be able to withstand the bangs and bumps associated with wheelchair use. A third consideration is customer support. With an AAC app, you are pretty much “on your own” in terms of assessment and implementation of the device. On the other hand, the larger, established SGD vendors provide highly personalized assistance with the assessment, funding and implementation processes, as well as extensive technical support and online trainings.

As is true with most purchases, in the long run you will likely get what you pay for when it comes to a speech generating device. If your client does not require a durable system or a high level of customer support, the iPad may be a great choice. If, however, you need to provide a system for someone with complex communication needs, you will want to consult with an experienced manufacturer who specializes in serving this population.

Betsy


  • Do you think it’s beneficial for Down Syndrome students to be in a class for the hearing impaired to gain sign language skills?

Question:

Hi Betsy,

Would you recommend teaching a young student with Down Syndrome to sign? In our district, many parents of Down Syndrome children are pushing for this very early, and want their children enrolled in a class with a teacher and staff who sign. Unfortunately, not many of our teachers are proficient signers, except for those who teach classes for the hearing impaired. Do you think it’s beneficial for Down Syndrome students to be in a class for the hearing impaired to gain sign language skills?

Confused SLP in Central California


Answer:

I completely understand your confusion about this, and also realize the frustration in finding the most appropriate augmentative and alternative communication (AAC) strategies for minimally verbal students who are not hearing impaired.

Sign language is recognized as “unaided” AAC strategy because it requires no special tools, making it very user-friendly for many beginning communicators with speech delays. However, the following considerations should be taken into account in regards to its use:

  • Advantages of sign language
    • Easy to access
    • Natural
    • Basic signs are easily taught
    • Highly visual
  • Limitations of sign language
    • Abstract nature of signs requires higher level cognitive skills.
    • Difficult to learn and use to create multiple word utterances
    • Does not allow for delayed message reception (as opposed to pictures or text)
    • User must possess adequate fine motor skills
    • Allows for only a limited number of communicative partners (they must know sign as well)

Now consider some of the characteristic features of Down Syndrome:

  • Low muscle tone
  • Poor fine motor skills
  • Cognitive impairments
  • Language delays

All of the above factors will significantly interfere with an individual’s ability to communicate effectively using sign language. You must also consider the fact that most people do not live in communities where sign language is widely understood and used. Although many individuals with Down Syndrome learn basic signs at an early age, they are typically not able to use this method as a primary mode of communication. For those who cannot rely on verbal speech, sign language, used in combination with other AAC tools and strategies, will likely be of significant benefit in the development of speech and language skills. The research is very clear that AAC does not inhibit speech or language development, and in fact may enhance these skills. Some of the other AAC tools and strategies commonly used with students who present with special needs include:

  • Signs and gestures
  • Eye gaze
  • Symbol-based communication books and boards (using objects, photos, or pictures)
  • Low tech voice output devices (VODs)
  • High tech speech generating devices (SGDs)

For further information and research data regarding communication strategies for young students with intellectual disabilities, including Down Syndrome, I highly recommend that you visit Penn State’s Early Intervention website (http://aackids.psu.edu/index.php/page/show/id/14). The website was developed by Dr. Janice Light and Dr. Kathy Drager through a research study funded by the National Institute on Disability and Rehabilitation Research (NIDRR) as part of the Rehabilitation Engineering Research Center on Communication Enhancement (The AAC-RERC) (grant # H133E030018).

You might also be interested in visiting the website for the National Down Syndrome Society (NDDS) at http://www.ndss.org/. This link provides a wealth of information for parents and professionals regarding Down Syndrome, including a comprehensive Speech and Language Therapy section. NDDS highly recommends the use of Total Communication (TC) with this population during the early stages of speech and language development, providing a combination of signs, gestures, speech and symbol-based communication tools.

I hope these informational websites will be useful in guiding your IEP teams (including parents) when developing academic goals and communication strategies for young students with Down Syndrome.

Betsy


  • Our AT Specialist has been out ill and I need assistance. Are there websites or trainings on AAC devices that will help me provide functional benefits of AAC device(s) when working with students.

Question:

Hi Betsy,

I’m working with two new students who came in with AAC devices. Our AT Specialist has been ill and I haven’t had access to any assistance. I was wondering if you could direct me to some websites or other means of training that would help me know how to give them the most functional benefit from their devices.

Jonell Walden
Northern California Speech-Language Pathologist


Answer:

Hi Jonell,

You bring up an issue I encounter regularly; districts relying on one person for all of their AT/AAC needs. Many districts or county offices of education now have AT or AAC Specialists to provide consultation services for students, but they often have large caseloads and are spread very thin. In addition, the amount of training they have had and their area or areas of expertise varies.

Typically, an AT Specialist is someone who has completed a training course in Assistive Technology, which by definition is any tool or strategy used to assist an individual with a disability. This includes anything from glasses, to wheelchair ramps, to sophisticated speech generating devices (SGDs). Most AT specialists have general knowledge about a variety of tools and strategies, but may not have specific training in high technology devices, such as SGDs. Augmentative and Alternative Communication (AAC) specialists are typically speech-language pathologists who have had extensive training in assessment and implementation of low-tech and high-tech communication tools. Best practice calls for a collaborative, team approach when considering any type of assistive technology. A speech-language pathologist should always be involved in the selection and implementation of any AAC device, low or high tech, as this clearly falls within their scope of practice. I would advise you to consult the ASHA (American Speech-Language Hearing Association) website (www.asha.org) for more specific details about the roles and responsibilities of speech-language pathologists in regards to AAC.

Unfortunately, many school districts to not have a speech-language pathologist with AAC experience, and the AT specialist may have limited knowledge and experience. If a student you serve has AAC needs, it is up to you to seek out the training and assistance you will need to serve that student. I commend you for taking the steps to do just that.

A good place to start is by visiting informational websites to learn about tools, strategies, products, research articles and trainings related to AT and AAC. Here are a few of my favorites:

I would also recommend that you contact the websites of the vendors who sell the devices your students are using. Many provide hands-on or webinar trainings, as well as on-line customer support.

Lastly, you can attend the professional conferences put on by ASHA and CSHA (California Speech-Language Hearing Association). AAC is a hot topic, and some of the leading experts in the field regularly present at these conferences.

I hope the above information is helpful. Please feel free to contact me with any additional questions or concerns.

Betsy