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Assistive Technology/AAC Archive 2013

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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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  • Increasing Literacy Skills for AAC User with Autism

Question:

Hello,

I just read your presentation on evidence-based AAC strategies for students with autism. It is very comprehensive and I thank you for sharing. I am a mother of an AAC user and I am looking for a curriculum to be used in the classroom which can help maximize her potential, but so far I can’t find one. I admire the work of Janice Light but this is more of a 1:1 setting and my child is with a mixed group of kids on the spectrum with various skills.

The current speech-language pathologist is new and I would like to have a detailed AT plan to ensure who does what, measure progress and adjust along the way. My child can answer “wh” questions but this is still prompt dependent, waiting for someone to ask and then her to answer. I want her to be able to initiate conversation and engage in functional communication beyond requesting. Any thoughts?

My child can read using her TouchChat on the iPad and if a word is not listed, she will go to the keyboard to type. WordPower with word prediction allows her to choose words.

I really want her to increase her literacy skills, but as an AAC user there should be some unique technique or methodology, right? I would appreciate it if you could share with me any suggestions on how to have the team think “out of the box” to help my child flourish. As a parent, I know my child’s potential but with my lack of knowledge in this field it’s hard for me to present and persuade the team.

Thank you for your time and I look forward to hearing from you.


Answer:

Thank you for your e-mail! I’m glad you enjoyed the PowerPoint presentation from the PrAACtical Website.

In your e-mail you mentioned that your daughter is an AAC user in a classroom with other autistic students who have a variety of skill sets. It sounds as if your daughter has some very good skills sets herself such as; answering “wh” questions, navigating her iPad to access TouchChat and WordPower, as well as using a keyboard to type words.
The goals you have in mind for her now include initiating communication and increasing functional communication beyond requesting. You would also like to increase her literacy skills.

You mentioned developing an implementation plan for your daughter, in collaboration with her speech-language pathologist. This is something I recommend for all students who use AAC and AT (assistive technology). I would recommend meeting with the entire IEP team to develop the implementation plan, keeping in mind that it is a working document and will change as your daughter’s skills, environments and interests change. One of the most important things to consider when developing this plan is to provide a variety of communication tools and strategies across settings – do not rely on only high-tech AAC, such as the iPad! Her communication system should be multi-modal, including signs/gestures, low tech communication boards/books, and of course vocalizations. An implementation plan, such as the example provided in my PowerPoint presentation (http://praacticalaac.org/?s=Betsy+Caporale) will help facilitate the use of these communication systems, clearly defining which modality will be the most efficient for specific activities of the school day. I highly recommend that topic or theme-based communication boards be provided for each activity of the day, containing predictable vocabulary that can be used for requesting, commenting and answering questions. These can be low-tech static boards, boards created on the iPad, or a combination of both. The speech-language pathologist should consult with the IEP team in the design of these communication tools.

I too admire the work of Janice Light, and would highly recommend you look into the Accessible Literacy Learning (ALL) Curriculum developed by Dr. Light and her colleague, Dr. David McNaughton. The curriculum is specifically designed for students with complex communication needs, such as autism, cerebral palsy and Down Syndrome. To see this program in action and learn more about the research behind it, visit their website at http://aacliteracy.psu.edu/. You may also want to investigate Literacy Lab, a computer software program for students with special needs, especially autism. Both of these products are available from Mayer-Johnson (www.mayer-johnson.com).

I hope this information is helpful. Please let me now if you have any further questions, and keep me posted as to your daughter’s progress!

Betsy


  • Role of SLP in Moderate-Severe Preschool SDC

Question:

Hi Betsy,

I work with preschool students with moderate-severe educational needs. Keeping Special Education teachers in mind: What are the key foundational communications components that a mod-severe special day class should offer as part of the base program, and what do you recommend the role of the speech-language specialist should be as a “support” to that base program?

Gloria del Rio, M.S., CCC-SLP


Answer:

Hi Gloria,

You pose some very interesting and important questions! I could write volumes about this topic but will summarize with some key suggestions and recommendations, which I have outlined below.

  • Providing foundational communication components for preschool students with mod-severe needs.

At this stage of development, students will likely present with a wide variety of communication deficits including minimally verbal and nonverbal students, as well as verbal students with significant articulation or phonological disorders. The goal for each student is to provide an efficient way for them to communicate across all contexts of the day using a multi-modality approach (i.e., verbalizations, gestures, signs and symbol-based communication systems). This should include tools and strategies that support both receptive and expressive communication.

Receptively, students with will benefit from visual supports such as transition items, individual schedules, classroom schedules, and task schedules. This will assist them in transitioning between activities, following directions and participating in structured learning tasks as independently as possible.

To assist students in expressing themselves, verbal speech can be augmented with the use of signs, gestures, pictures, photos or objects for requesting, choice-making, commenting and sharing of information. Sophisticated speech generating devices (SGDs) might also be an option, but most students at this age do not have the skill sets to use these independently as a functional means of communication. I would suggest starting with a simple single or multi-message voice output device (VOD).

With the above goals in mind, I recommend that all special day classes have a variety of tools and strategies readily available in the classroom that can quickly and easily be accessed for communication purposes. Here are some examples:

  • Visual Supports
    • To assist students in transitioning from one activity to the next, offer a visual prompt representing the next activity, which they can carry as they transition. Many students can use picture or photo icons, but for students who don’t understand this type of symbol, you will need to use an actual object or part of object (i.e., CD for music; crayon for art).
    • A classroom photo or picture schedule posted in a prominent place in the classroom helps to keep students and staff focused and engaged. Refer to the schedule often throughout the day.
    • Students will also benefit from individual schedules, again using pictures, photos or perhaps objects. Simplify as needed for the individual student. A “first/then” schedule is often a good place to start.
    • Task, or embedded schedules will help students complete simple tasks independently (i.e., putting away backpack and hanging up coat upon arrival, washing hands before snack, preparing a simple snack).
  • Symbol based communication systems and VODs can be used by students with verbal communication difficulties to participate in classroom activities. Here are some simple ways to implement these strategies:
    • Create topic or theme based communication boards for requesting and choice-making (i.e., requesting a snack item; requesting items to complete an art activity, choosing a song at circle). These do not have to be Velcroed; students can simply point to the picture or photo.
    • Create additional communication boards for making comments or sharing about an activity (e.g., telling the weather, indicating who is absent, indicating a favorite song or book).
    • Students can also use VODs to :
      • Share about an event from home
      • Announce the title/author of a story
      • Ask for the page to be turned in a book
      • Repeat lines in a story
      • Announce the day of the week
  • I’m also a huge fan of interactive books which encourage participation and interaction by the reader. These might include pop-up books, textured books, books with talking buttons, or books with Velcro which allow the student to match or sequence pictures to help tell the story. Interactive books can be accessed on a tablet computer or iPad as well!
  • Defining the role of the speech-language pathologist for SDC students with significant speech-language impairments.

Students with significant speech-language impairments will benefit most from a program in which a variety of intervention strategies are implemented across all environments and daily activities. This is best accomplished when the speech-language pathologist is able to work in the classroom, providing individual support to students while modeling effective strategies for the teacher and staff. In this way, the IEP team and SLP work collaboratively to address the communication needs of the student throughout the school day. It also provides an opportunity for students to learn and practice skills in a natural environment with peers. The SLP and IEP team members should all take active roles in creating materials and providing communication supports for the students in the classroom. I have found that an Implementation Plan, such as the sample given below, is an invaluable tool in the collaboration process. This is a working document, developed as a team, which clearly defines which strategies will be used when for a particular student, and who will help facilitate. I hope these recommendations and strategies will be of help to you and the IEP team in serving your pre-school SDC students. Thank you for writing Gloria!

Betsy

AAC Implementation Plan and Goal Matrix


  • Purchasing an AAC app for a Preschooler with Autism

Question:

Hi Betsy,

I am working with a family who is wanting to purchase an iPad or tablet for one of my preschool students who is non-verbal and has an autism diagnosis. We would like it to be used as a communication device and have been researching not only iPads and tablets, but apps as well. We have mainly been looking at Proloquo2go and Avaz and would like to get some feedback in regards to your opinion/experience with these apps. I realize there are hundreds of apps out there; however, the more we research, the more overwhelmed and confused we become. We are hoping you can provide some guidance, as we would like to move forward with the purchase as soon as possible. Thank you for your help in giving this child a voice. :)

Linda Gay
Education Specialist


Answer:

Hi Linda,

“Overwhelmed” and ”confused” are words I hear often from families and speech therapists trying to determine which augmentative, alternative communication (AAC) app is most appropriate for a student. Last time I checked there were well over 200 AAC apps available from the iTunes store. Some are very basic single message voice output devices (VODS), while others are extremely sophisticated, offering robust vocabularies and highly customizable features. The two you mentioned, Proloquo2Go and Avaz, fall in the latter category. Proloquo2Go was actually the very first AAC app offered by iTunes. It debuted in April of 2009, and the concept took the world of AAC by storm! Avaz debuted a few years later, and has received top international awards, including a spot on MIT’s list of Top 35 Innovations in 2011. These two apps are similar in many ways, both including features such as:

  • Multi-level dynamic screen display
  • Pre-programmed vocabulary
  • Libraries of over 10,000 SymbolStix symbols
  • A variety of grid sizes
  • Customizable buttons (can add your own images or photos)
  • Customizable keyboards with word prediction

To get a full list of features, I would recommend you visit their websites:

  • Avaz

http://www.avazapp.com/

  • Proloquo2go

http://www.assistiveware.com/product/proloquo2go

I am a little concerned that you have already narrowed your selection process down to just two AAC apps, and am wondering why these two in particular were chosen. You mentioned that the student is a preschooler with autism who is nonverbal, which tells me there are significant language impairments and perhaps cognitive deficits as well. Keep in mind that Avaz and Proloquo2Go are sophisticated language systems. You will need to make sure your student has the cognitive and linguistic skills (i.e., symbol recognition, categorization, visual association, sentence formulation, vocabulary) to use these apps independently, as a functional communication tool. A comprehensive, collaborative assessment should be conducted to determine skills sets before any recommendations regarding AAC systems are made. This can be a lengthy process, with the goal being to determine a variety of AAC tools and strategies that the student can use to communicate quickly and easily across settings, using a multi-modality approach (i.e., signs, gestures, vocalizations, choice boards). I can guarantee you an iPad or any other electronic device will never be the student’s only mode of communication and in fact may never be the primary mode. To get you started in the evaluation process, I recommend you look at the following assessment tools:

  • Communication Supports Inventory-Children and Youth (CSI-CY) for children who rely on augmentative and alternative communication (AAC) (2009, Rowland, Fried-Oken & Steiner)

http://icfcy.org/aac/

  • The Communication Matrix (2004 Charity Rowland, Ph.D.)

https://www.communicationmatrix.org/

Both of these tools were developed by the Oregon Health and Science University, and are free resources. They are criterion based rating scales which will provide information regarding communication skill levels and barriers to effective communication. With this information, the IEP team can make informed decisions about appropriate AAC tools and strategies.

Once you have a clear understanding of this student’s skills, I recommend you expand your search of AAC apps to determine which features best match your student’s needs. Jane Farrall Consulting provides an excellent review of hundreds of AAC apps, including a detailed description of their features. (http://www.janefarrall.com/appstextlist.html).

Thank you for writing Linda. I admire your dedication in helping to give this student a voice!

Betsy


  • Becoming an Assistive Technology (AT) Specialist

Question:

Hello,

I would like to become an assistive technology trainer/specialist in a rehabilitation setting - not a formal educational arena such as a K-12 classroom, but rather focus on helping other rehabilitation clients and other individuals. I am blind and hard of hearing, and I have been on disability and in a rehab plan of my own for a number of years. What precisely should I ask of my rehabilitation counselor in order to get refocused on this goal? I want to be able to become certified and ready to work within 2 years; I can continue training while I work, ideally.

Thanks for your help!

Karl
El Cerrito, California


Answer:

Hi Karl,

Thank you for writing to inquire about the Assistive Technology (AT) certification process. I admire your passion for wanting to help others who require rehabilitation services, and your commitment to becoming certified in this area.

AT is an extremely broad field. The Individuals with Disabilities Act of 1988 (P.L. 100-407) defines AT as; “any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” Assistive technology is generally divided into three main categories; low-tech, mid-tech and high-tech. Here are some examples of each:

Low tech:

  • Pencil grips
  • Highlighters
  • Enlarged text
  • Reading glasses
  • Wheel chair ramps

Mid tech:

  • Hearing aids
  • Electronic page turners
  • Electric scissors
  • Switch operated toys and games
  • Books on tape

High tech:

  • Electronic wheelchairs
  • Computerized speech generating devices
  • Voice recognition software
  • Voice command software
  • Text to speech software

The above examples are just a small sample of the types of AT available for individuals with disabilities. The list of AT tools and strategies is exhaustive and you can be sure new AT technologies are being developed as I am typing this document!

To get a taste of the AT world, I would highly recommend attending an AT conference and visiting the exhibition hall, where vendors are displaying the latest and greatest technologies. You will have the opportunity to observe and trial various forms of AT equipment, and in many cases meet the developers in person. I guarantee it will be a unique educational experience! Some of the largest AT Conferences include:

  • Assistive Technology Industry Association (ATIA)

 http://www.atia.org/

  • California State University, Northridge (CSUN) –

 http://www.csun.edu/cod/conference/index.php

  • Closing the Gap

 http://www.closingthegap.com/

  • Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) - http://www.resna.org/

In terms of AT certification, there several programs offered online with a variety of different specialty areas on which to focus. For instance, some AT specialists focus on educational technologies for students, while others focus on vocational technologies to help individuals in the workplace. Others may specialize only on seating and mobility, or augmentative and alternative communication (AAC), which happens to be my area of expertise. Both CSUN and RESNA offer AT Certification programs. Cal State University, Dominguez Hills (CSUDH) also offers an online certification program (http://www.csudh.edu/at/). Some certification programs require a bachelor’s or master’s degree in a related field (i.e., Speech Pathology, Occupational Therapy, Physical Therapy), while others offer a more basic certification program.

By exploring the above websites, you should get a better understanding of the types of certification programs available, and the requirements set forth by each educational institution.

Best of luck to you Karl!

Betsy


  • PECS Training and Use

Question:

Hi Betsy,

Can you please clear up some confusion we are having in my district about the use of PECS. I am a speech therapist who has taken the basic PECS course and use it with several students on the autism spectrum. I serve several special day classes in which the staff claim to implement PECS in the classroom, but none of the teachers or staff have been PECS trained. It’s my understanding that unless you have had PECS training, you shouldn’t be using it. I hope you can help us clear this up!


Answer:

I’m glad you wrote about this because it’s an issue that comes up frequently during assessments and trainings here at the Diagnostic Center, Northern California. First here are some basic facts about the Picture Exchange Communication System, also known as PECS:

  • The PECS communication tool was developed by Andrew Bondy, Ph.D., and Lori Frost, MS, CCC-SLP, who formed Pyramid Educational Consultants, also known as PECS. (Yes, it can be confusing!)
  • PECS (the communication tool) stands for “Picture Exchange Communication System”, and was designed to be used with students who demonstrate communication disorders related to autism and other developmental disabilities.
  • The approach itself is based on Applied Behavioral Analysis (ABA) principles.
  • Pyramid Educational Consultants, Inc. offers a variety of trainings in the use of PECS. The PECS Basic Training is a two day workshop. Each participant learns the basics of PECS, receives a Certificate of Attendance, and is provided with the PECS Training Manual. Participants learn how to implement the six phases of PECS. A PECS Advanced Training is also offered to provide ideas for further expansion of PECS implementation.
  • PECS Certification assures that you are implementing the strategy according to standard protocol.
  • Pyramid Educational Consultants, Inc. also provides a wide range of products, including picture symbols, communication boards, binders and books which can be used to implement PECS.
  • For more information, please visit their website at www.pecsusa.com

Now I want to address the issue of using picture or symbol based communication systems as Augmentative/Alternative Communication (AAC) tools. Many speech therapists and specials educators implement the use of pictures or symbols with students who have significant verbal communication deficits. This does not mean they are using PECS!! Unless you have had the basic PECS training, and are using Pyramid’s products according to the protocol outlined in their training manual, you should not be calling it PECS!! I always advise that another term be used, such as “picture communication system” or “symbol based communication system”. By the way, a “symbol” can be anything that represents an object or action, including the object itself, part of an object, a photo, picture, line drawing, or even text. Most of the special day classes I visit have some kind of picture or symbol system in place, including:

  • Low-tech communication boards
  • Communication books
  • Visual schedules
  • Single or multi message voice output devices

All of the above tools and strategies are extremely effective in developing communication skills, enhancing classroom participation, and increasing independence for non-verbal or minimally verbal students, when implemented correctly. The implementation process can be tricky, and requires close collaboration among IEP team members on a frequent basis. Best practice calls for implementation of these strategies within meaningful, functional activities, at the student’s instructional level. It’s important to remember that as a student’s skill levels change, his or her AAC systems will need to be altered to meet current communication needs, therefore the assessment of AAC is an ongoing, dynamic process.

In summary, pictures and/or symbols can be used as communication aids by any speech-language pathologist or educator, and I would highly recommend the implementation of this practice. Just be careful not to call it PECS unless you have had training and are specifically adhering to the guidelines set forth in the PECS Training Manual.

Betsy


  • iPad AAC app for Kindergartner with Autism

Question:

I am looking for an app for an iPad that will speak words for an autistic student in kindergarten, kind of like Speaking Dynamically Pro on an iPad that will speak words and allow me to put words in.

Julie Strong
Inclusion Specialist – LP


Answer:

Hi Julie,

There are currently hundreds of iPad apps available for students who require Augmentative and Alternative Communication (AAC). You mention Speaking Dynamically Pro, a software program which utilizes Boardmaker symbols to create “speaking” communication boards on a computer or windows based AAC device. These boards can be static (a single page) or dynamic (meaning multiple pages can be accessed by linking buttons to another screen). There several AAC apps which operate very much like Speaking Dynamically Pro, providing robust vocabulary and the ability to create personalized sophisticated communication systems. However, this type of app might not be the most appropriate for your student. Before considering an AAC app for any student, a comprehensive assessment must first be completed. This will require a collaborative team approach, with the speech therapist playing a key role. I would suggest calling for an IEP team meeting to plan the assessment as your first step in the process. The AAC assessment team can than collaboratively look at the student ‘s skill levels across all areas (speech-language, motor skill, cognition, etc.) and across environments. Once this is done, a feature match can be determined to make decisions regarding appropriate AAC tools and strategies. I highly recommend you refer to an article I recently authored on this very subject, entitled AAC and Autism; Implementing Evidence Based Strategies in the Classroom, published in the most recent edition of Closing the Gap Solutions.

There are currently hundreds of AAC apps available, ranging from low to mid to high tech. Prices vary tremendously, ranging from free to several hundred dollars. You may find that one of the free apps fits the needs of your student for the time being – many are quite user friendly and offer many customizable features. I would encourage you and the assessment team to refer to the following websites to learn about the specific features and costs of the various AAC apps. These websites provide detailed descriptions of the apps, as well as overall “ratings” by the author.

Spectronics, AAC Apps

Spectronics, Visual Support Apps

Hope this information is helpful in guiding you and the assessment team!

Betsy