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AUGMENTATIVE COMMUNICATION FOR STUDENTS PARTICIPATING IN ALTERNATE ASSESSMENT
JENNIFER NINCI (jninci@hawaii.edu)
PATRICIA SHEEHEY (sheehey@hawaii.edu)
MIN OK (okmin@hawaii.edu)
MARY JO NOONAN (noonan@hawaii.edu)
Department of Special Education
University of Hawaii at Manoa
AGENDA
• Developing individualized augmentative/alternative communication systems
• Establishing reliable responses
• Using technology for reliable responses
• Using technology for assessment and intervention with academic, social/play, and functional skills
• Case study applications
INTRODUCTION
• How many of us use portable technology?
• How do you use them?
• How do your kids/students use them?
BENEFITS OF TECHNOLOGY FOR STUDENTS
• Academic
• Organizational
• Play/leisure
• Communication
• Social • Sharing common interests
• Behavior management
• Functional
• Fine motor/gross motor
SUPPORT THROUGH ASSISTIVE TECHNOLOGY LAW/POLICIES
PL 100-407:
AT is “Any item, piece of equipment, or product system, whether acquired commercially or off the shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.”
AT INCLUDES SERVICES
AT Service:
Any service that directly assists an individual with a disability in the selection, acquisition, or use of an AT device.
COMMUNICATION AND LANGUAGE
• What is communication?
Conveying meaning (talking, nonverbal)
Can be intentional or unintentional
• What is language?
System, rules
• What is speech?
Sound formation and production
FORMS/MODES OF COMMUNICATION
NONSYMBOLIC
• Vocal
• Affect
• Tactual
• Body movement
• Gestural
• Physiological
• Visual
SYMBOLIC
• Verbal
• Sign language
• Photographs and pictures
• Representational objects
• Graphic system
COMMUNICATION BILL OF RIGHTS
1. The right to interact socially, maintain social closeness, and build relationships
2. The right to request desired objects, actions, events, and people
3. The right to refuse or reject undesired objects, actions, events, or choices
4. The right to express personal preferences and feelings
5. The right to make choices from meaningful alternatives
6. The right to make comments and share opinions
7. The right to ask for and give information, including information about changes in routine and environment
8. The right to be informed about people and events in one’s life
… (Brady et al., 2016)
COMMUNICATION BILL OF RIGHTS, cont. 9. The right to access interventions and supports that improve communication
10. The right to have communication acts acknowledged and responded to even when the desired outcome cannot be realized
11. The right to have access to functioning AAC and other AT services and devices at all times
12. The right to access environmental contexts, interactions, and opportunities that promote participation as full communication partners with other people, including peers
13. The right to be treated with dignity and addressed with respect and courtesy
14. The right to be addressed directly and not be spoken for or talked about in the third person while present
15. The right to have clear, meaningful, and culturally and linguistically appropriate communications (Brady et al., 2016)
DEVELOPING INDIVIDUALIZED AAC SYSTEMS
AAC = Augmentative & Alternative Communication
FUNCTIONS OF COMMUNICATION (PRAGMATICS)
• Requesting (get or remove an object, activity, or person)
• Protesting
• Terminating interaction
• Commenting/Labeling (social reciprocity)
• Answering questions or filling in the blank (providing information or conversation reciprocity)
• Repeating someone else (basic skill demonstration)
• Adding descriptions (providing clarity or adding information)
• Understanding language (receptive language; behaviors of the listener to convey skills, demonstrate understanding, or comply)
EARLY COMMUNICATION DEVELOPMENT
• Prelinguistic communication • Crying, smiling, looking, reaching, joint attention, cooing, laughing, babbling
• Emerging single word vocabulary • Between 12 and 15 mo (typically developing kids)
• Successive single word • Words relate but are not correctly structured (syntax)
• Multiword utterance • Agent action (me go)
• Agent object (mommy sock)
• Action object (kiss baby)
SELECTING GOALS AND VOCABULARY
• Based on assessments, IEP goals, and family and self-identified needs
• Observe within the typical daily routine as a guide to potential communication opportunities, necessary communicative functions, & vocabulary
• If school-aged, include curriculum vocabulary
• Program new vocabulary into the AAC device, organized by context
(Ganz et al., 2014)
SETT FRAMEWORK
Retrieved from www.zoyzabala.com
AAC ASSESSMENT (SETT FRAMEWORK) 1. Student: What are the student’s abilities and difficulties related to the area of communication?
• Communication, motor, vision, sensory, cognitive ability & difficulties
• Preferences, interests
2. Environments: What environmental considerations impact the student’s communication?
• Communication partners, daily schedule, vocabulary to support environment, other challenges/concerns
3. Tasks: What communication skills do you want the student to do? • Initiating, commenting, requesting, exchanging information, etc.
4. Tools: What communication devices will best meet the student’s need and demands of the environments & tasks?
OTHER ISSUES
• Audience
• Portability
• Cost
• Team collaboration & training
• Vocabulary & design
• Access
AAC SYSTEMS
FEATURES OF AAC DEVICES
• Low Tech – High Tech
• Dynamic – Static Display
• Output Voices
• Symbol Sets
• Vocabulary Size
• Access
LOW VS. MID VS. HIGH TECH
Cheaper Simpler Functions
More Expensive Advanced Functions
STATIC VS. DYNAMIC DISPLAY
VS.
No Change Display is changed if students presses symbols
DIGITIZED VS. SYNTHESIZED VOICE
VS.
Record and use human voice Device reads out
SYMBOL SETS
Letters Pictures Objects
Consideration: Symbol Size, Color, how many symbol per page
VOCABULARY SIZE
Tiny Vocabulary (<15 items) Small Vocabulary (16-99 items)
Midrange Vocabulary (100-259 items) Extensive Vocabulary (>250 items)
Consideration: Vocabulary organization
ACCESS
Direct Selection Indirect selection (Eye gaze & Switch)
LOW TECH
1. CONCRETE REPRESENTATIONS
Students pick, point, or exchange real tangible objects to communicate
2. COMMUNICATION SYSTEM WITH PICTURES, SYMBOLS, LETTERS AND/OR WORDS
A student looks or gazes at symbols (pictures, letters and/or words) to
communicate to a partner that symbols’ meaning
Idaho Assistive Technology Project (Nora Jehn)
• Eye Gaze Board
2. COMMUNICATION SYSTEM WITH PICTURES, SYMBOLS, LETTERS AND/OR WORDS
A student exchanges, moves or points symbols to communicate
• Communication Books or Boards
MID TECH
3. SIMPLE SPEECH GENERATING DEVICES
• Usually one button, delivering one message or a sequence of messages
• Example Devices: Single message: BIGmack A sequence of messages: Step by Step
• Students press the switch; it delivers recorded messages. Wati.org
4. SPEECH GENERATING DEVICE WITH LEVELS
• Capable of storing several layers of messages & delivering many messages, requires physical manipulation to change levels
• Example Devices: • Go Talk • Tech Talk
• Capable of changing symbols (picture and/or vocabulary) & Recording a message for each symbol
• Student presses each symbol to communicate using recorded messages Wati.org
HIGH TECH
5. SPEECH GENERATING DEVICE WITH A DYNAMIC DISPLAY
• Pictures, words, or symbols are represented on a screen, capable of touch or switch activation
• The devices automatically change the picture displays and corresponding messages
• Students need to navigate to different pages to communicate about different topics
Wati.org
6. TEXT-BASED DEVICES WITH SPEECH SYNTHESIS
• Anything the student types can be spoken by the device
• Requires good literacy skills including grammar, spelling, and punctuation
• Most have supplementary features such as word/phrase prediction, abbreviation expansion, pre-stored messages
Wati.org
MOBILE DEVICE AAC APPS
• Many AAC applications for mobile devices
• Apps often much cheaper than the existing AAC devices
ESTABLISHING RELIABLE RESPONSES
IDENTIFYING INITIAL COMMUNICATION RESPONSE TO TEACH
• Use common communication gesture if possible • Point, head nod, etc.
• If motor impairments present, consider shaping reflexive response • Head turn, arm extension/contraction (ATNR) reflex
• Teach movement for switch activation
• Teach sustained eye-gaze/eye-point • Difficult to establish reliable response
A B C • A____________: events that precede behavior in time. ntecedents
•B_______ : the activity of a living organism. ehavior
•C_____________: events that follow a behavior onsequences
ABC EXAMPLE
Setting Events: Noe has not played with her favorite toy truck all day.
Antecedent: Independent play time. Noe’s favorite truck is in sight but out of reach.
Behavior: Noe grabs
teacher’s hand and pulls her to
the shelf.
Replacement Behavior:
Noe asks for truck using AAC.
Consequence: Teacher provides Noe her favorite
toy truck.
Latency Prompt
INSTRUCTIONAL RECOMMENDATIONS FOR ESTABLISHING RELIABLE COMMUNICATION RESPONSE • Teach in naturalistic conditions/situations
• Teach when powerful motivation is present
• Be 100% consistent in using prompt(s) • Do not repeat or add extra prompts if no response
• Be 100% consistent in using corrections/consequences • Use precise latency
• Corrections/consequences must correspond to student response (or lack of response)
TEACHING STRATEGIES
• Communication temptations and arranging the environment
• Join the individual in a task or activity
• Interrupt the task or activity by manipulating reinforcing materials
• Have materials in sight, but unattainable (Wetherby & Prutting, 1984)
• Modeling AAC use
• Simultaneously speak and select AAC symbols
• Talk about what he/she is doing (Binger & Light, 2007)
TEACHING STRATEGIES
• Expand/elaborate on previously acquired language/scaffold
• Incidental teaching (a structured form of naturalistic teaching) • Instructor sets up the environment to be appealing to the target individual • Child initiates interaction (e.g., looks, points) • Respond to child’s initiation with model of target behavior or request for target behavior
(e.g., Tell me what you want) • Respond to child’s communication by elaborating on the child’s response (Oh! You want the
blue ball.) and honor child’s request • Communicative partner ends the exchange on a positive note
(Hart & Risley, 1978)
TEACHING STRATEGIES
• Errorless learning (to avoid an incorrect response, prompts are immediately implemented to result in a correct response)
(Cosbey & Johnston, 2006; Fillingham, Hodgson, Sage, & Ralph, 2003; Reichle, Drager, & Davis, 2002)
TEACHING STRATEGIES
Prompting (anything that helps a student make a response) • To avoid prompt dependence, fade prompts as soon as possible:
• Increase the length of delay
• Use less-intrusive prompts gradually (most-to-least prompting)
• Use least-to-most promoting
(Cooper, 1987a; Durand, 1999; Johnston, Nelson, Evans, & Palazolo, 2003; Macduff, Krantz, & McClnnahan, 2001)
TEACHING STRATEGIES
Reinforcement (a consequence is presented that increases the occurrence of behavior)
• In the natural environment, communication attempts should result in outcomes/reinforcers that are typically available and appropriate to each situation
(Cosebey & Jonston, 2006, Johnston et al., 2003; Skinner, 1951)
USING TECHNOLOGY FOR RELIABLE RESPONSES
ACCESS TO DEVICE ≠ INTERVENTION
• Not all educational apps/software incorporate evidence-based instructional procedures and few have sufficient levels of evidence to date
• Collect data and make comparisons between options, modifying as necessary
• Look for core features when appropriate, such as: • Customization for learning targets and reinforcers • Embedded prompts • Incorporation of generalization strategies
• Apps/software can also be paired with teacher-delivered antecedents, prompts, and consequences
TECHNOLOGY FOR RELIABLE RESPONSES
• Some apps will incorporate: • Prompts
• Customizable time delays
• Teachers can additionally provide prompts
Headsprout educational software
ACADEMICS
EDUCATIONAL APPS - ACADEMICS
• Can expand children’s social and cognitive abilities
• Technology and media offer opportunities to extend learning in much the same way as other materials (e.g., blocks, manipulatives, art materials, play materials, books, and writing materials)
• Screen media can expose children to animals, objects, people, landscapes, activities, and places that they cannot experience in person
• Discrete Trial Training (DTT) Apps (Android/Apple) • Feed Me! (Apple)
SOCIAL AND PLAY
EDUCATIONAL APPS - SOCIAL & PLAY
• Turn taking, interactive play skills • Digital games = Board games
• Play and Creativity
• TocaBoca (Apple) make fairy tales, bands, tea parties, train sets, style hair at the salon, go to the store, make food, celebrate a birthday, design clothes, create a fairy tale, etc.
SOCIAL SKILLS
• Emotions • ABA Flash Cards & Games (Apple)
• Social Behavior • MyFamilyNPals (Apple)
FUNCTIONAL SKILLS
VISUAL SUPPORTS
• Picture Schedules • StepByStep (Apple)
• Sesame Street and Autism (Apple)
• Visual countdown timers • Timer (Apple)
• First/Then visual cues • Blossoming (Apple)
• Social Stories • Social Stories (Apple)
MOTIVATION
• Token Economy • Token Board (Apple)
• The device itself can be motivational!
VIDEO MODELING
• Large evidence-base to teach a variety of skills
• Make own video models with edits • iMovie (Apple)
• Pre-made video models • Model Me Going Places (Apple)
CASE STUDY APPLICATIONS
QUESTIONS?
RESOURCES Binger, C., Kent-Walsh, J., Berens, J., Del Campo, S., & Rivera, D. (2008). Teaching Latino parents to support the multi-symbol message productions of their children
who require AAC. AAC: Augmentative & Alternative Communication, 24, 323-338. Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., ... & Schoonover, J. (2016). Communication services and supports for individuals with
severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities,121, 121-138. Cooper, J.O. (1987a). Stimulus control. In J.O. Cooper, T.E. Heron, & W.L. Heward (Eds.), Applied behavior analysis (pp. 299-326). Columbus, OH: Merrill. Cosbey, J. E., & Johnston, S. (2006). Using a single-switch voice output communication aid to increase social access for children with severe disabilities in inclusive
classrooms. Research & Practice for Persons with Severe Disabilities, 31, 144-156. Durand, V. M. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement. Journal of Applied Behavior
Analysis, 32, 247-267. Fillingham, J.K., Hodgson, C., Sage, K., & Ralph, M.A. (2003). The application of errorless learning to aphasic disorders: A review of theory and practice.
Neuropsychological Rehabilitation, 13, 337-363. Ganz, J. B. (2014). Aided augmentative and alternative communication for people with ASD. In J. Matson (series ed.), Autism and Child Psychopathology Series.
New York, NY: Springer. doi: 10.1007/978-1-4939-0814-1 http://www.springer.com/psychology/child+%26+school+psychology/book/978-1-4939-0813-4
Hart, B., & Risley, T. R. (1978). Promoting productive language through incidental teaching. Education and Urban Society, 10, 407-429. Johnston, S., Nelson, C., Evans, J., & Palazolo, K. (2003). The use of visual supports in teaching young children with autism spectrum disorder to initiate interactions.
Augmentative and Alternative Communication, 19, 86. MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (2001). Prompts and prompt-fading strategies for people with autism. Making a difference: Behavioral
intervention for autism, 37-50. Parette, H. P., & Brotherson, M. J. (2004). Family‐centered and culturally responsive assistive technology decision making. Infants & Young Children, 17, 355-367. Reichle, J., Drager, K., & Davis, C. (2002). Using requests for assistance to obtain desired items and to gain release from nonpreferred activities: Implications for
assessment and intervention. Education and Treatment of Children, 25, 47-66. Skinner, B.F. (1951). How to teach animals. Scientific American, 185, 26-29. Wetherby, A., & Prutting, C. (1984). Profiles of communicative and cognitive-social abilities in autistic children. Journal of Speech and Hearing Research, 27, 364-
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