A PrAACtical Look at PECS

This week, we’re heading back to the Autism and Tertiary Behavior Supports Project of the Kansas Technical Assistance Network. They have two wonderful videos by Lori Chambers on Picture Exchange Communication System (PECS). You can view an overview of this approach here: Part 1 and Part 2 . Also, look for the handouts that accompany these videos.

5 More Handouts from ISAAC 2012

In past posts, we shared links to some handouts from the ISAAC 2012 Biennial Conference in Pittsburgh. While it is great for those of us who attended but couldn’t get to every presenter we wanted to hear, the main idea was to help spread the awesome content to those of you who couldn’t be there.

Here are some others that may be of interest.

1. Creating a Core Vocabulary for a Common Core Curriculum by Karen Erickson, Penelope Hatch, Allison Dennis, & Marlene Cummings
2. Baby Talk/Kid Talk PWUAAC Talk to Little Ones! by Krista Howard, Kaitlyn Graham, & Caroline Musselwhite
3. Evaluating Preferred Augmentative and Alternative Communication Strategies for Patients in Long Term Health Care Hospitals by Susan Fager, Jenna LeDoux, & David Beukelman
4. Prompting:  A Cautionary Tale of Use, Misuse & Abuse by Jane Korsten & Terry Foss
5. Supporting Linguistic Skills Through iDevices: Cool Tricks with New Applications  by Caroline Musselwhite, Deanna Wagner, Laurel Buell, & Marilyn Willcoxon

Get Ready. Get Set...

Get ready, AAC lovers, AAC Awareness Month is coming!

One of the most wonderful things about the AAC community is the pervasive sense of sharing and giving. When we told some of the people we know that PrAACtical AAC was planning a giveaway for AAC Awareness Month, they responded with an overwhelming level of generosity.

So far, we have books, switches, software, apps, a low tech SGD, subscriptions, and more to give away from some of the companies whose logos are appear in his collage and more.

We’ll be sharing more information about how to enter to win some fabulous AAC-related goodies, but we’ll give you one big hint. Get ready to take some pictures. If you’re the competitive type, you’ll want to snap some shots of your AAC Awareness work and get comfortable uploading them because this will give you a big boost. 

If photography is not your thing, don’t worry. There will be plenty of other ways to get a piece of the action. Stay tuned. 

In the meantime, get ready to spread the word about what AAC is, who can benefit, and how to better implement it. We’ve started you off with some suggestions here: 50 PrAACtical Things to Do In Celebration of AAC Awareness Month.

What Really Matters

We love this video that reminds us that technology is a beautiful thing, but the real power is in communication. 

Kudos to the AAC team at Thames Valley Children's Centre for this wonderful reminder of three important things. 

1. Language learning happens through good teaching, not the mere provision of equipment.
2. Verbal expression without technology is not only powerful but awesome.
3. Literacy is something we should prioritize for all learners.

As we prepare for AAC awareness month, enjoy this lovely conversation.  

Speak Up

by Robin Parker

Speaking Up is our way of thinking and writing  about things that come up in clinical practice that make us think, celebrate, or vent.  This time it's about multimodal communication and the appropriateness of using  multiple technology tools. 


This is a relatively new issue. Not to state the obvious, but  technology options have expanded almost exponentially.  Between the two of us, we have at least 9 devices we may use daily for communication.  So it should not surprise anyone that some AAC users also have multiple technology tools to use to communicate.  Sometimes though the new technology reality will surprise educators and they will get stuck in old paradigms. 

We know an amazing young girl, Holly.  She has communication challenges secondary to autism.   She uses multimodal communication that includes natural speech, no-tech, low tech, and high tech supports, as well as behavior and gestures.  Her high technology tools are not unlike ours, she has an iPod Touch, an iPad, and a laptop.  She uses Proloquo2go for expressive communication and a variety of other apps for receptive and behavioral support.  She also uses the Vantage Lite, a high tech dedicated communication device.  Sounds great, right? So what is the issue?  

The family was being criticized for not using the Vantage Lite enough and relying on the iPod Touch too much.  The family was instructed to use the dedicated device more often.  Mom was feeling guilty.  Putting that into perspective, the school felt that they family was using the iPod Touch TOO much for communication.  Everyone was stuck. 

How to resolve the question of when to use which AAC technology? Here are some PrAACtical thoughts on the issue...  

1. We considered Holly's LIFESTYLE.  

• She is very active.  (We are envious, continually wishing that we could do all that she does.) She  gardens (vegetables to eat), hikes (up and down mountains), shops (food, kitchen appliances, & clothes),  rides horses (sometimes), surfs, and swims (daily).    

2. We considered Holly's SCHOOL.  

• They were initially resistant to AAC. It took many years for them to integrate her dedicated device into her school curriculum and  programming. So the fact they wanted her to USE her AAC device more was a good thing. 

3. We considered FUNDING. 

• The school was not being asked to fund any of her devices (employer benefits allowed for a spending limit on therapeutic materials). This made us think though of traditional funding where one device is funded for 3-5 years. This would be so restrictive for anyone who is active in their community.

So after 'venting' about the absurdity of it all we were able to do something productive.  We had a family-school meeting to discuss the 'problem' and facilitated reframing the issue as a good thing. 

Then we were able to help the team do a mini feature match process for different contexts based on both time and activity.  As the information was laid out visually, everyone was able to see the benefit for the use of multiple technology tools and became comfortable with the new technology paradigm for Holly (and hopefully others).  

Helping the school reframe their technology paradigm turned out to be the easy part. Now we have to Speak Out about the idea of one single communication device over years so that other people aren't stuck in this same situation.

How It Is: Images for Sensitive Subjects

There are things no one likes to talk about. Serious things. Sensitive things. Nonetheless, everyone deserves the tools to be able to talk about whatever they want to share. 

The How It Is Project, by the UK-based Triangle organization, offers a set of free pictures developed so that everyone has access to images they can use to talk about their feelings, their rights, personal safety, personal care, and sexuality. We love how they developed the vocabulary list and symbols on the site with the help of children and youth with and without disabilities.

You can browse the images by topic here.

Turn Taking

We’re always looking for new ways to represent things visually. Today, we’re sharing an idea from Amy Laurent on helping children take turns. You can view a video explaining the strategy she uses and download the visual support here.

Apps To Learn & Practice Talking About Pain, Illness & Injury

We were looking over the great hospital resources from Patient Provider Communication Forum, Central Coast Children’s Foundation, Dr. Bronwyn Hemsley, and Widgit Software that Carole wrote about and realized that not everyone automatically knows how to talk about pain, illness and injury. We often need to teach the expression of these concepts. We use various types of modeling and create Boxes or Drawers that have items (i.e., bandaids, antiseptic, washcloth, ice buddy, etc) to 'help with Cuts/Scrapes' (or any other illness).   We have had some fun and lots of practice using these apps to also help the learning process.

5 Apps To Learn and Practice Talking About Pain, Illness, & Injury

Don't forget to model, play, and use the apps often in the teaching process so when they are really needed you will see spontaneous communication and language.

Toca Doctor- learning about injury and sickness through fun noncompetitive challenges that involve ‘healing’ the damaged part. Relate the body part challenge to real times of distress.

Autism Xpress- learning about feelings (good variety- i.e., happy, sneezy, sleepy, sickly, etc.)

Autism 5 Point Scale EP- Customizable 5 point Scale that can be used to talk about levels of pain, stress, etc. Can model by labeling when learner/facilitator is in physical discomfort, pain, or illness.

Small Talk Pain- Can be used to teach labeling of specific severity, type, and location of pain.

Small Talk ICU- Can be used to teach talking about various comfort items, sickness, and level of pain.





We would love to hear about what you use and we will continue to talk about other teaching/learning strategies we use as we think these are very important concepts to begin teaching early and frequently.

5 Charitable Programs that Support Funding for Communication through iDevices

For some people with significant communication difficulties, mobile devices and AAC apps play an important role. When selected after a process of careful evaluation, they can be incredibly useful in building communication, literacy, self-regulation, and other important skills. Here are links to organizations that provide support to families seeking mobile devices and/or communication apps for their children.

1. The iTaalk Autism Foundation
2. Babies with iPads
3. Small Steps in Speech
4. Different Needz Foundation
5. Gift a Voice Program from Different Iz Good™: iPhones only

Communicating in the Hospital

We are so happy to share a link to downloadable resources that come from the collaborative effort of the Patient Provider Communication Forum, Central Coast Children’s Foundation, Dr. Bronwyn Hemsley, and Widgit Software. These research-based materials were developed to help improve communication in hospital settings.  

The link takes you to the Widgit Health site and is a set of cards with 26 key phrases for patients who use picture symbols to communicate. The cards are printable and available in 20 different languages.

You can access those materials here.

Eye Love

So much to love about Speakbook, a lovely and hugely functional tool for people who communicate by eye gaze

• Love the generosity of its designer, Patrick Joyce, in making this available under a Creative Common license
• Love the creative approach of blending an eyegaze board with a communication book
• Love the use of color encoding so that the communicator has access to more words/messages
• Love the plentiful access to the alphabet for spelling novel messages
• Love the beautiful feel of the Speakbook website

Check out this when you can and share the eye love.

Video of the Week: AAC in College

It's a beautiful Sunday here in South Florida and we are ready to turn our faces to the sun. Nothing makes us smile more than hearing directly from people who communicated effectively with their AAC systems. 

Enjoy this panel presentation of young adults who are using AAC in college. 

Not Good Enough

It’s been a depressing week for us. Too many exchanges with SLPs who should know how to ‘do’ this intervention and don’t. Too many conversations with parents who have not been able to access decent AAC services. Too many delays in getting devices in the hands of clients. We’ll get back to being positive and solution-oriented, but first we need to wallow in the misery of it a bit.

The case for improved services to individuals with little or no functional speech is perhaps best made by those whose voices we cannot hear in a traditional sense. Below is a sampling of quotations from scholarly and personal writings of and by users of AAC.

Michael

Twice a week my academic pursuits were interrupted.  I was sent out of the classroom and wheeled down to the other end of the building where I was put into a small, airless room to await the arrival of the school speech therapist.  He was a youngish man, full of energy and enthusiasm.  He was convinced that he could teach me to speak…He was not the first.  There had been others before him…For me these twice weekly therapy sessions were torture.  I never doubted the dedication of the people who were working with me.  I knew they were sincere and went through many years of education to get where they were.  On the other hand, I had been going through this business for more years than I cared to remember…Five more years of blowing candles out; five more years of running through the vowel sounds; five more years of trying to force my unruly lips to form difficult consonants; five more years of attempting singsong nonsense syllables; five more years of failure.  I was, as I had been before, still unable to communicate verbally with the majority of people with whom I came into contact. (Williams, 1984, pp. 48-49)

Dawn  

I had a few speech teachers.  Every speech teacher had their own way of doing things.  I was confused.  One would say do it this way and another would say do it another way.  The last speech teacher I had in elementary school said “O.K., it’s time for a Canon” but the one I had before said “Use speech.” (cited in Smith-Lewis & Ford, 1987, p.15).

Ruth  

None of the staff … had noticed my yes-and-no signals until that day, when Wessie discovered them.  For more than three years I hadn’t been able to communicate any of my thoughts or feelings to the people on whom I depended for my survival.  Back when my parents first brought me to [the institution] they made a point of telling Dr. S. and the others about my facial signals, but no one paid any attention to what they said.  They just assumed I was a helpless cripple, and with the constant turnover of staff, the very suggestion that I could communicate was soon lost. (Sienkiewicz-Mercer & Kaplan, 1989, pp.110-111).

Vi’s Family

The day and hour had finally arrived.  This was to be the day when the consulting speech pathologist was going to let us know when Vi was finally going to get her augmentative communication system.  Anticipation loomed like the hot sticky July air…where we had all gathered to hear the news.  Five minutes into his polite but rambling recitation, though, it became apparent that the only news he had for us was no news at all: a glitch had developed here or there…I asked how much longer it’d take to get back on track this time.  Why?” he quizzically replied, “Is there any special reason for all the rush???”  “No, no special reason,” I said, …”except that she has had 50 years of no special reasons. (Williams, 1989, pp.16-17)

Though they address very different issues, these remarks should serve as a call to arms for improved intervention services for individuals with significant communication difficulties.  They are painful reminders that good intentions aren’t good enough, and that the stakes can be very high. 

What is it going to take for us to get this right?

30 Things A Student Can SAY When They Have AAC!

AAC Supports- Don't Go ANYWHERE Without Them..
Access To AAC & Visual Supports Allows Students to:

1. Let you know what they want
2. Let you know nicely what they don’t want
3. Answer class questions
4. Ask a question
5. Say ‘I don’t know’
6. Ask for help 
7. Tell you they are having fun
8. Create a Sentence
9. Argue
10. Negotiate
11. Say a line in a school play
12. Say ‘here’ during attendance
13. Tell what they did on the weekend
14. Tell what they did over the summer
15. Tell you what they want to do at home
16. Tell you if they are happy
17. Tell you if they are scared
18. Tell you if they are frustrated
19. Tell  you about their family
20. Tell you about their pets
21. Say please
22. Say their name
23. Say hello to a person
24. Tell you what they like to do
25. Ask for more
26. Tell you which color they want
27. Ask for a break
28. Tell you why they are upset
29. Tell you to stop
30. Say THANK YOU

Communicating About Communicating

Last week I was talking to a bright, young professional who is starting her second year as a school-based SLP. She has a caseload of 60+ students, including a class of students who have significant communication impairments. When the conversation turned to building a support system for her students who use AAC, we talked about strategies for keeping all of the stakeholders in the loop. 

Here are some of the the things we touched on.

'Just Because I don't Speak, Doesn't Mean I Don't Have Anything To Say'

We have recently been surprised (ok, shocked) by the absence of communication supports in  educational settings that are supposed to be supporting learners with significant communication challenges.  To be even more specific and blunt, the students do not have functional spoken speech. They can’t speak to let you know:  what they need, what they don’t need or want, how they feel, what they see, what interests them, what questions they have, what they like and don’t like, when they really really want something, etc., etc. etc.  And, trust us, they do need to say all of these things.          
       
If you work with anyone who does not use spoken speech and we mean ANYONE, they deserve the basic right to communicate with you.  Our PrAACtical AAC Absolute A's:

1. AAC displays need to be accessible ALL OVER.  There is no special ‘communication time.’ Communication teaching is ALL the time in authentic situations. There need to be AAC/communication displays wherever you go. Each adult should USE and have available AAC displays (from gym teacher to attendance officer).  

                                                                        

2. Use Aided Language Input ALWAYS.  Aided Language Input is modeling, AAC style.  

The adult points to or touches the picture symbols on the communication display (board, app, device etc) in conjunction with key words they say. It is about the 'teacher' doing the modeling. This shows that they are 'speaking' the language we expect the 'learner' to use.

The benefit of aided language input is that it slows the adult down (while they are finding vocabulary), they learn where vocabulary is located on a communication display, and gives a static visual representation of language. Remember, though, to use aided language input, you need communication displays (they can be AAC apps for the group or individual, communication boards for the group or individual, low tech single message devices, etc.)

3. Use 'Tell Me' to prompt for ACTIVE PARTICIPATION. Help a learner 'tell you' what their behavior says.  If a child is leaning towards something he wants, help him access the communication display to say it with symbols (i.e., picture symbols, written word, object, etc).  You can say "tell me" “want ball,” for example, while prompting learner to touch/activate the corresponding symbols. Opportunities for the learner to 'speak' can be things like showing desired objects, offering non-preferred items, and helping the learner say 'no stop', answer questions, etc.

4. Use Visual Supports for Receptive Language ALSO. Use extra visual supports for understanding, remembering schedules, signs, calendars, rules, etc. The communication displays are helping learners to expressive themselves but we also need to use visual language to support understanding/receptive language.  Think about learning language we need to hear and understand as well as talk and express ourselves.

5. Learn more tips for embedding  AAC into everything you do and be AMAZED at what can be learned.  Just a few resources: Jane Farrall’s- Speaking APPropriately AAC for Apps for the iPad,  Visual Supports Downloads, Early Intervention Penn State AAC Style, Real Look at AAC Teaching

For More Resources, follow our blog, PrAACtical AAC.

'Real Look' at AAC Teaching

Our Video of the Week is an AWESOME demonstration of AAC teaching strategies and rationales.
With the 2012 Paralympics going on now and in our minds - a 10 out of 10.  10 for the SLP, the MOM, & the BOY.
Thanks so much to Real Look at Autism for producing this great video (and many others).  Do you use these strategies?

5 Resources for AAC Core Vocabulary Selection

Whether we are creating a communication book, programming an SGD, or customizing and app, we can’t get very far without thinking about core vocabulary. Here are some of the resources we consult in that process.

1. Normal Language Development, Generative Language & AAC by Gail Van Tatenhove tops the list for the clinically useful material on this topic.

2. The AAC site at University of Nebraska-Lincoln has some of the most comprehensive lists and covers a wide age range: You can view them here.

3. Vocabulary for medical procedures, also from UNL

4. Preschool vocabulary from Frequently Occurring Home and School Words from “Vocabulary Use Patterns in Pre-School Children by Christine Marvin, David Beukelman, and Denise Bilyeu

5. A brief article on how one school approaches this task: A Few Good Words Using Core Vocabulary to Support Nonverbal Students by Barbara Cannon & Grace Edmond

What sources do you find helpful in selecting core language?