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.