Sunday, April 22, 2018

What's the Purpose of THAT?!

My apologies for my absence last week.  Like many of us this Winter, I finally succumbed to this miserable crud that is infecting so many.  And I can't even blame it on having to shovel snow or scrape ice.  I no longer do such frigid tasks, here in Southern California.  
But I'm back on track - mostly. Although my poor cat, who likes to sit on my lap, has become extremely distrustful.  He's easily disturbed by loud noises, and my coughing and honking evidently count as such.  But, he'll get over it, in exchange for some treats.

So, on to this week's post.

We tend to talk a lot about use of core vocabulary and expanding functions beyond requesting, but we don’t talk quite so much about social skills and pragmatics with AAC users.  
The Pragmatics Profile for People who use AAC was developed based upon the Pragmatics Profile of Everyday Communication Skills in Children (Dewart & Summers,1988), which the authors assert is useable by many populations, as it is descriptive rather than a measure of skills.  
The Profile allows clinicians to collect information to describe an individual’s communication skills functionally and usefully.

While the original Profile was written for the preschool population, it soon extended to Elementary aged students, and then adults.  The original authors suggested that the Profile could be used with a wide variety of students; including those with physical and other disabilities.  This version for students who use AAC was adapted so that it is simple to administer to describe the pragmatic communication skills of students using, or who have used, AAC.

The Profile provides a 5 point scale that includes “Does this,” “May do this,” “Does not do this,” “Not applicable,” and “Potential target.”

Communication functions questions range from gaining attention to the full array of communication functions/intents and participation in various communication interaction types.  There are example provided and space for narrative remarks.  At the end is a summary chart, that can be used by teams to establish objectives and measure progress.

Until next week .........Keep on Talking!

Sunday, April 8, 2018

Can Nonspeaking Students Learn to Read? Why Not?!

If you follow my blog you’ve probably read before about developing literacy skills in children with limited language and/or complex communication needs (CCN).  We just do not spend sufficient time teaching literacy skills to these children; not anywhere near the amount of time devoted to teaching reading in general education classes and even less than students in general education classes who are struggling readers and who receive additional support in the resource room.

A recently published article by Barton-Hulsey, Sevcik, and Romski (2018) examined the relationship between receptive and expressive language skills and phonological awareness skills in children with development disabilities.  They attempted to help us understand how children with developmental disabilities and minimal speech develop reading skills; specifically phonological awareness skills.

The National Reading Panel has reported that instruction in phonics and phonological awareness is very effective.  In fact research has shown that, while taking significantly more time than neurotypical peers to acquire literacy skills, the relationship between phonological awareness and reading skills is the same in both groups. (The Institute for Educational Sciences - IES, 2014).
Children’s understanding about the sound structure of language plays a significant role in their understanding of how speech and reading support each other (Frost et al, 2009).  Contrary to widespread belief, letters do not actually represent the sounds in a word; rather they represent the underlying phonology (Liberman, Shankweiler, & Liberman, 1989).
While there have been a number of studies exploring the relationship between speech sound disorders and development of phonological awareness skills, little has been done to explore this relationship in students with minimal speech with filtered variables.  There have been some studies exploring reading development in individuals with motor speech impairments but no significant impairment in cognitive skills.  However, there are very limited studies that have looked at the development of reading skills in children with intellectual impairment.
In one study (Card & Dodd, 2006) it was found that children who could speak performed better on some tasks of PA (phoneme manipulation & visual rhyme), but not in other tasks (segmenting syllables, spoken rhyming words, and reading nonwords).  If development of PA skills is not dependent upon the ability to speak, then we should be able to develop these skills in AAC users.

This newest study looked at the relationships between receptive language, speech ability, early literacy skills and phonological awareness in children with developmental disabilities.  The results suggest that “…speech ability does not play a significant role in PA for those children.”

“Speech ability and letter-sound knowledge we found to have a small, nonsignificant correlation.”  Similar to the 2006 study by Card & Dodd, the findings suggest that limited speech does not result necessarily in limitations on tasks of PA.

The study concludes that the “ability to speak may not be an important component in the linguistic knowledge necessary for PA…”  While significant modification may be necessary for reading tasks for students who use AAC, there is nothing to suggest that we cannot teach them to read.

As David Yoder said (ISAAC, 2002): No child is too anything to learn to read!

Sunday, April 1, 2018

The 30 Million Word Gap

That's an amazingly big number, isn't it?  30 Million.  It's even more amazing - and frightening - that this is the number of words that children from low SES (socio-economic status) are missing from their environments, when compared to children from professional families - those from higher SES.

If you can stand reading about statistics, here are a few from different studies:
Von Tetzchner (1997) and Porter (2009) both refer to the differences in language environments between typically developing children and AAC users.  
Children are typically surrounded by examples of others using the communication systems they are learning. Hart and Risely (1995) found that typical children in working class families hear approximately 1,250 words per hour and accumulate a listening vocabulary of 6 million words by the time they are 3 years old. 
They also reported (1995) that 4-year-olds from working-class families and families on welfare had considerably smaller vocabularies than their age-mates from professional families. 
This difference has been called the “30-Million-Word Gap” and “The Great Catastrophe.”

The average 3 year old in a middle class household hears about 6 million words per year.  The average deaf child the same age and background (and in a signing home) sees approximately the same number of signs.  
But the average nonverbal 3 year old sees 0 instances of someone using pictures to communicate.

According to Von Tetzcher (1997) “the difference between their own expressive (and for some also receptive) language and the language used by significant people in their immediate surroundings” is a critical factor in the acquisition of language for AAC users.  
There is an assumption in all major theories of language learning that the individual is surrounded by others in the environment using the same language system.    
Even in second language learning the importance of immersion has been noted. Learners of second languages need to participate in an environment that exposes them - immerses them - in experiences with that language in order to become competent communicators. 

Parents and others engage often in routines with children that demonstrate how the world is organized, what words people use in those organized routines, what people’s roles are in routines (who says what when) and how to interact with others in these routines; even before they can participate in the conversation.

“The average 18 month old child has been exposed to 4,380 hours of oral language at the rate of 8 hours/day from birth.  
A child who has a communication system and receives speech/language therapy two times per week for 20-30 minute sessions will reach this same amount of language exposure in 84 years.” (Jane Korsten).  

Because this type of immersion environment is rarely provided (although beginning to find foothold) to learners of AAC, there is a great discrepancy for them between the language environment to which they are exposed, which uses verbal language, and the language system they are being asked to use, which is a picture-based language. 

That's all for the numbers this week.  The take-away? Talk to your children/students. Read to your children/students. Expose them to vocabulary.  And for your AAC users - use their system when talking or reading to them.
More next week.
In the meantime, keep on talking!

Sunday, March 25, 2018

Are You Practicing Enough?

We all know that it takes many more exposures to words and concepts for our AAC users to learn them than typical students.  But do you know how to increase that exposure? Do you know how to provide repeating, on-going, opportunities for practice in your AAC user's day?

Obviously, we want to maximize the contexts in which students can practice 'their words.'  But how do we make sure all those opportunities happen?  Often the best way is by creating opportunities for modified incidental teaching.

Many of our students don't learn naturally through incidental teaching moments. So how can we modify those moments?  Take a look at some of these ideas:

"It is (size, color, shape)" - practice with objects in the environment.  A big book and a little one.  A blue pencil or a red one.

Pronoun + to be + preposition: A student on a swing = "He is on it."
"What is in the (crayon box, paper tray, rug, etc.)?" = "They are."
"Where are they?" = "On it."

"Who is washing hands?" =  "He is"
"Who is reading?" = "She is."
"Whose pants are pink?" = "Hers."
"Where is the red one?" = "There."
"What is blue?" = "It is."

Extend these types of questions to read alouds.  Ask questions while reading and looking at the pictures.  And, per Gail Vantatenhove's 'descriptive classroom,' ask questions that focus on core word responses, rather than referential questions that require a name or other fringe word that won't be needed ever again.

Try it.  And, Keep on Talking!

Sunday, March 11, 2018

Being a Good Communication Partner to a Child Who Uses AAC

Good Communication Partners:
     create a positive communication environment
     respond to all communication attempts
     use the child’s AAC system to communicate to them

Creating a Positive Communication Environment:
          There is a positive communication environment when we respond to all of a child’s communication attempts, provide support as needed, focus on positive results, and find solutions to challenges. Even when you respond to an undesirable behavior, if you do so while also modeling how to use the correct message in the AAC system you take advantage of a communication opportunity.

As much as possible, do NOT ask yes/no questions, do NOT ask closed-ended questions

DO ask Wh-questions or other open-ended questions. If necessary, ask multiple choice questions.

Strategies to create opportunities to communicate include:
     providing choices, 
     sabotaging the environment, 
     giving small amounts of desired item/activity, 
     briefly delaying access, 
     using pause time, 
     using fill-in-the- blank activities.

Respond to all Communication Partner’s Attempts:

All children communicate. They don’t all communicate symbolically - that is, with pictures, words, text. And some of their nonsymbolic communication is undesirable.

Think about how this child responds to his/her own name; what (s)he does when a routine is interrupted; what (s)he does when wanting an item, action, attention, or help; or tells you when something is wrong. What we’re talking about is how this child communicates to reject/protest, request, comment. Those are some of the main, early functions of communication. The earliest communication behaviors are social regulatory - regulating another’s actions.  What we need to do is to respond to those other communication behaviors, while shaping them into more acceptable or understandable forms.

The more you practice using the aac system during real contexts, and increase the number of those contexts in which you use the aac system, the more automatically the child will learn to use the system.  Use the AAC System to Communicate TO the Child:

Aided Language Stimulation - also called Partner Aided Input - is crucial to the child learning to use their aac system.
Language is learned through models. Children learn spoken language by listening to others using it. A child using picture-based communication is learning an entirely different language. They need to see models of people using it effectively. And models provided in response to their communication are most powerful.

Facilitating Communication:
  1.    provide access to the aac system - it needs to be available all of the time. This is how this child “talks” and (s)he needs to know that communication is valued enough to be there whenever it is needed 
  2.    provide AAC models - use aided language stimulation as much as possible. When asking questions during an activity, highlight key words by using the aac system
  3.    provide opportunities for the child to take a turn - i.e. by pausing after each turn you take. Don’t be the only one “talking”
  4.    pause/expectant delay - give the child time to process, time to formulate a response. Looking expectant while pausing lets the child know you expect a response
  5.    ask open-ended questions - and wait for the answer before you provide it; if necessary, you can answer the question then provide a prompt for the child to imitate the answer. Asking Wh-questions instead of yes/no questions allows the child to learn higher-level responses.
  6.    prompting those responses - providing verbal prompts lets the child know what they are supposed to do.

When do I do Each of Those Things?
     Begin with routine activities. Many routine activities have a set beginning - middle - end that are predictable , use words that are predictable. This makes it easier for the child.

Other activities are a little less predictable but can easily provide communication opportunities.

Sample activity (based on Kent-Walsh and Binger):
1. Read from a book (a 2-pg. spread) + Model using the AAC system.
2. Ask a question + Model using the AAC system. Then PAUSE
3. Answer the question + Model using the AAC system. Then PAUSE
4. If necessary and appropriate to the target goal: Prompt a response.

Take turns with other adults role playing how to do this so it becomes automatic.  Start using ALgS (Aided Language Stimulation) with one activity. When you’re comfortable, add another activity/time.  Keep adding activities throughout the day until the strategies are used all of the time.

Keep track of the need for new vocabulary. By the time you have increased the number of contexts, you may find that there is more vocabulary that you need. Have a plan for how to keep track of this. For example, some classrooms keep a list on a clip board for each applicable student, staff write down words as they come up. The list is given to the
person who updates the system every day/week/2 weeks - as appropriate.

Keep on talking!

Sunday, February 25, 2018

Presume Competence to What?!

“There is nothing in a caterpillar that tells you it’s going to be a butterfly.” ‐ Buckminster Fuller

This quote from Buckminster Fuller appears at the beginning of Hussman’s (2017) Autism Support manual entitled, “Presume Competence; Autism support 1.0.”

I’ve been hearing some backlash against presuming competence in our AAC users/ potential users recently.  The greatest number of students with autism I have worked with over the past 44 years have been nonverbal or minimally verbal. And at some point in every one of these children’s academic career has been the question, “Are we expecting too much? Or too little?”

Over the course of Special Education as it has existed both before PL94-142 and after, we have a miserable history of under-estimating the potential of many of these students and offering them far too little education and support.

Yet, with recently higher expectations we’ve seen these students succeed at tasks “we” thought they could not. We’ve discovered literacy skills in students who have, historically, not even been taught to read.  We’ve discovered communication skills in students we thought would never learn beyond, perhaps, some basic requesting.

I recently read a discussion about how those who eschew the “presume competence” construct are not actually presuming incompetence, but rather are avoiding putting too many eggs in a particular child’s basket. 
To me, this discussion smacks of cognitive referencing; a practice that ASHA has firmly denounced.  Unfortunately, the term is being used a lot by practitioners of Facilitated Communication, a practice that ASHA has also denounced.

Hussman’s manual lists the following constructs:

  • Presume competence
  • Follow the lead
  • Make communication the centerpiece
  • Offer positive behavior support
  • Include and adapt
  • Accommodate sensory and movement differences
  • Build relationships
  • Support autonomy

It strikes me that these are the very ideas that we need when working with students who need to use AAC to bee verbal.  They are, in fact, exactly what I, and others in the AAC arena have posited for many years.

Hussman goes on to say:

“What you will need is the awareness and patience to embrace people with autism as different, not less; the willingness to presume that people with autism are competent – even if evidence may be not be available at first; and the understanding that behavior is not random, but is instead motivated by necessity, frustration, sensory differences, or the need to communicate a request or thought. “

Hussman further says that what is needed is the kind of engagement and interaction that provide the student with models of language models that the students can then process, copy, and eventually use.
This sounds to me like the very process that our AAC users need; this aided input or modeling of the AAC system. And I very much worry about what will happen if we stop presuming competence in our students with the most complex communication needs.

I’d like to end this post with the stories of 2 young men and their AAC.
One, is shown in this short video created by MeloSpeech about one of my students. You can see it here:

The other is another amazing young man who could have continued to be locked in if his parents had not presumed his competence.  He has severe cerebral palsy; spastic quadriplegia.  His time in school was consistently characterized by sitting in his wheelchair in the back of the classroom, doing nothing.  Because they could not see a way to engage him or get a response from him, they ignored him.

His parents took him out of school at 16, and placed him in an adult day program, which happened to bee run buy an organization that understood communication strategies.  They made a picture communication book, and taught him to use Partner Assisted Scanning strategies.

Once an Assistive Technology Center opened in his area, his parents brought him to the center for an AAC assessment.  To get to the punchline, when the dynamic display speech generating device arrived and was mounted on his wheelchair, the first thing he did was to use the switch to navigate to the keyboard, which he used to say, “Thank you so much. Now I can talk like everyone else.” Nobody ever taught this young man to read.  They assumed he could not. He sat in the back of those classrooms and learned incidentally.  Where would he be if nobody presumed he was competent?

The bottom line: 

“All individuals, regardless of the severity of their disability, have the basic right to ongoing instruction that will help them develop versatile communication skills.”  (Geist, Erickson, et al, 2016)

Monday, February 19, 2018

You Have to Stop Listening to These!

It’s been more than a decade since Romski and Sevcik wrote their article about the myths of AAC. They wrote that “Despite the advances, the inclusion of AAc services and supports into early intervention service delivery for young children has been hampered primarily by myths about the specific types of roles AAC plays.”

Here we are more than 12 years later, and many of these myths still run rampant through our service delivery - or lack of it. Romski and Sevcik addressed the ways in which AAC can facilitate the development of children with communication disabilities.

Children need both comprehension skills and expressive skills. Routines create consistent language environments (did you read last week’s post about routines? Or this older one here?), and consistent opportunities for partners to create learning opportunities. Research by Hollich et all (2000) is cited in the article as indicating that children rely “…on comprehension to build a foundation for later productive word use.”

Romski and Sevcik list 6 myths of AAC:

1. AAC is a “last resort” in language intervention
Research has shown that it is actually important to introduce AAC before the child fails so that he has a communication mode before frustration sets in.

2. AAC hinders or stops further speech development
Research again has shown that use of AAC can actually help children develop speech.

3. Children must have a certain set of skills to be able to benefit from AAC
As the exact relationship between cognition and language is unknown, we do know that many children cannot demonstrate their abilities without a way to communicate.

4. Speech Generating Devices are only for children whose cognition is intact
Advances in technology mean that advanced cognitive skills are not necessarily needed to use high tech systems and, as a wide range of options are available, there are many tools that children can bee taught to use effectively

5. Children have to be a certain age to benefit from AAC
Again, research shows that providing children a mode of communication early is beneficial and will not hinder speech development.

6. There is a representational hierarchy of symbols from objects to written words.
Romski and Sevcik site the research that shows that children do not actually learn less abstract symbols better or faster. To the child, all symbols work the same way. We just need to teach them consistently.
(Did you read my last post about the myths here?)

Romski and Sevcik go on to discuss the important role parents play as interventionists. Certainly, family is all-important in providing intervention when children are young. The article concludes with the reminder that it is never too early to begin using AAC for language and communication support, and that AAC is a tool; not the end goal. “AAC is not a last resort but rather a first line of intervention…” 
 The message of this article is as important in 2018 as it was in 2005.
 I, for one, am saddened that these myths still abound in our profession and in the minds of other educators. It is about time that we acknowledge that ALL children can communicate.
Please, keep on talking!