CSHA 2013 AAC, the iPad and Autism: Moving Beyond Choice-Making (Meier, Kappe) 3.8.13

AAC, the iPad and Autism: Moving beyond choice-making

Gwendolyn Meier, MA, CCC-SLP, MT-BCSpeech Language Pathologist, Music Therapist

Villa Esperanza ServicesPasadena, CA

Terry Kappe, MS, CCC-SLPSpeech and Language Therapy Services

CSHA District 7Temple City, CA

AAC, the iPad and Autism - Moving Beyond Choice-making. CSHA 2013

Disclosure• Nothing to sell, nothing to buy

• Thank you to the students and their parents for video permissions

• No video recording of this session permitted

• FYI - there is no Wi! in this room

Why are we here?• We all have iPads

• To talk about moving beyond choice-making and requesting with difficult-to-motivate, nonverbal students

Why are we here?• Because we can pave the way for

“Requesters” to learn additional functions of communication using AAC with the essential teaching strategies of modeling and demonstration

Why are we here?• Because we want you to

consider that even “symbol-blind” individuals can be taught to use visually-based communication

From an AT Specialist: A tale of AAC Failure

• Parent bought an iPad

• AT Specialist provided an iPad

But, “It’s not working”

“He’s not using it”

• The iPad is not the best communication tool for every student

• That being said, exposure to visually supported communication may lay the foundation for future skills

From an AT Specialist:A tale of AAC Failure

• SLPs are the most quali!ed amongst the team to provide skilled AAC intervention and implementation support.

Which means...

Nonverbal, Difficult-to-Motivate “Lower Functioning” Students

• These kids are on regular school sites

• ...on your caseload

• ...their communication needs are complex

So, how do we go from this...

...to this?

Much of the info on teaching AAC focuses on teaching non-oral individuals with

INTACT SOCIAL SYSTEMS

• More info needed on how exactly to teach AAC to learners with social de!cits

• Children with autism often have to be taught to take pleasure in social engagement

Difficult-to-Motivate Students

“iPad”Tonight’s terminology:

• In today’s presentation: Info. applies to any Speech Generating Device

• iPad, Android, Vantage, Maestro Tech32, GoTalk

• We’ll use the term “iPad”

Autism: Communication Options Using the iPadMarch 1, 2013

An AAC system should...• Increase participation: classroom, work,

community, home

• Address goals: IEP, work, personal

• Support efficient and interactive communication

• Provide the user with meaningful language

• Support language and literacy learning

• Be age-respectful

• Provide a positive support to behavior

Getting Communication Going

In autism we know we can teach:

Cause-and-Effect Requesting

Cause-and-Effect Rejecting

• Builds “buy-in”

• Adds pay-off to the effort of communicating

START with One-word/One-button Requesting for items, actions or recurrence (“more”)

START with One-word/One-button Requesting for items, actions or recurrence

• BUT DON’T STOP HERE!

• It’s very easy to get stuck on requesting ...but additional functions ARE possible!

Communicative Functions *Sometimes Present* In Nonverbal Autism

• Attention Directing

• Requesting

• Rejecting*

• Greeting*

• Self-Expression and Self-Assertion

• Naming

• Commenting

• Giving Information / Requesting Information

Early Pragmatic Communicative Functions

• Requesting

• Rejecting

• Greeting

• Naming

• Commenting

WHY communicate?

In typical development,

does not need teaching

Early Pragmatic Communicative Functions

• Requesting

• Rejecting

• Greeting

• Naming

• Commenting

The stories I hear...

• It is rare for difficult-to-motivate students to naturally move out of the requesting function

• Modeling and Augmented Input are KEY to the process of expanding communicative functions

Model and Expand Language• Oral language development

Model and Expand Language• Non-oral language development

Sign language Speech Generating Device

AAC, the iPad and Autism - Moving Beyond Choice-making. CSHA 2013 Speech

PicturesPictures

Augmented InputPartner Augmented Input

Speech

Point to pictures while you are talking.*• Use parallel talk, self-talk, break down,

build up.• Produce a variety of communicative Pictures

Pictures

functions such as questions, comments, greetings, requests, etc.

• Use a large percentage of available vocabulary

Pictures

vocabulary• Use a large percentage of vocabulary

as they appear in your speech• 80:20 ratio of statements toBuild language skills by • 80:20 ratio of statements to

questions/commands• Strive to provide Partner Augmented

Input at least 80% of ongoing daily

Build language skills by demonstrating use of AAC!

p g g yactivities

• Use scripts to develop ideas* See references for sources

Copyright notification: User may not copy or distribute these materials except for use with the students, patients, clients, or other individuals who receive instruction, therapy, supervision, assessment, care or other services directly from the User. Otherwise, these materials may not be copied without the written consent of DynaVox Mayer-Johnson.

WEB ADDRESS IN YOUR HANDOUT

In ASD, modeling is essential to:

First) Demonstrate the use and power of additional functions of communication: attention directing, commenting, sharing opinions, greeting

Then) We can worry about teaching the vocabulary/symbol location for these functions - after they know WHY

• Gissette - (16 years old) - JB Music video

✴ Sharing Opinion - Modeling

Augmented Input

Attention Directing, Comments, Sharing Opinions

Sounding Board

Download Video from YouTube

Augmented Input in ASDVIDEO

• Ryan (20 years) - Bracket Assembly

✴ Requests for items - Mastered

✴ Attention Directing - Teaching

Sounding Board Attention Directing, Greeting, Requests

Augmented InputTonight’s terminology:

• “Augmented Input”

• “Modeling”

• “Demonstration”

• “Aided language input”

• “Aided language stimulation” (ALgS)

• “Aided language support”

• “Simultaneous Communication”

Augmented InputVIDEO

• Milo (4 years old)

✴ Naming, Describing- Teaching

Pogg - $0.99

Augmented Input at Early Language Stages

• Requires pre-planning

• Occupies valuable ‘real estate’ on the visual display

• Takes dedicated modeller(s)

• Like oral language development - aided language development also TAKES TIME

• Requests

• Sharing Opinions

• Commenting

• Greeting

One-Hit at a Time

Don’t forget these!

• Answers:YesNo ($1.99)

• Sounding Board (FREE)

• Picture Card Maker (FREE, $5.99)

• Digitized (recorded) voice

• Icons: Take a pic, online pic, Photos

Inexpensive AppsOne-Hit at a Time

One-hit: Moving Beyond Choice-Making

Attention Directing• Delivering a message

✴Delivering/picking up items

✴ Social scripts

• Making announcements

✴Before transitions, “It’s time for...”

AnswersYes/No (Requests)

STANDARD

CUSTOMIZED

AnswersYes/No (Deliveries)

2-part scripts

Attention Directing - Delivering Messages

Pic Card Maker

Attention Directing - Delivering Messages

Pic Card Maker

3-button script;one-hit per turn

Pic Card Maker

Script

Nicolas (6 years) - Delivering $yers

✴ Attention Directing - Teaching

Attention Directing - Making Announcements

Pic Card Maker

One-hit:

“It’s time for...”

Attention Directing - Making Announcements

Pic Card Maker

One-hit:

“It’s time for...”

Attention Directing

✴“Look!”

✴Naming• Item or action label

✴Descriptive word • Broken, dirty, ...

Attention Directing

✴“Look!” - Versatile- Best use of real estate

✴ Naming• Item or action label

✴Descriptive word • Broken, dirty, ...

Comments & Sharing Opinions

• Expressing taste

• Cool, oh man, good, bad, gross...

• Giving Compliments

Comments, Sharing Opinions

Sounding Board app One-hit: Mixed Function Board

Attention Directing

Sounding Board app

Naming

One-hit: Mixed Function Board

Sounding Board app

Directing Action

One-hit: Mixed Function Board

AnswersYes/No (Compliments)

Just Comments Sounding Board app

TouchChatHD ($149.99)

• Versatile Requests for actions

• Sharing Opinions

• Commenting

• Greeting

Sounding Board

Core Vocabulary Board:

Borrowed Symbol

Stix icons

Sounding Board

Core Vocabulary Board:Request Action

• Milo - Fire!ghters Book

- Augmented Input, Core Words board

One-hit: Request Action

Question:What will be Milo’s first core word?

Sounding Board

Core Vocabulary Board:Request Action

One-hit: Moving Beyond Choice-MakingGreetings

✴Hey / Good Morning / Hi

✴Bye / See you later / Have a good weekend

- One of the easier ones to teach

- Create motivating equation for any of these additional functions of comm.

Book Reading - Requests, Comments, Directions

One-hit: Mixed Functions

Butter!y Coffee #lter craft - Requests, Comments, Sharing Opinions

One-hit: Mixed Functions

Teach it! Model and demonstrate

Reinforce it! Provide motivation to perform

Attention Directing

Sharing Opinions

Comments

Greeting

Early Language Stages1. One word at a time

2. Two- and three-word phrases

3. Building phrases and early sentences

4. Learning grammar and sentence structure

5. Sentences with more grammatical endings

2- and 3-hit GoalsChoice-Making and Beyond

• Elaborated requests: “I want” + item, “More” + item/activity, “I want” + “to go” + place

• Attention Directing: “Look” + item/location, “It’s time for” + activity

• Directing other’s actions, core vocab: Open it, give me, my turn, put in, you go

• Greet using names

Elaborated requests

Attention Directing

Directing other’s actions

Greet using names

• Comments/Sharing Opinions often still one-hit

Rather than expecting a sequence of hits

Lots of modeling/augmented input & reinforcement

2- and 3-hit GoalsChoice-Making and Beyond

Will require some navigation/

links between boards

Apps for 2- and 3-hit2- and 3-Button Phrases

• Sounding Board (FREE)

• Picture Card Maker (FREE; $5.99)

• Full-featured Communication Apps($149+)

Sounding Board - Requests

• Gissette (16 years)

1. Elaborated (3-hit) request - Almost mastered

2- and 3-hitsElaborated Requests

Intuitive navigation allows for complete sentences

At Work Break Choices

2-hit request embedded in a Multi-Function board

Picture Card Maker

Sentence Strip - 2, 3, or 4 symbol

Elaborated request

VIDEOS

• Gissette (16 years) - Watch video clip

1. Directing Actions & Attention (really, a descriptive request) - Emerging

2- and 3-hitsDescriptive Request

2- and 3-hitsMoving Beyond Choice-Making

• We know we can teach: Elaborated requests: “I want” + item, “More” + item/activity, “I want” + “to go” + place

• Directing attention: “Look” + item/location, “It’s time for...”

• Directing other’s actions, core vocab: Open it, give me, my turn, put in, you go

• Greet using names

Sounding BoardCore Vocabulary

TouchChatHD ($149.99)

2- and 3-hitsCore Vocab, Directing Actions & Attention

• Gissette (16 years old)

Comments, Directing actions, using core vocab

- Put on (nail polish)

Teaching the Power of Core Vocab

• Single button - or - a sequence

• Same page - or - navigating between board/pages

• Gissette’s Symbol Recognition

• How is she going to learn to use “Put” + “on” to request?

Symbol Recognition• When we’re teaching communication, we

should not be testing symbol recognition

• When we create multiple pages for communication, we need to keep same messages in same locations

• By shifting locations of pictures we are actually testing symbol comprehension

PECS - Symbol Recognition

• PECS Phase 3: Discrimination Training

- Aims to teach symbol discrimination skills given a limited "eld of choices

Picture Communication BooksRely on symbol understanding

Motor Plan VS. Icon Recognition• We have found that consistent placement

of icons may be more important than symbol recognition

• Learners don't need to be able to recognize/"point to"/"give" a symbol that is named before they can use that symbol to get something done in the world.

Motor Plan VS. Icon Recognition• We have found that consistent placement of

icons may be more important than symbol recognition

• Learners don't need to be able to recognize/"point to"/"give" a symbol that is named before they can use that symbol to get something done in the world.

THIS IS COUNTER-INTUITIVE...

Location, Location, Location!When teaching AAC: Teach location

• Stable key location enables the development of motor automaticity

• Motivating outcomes/consequences of the act strengthen motor plans

• Consistent motor plans reduce the cognitive requirement of symbol recognition

Motor Planning

EVERY learned physical activity depends on motor planning

• Walking, talking, driving, climbing/descending stairs, eating dressing, typing reading, Smartphone or computer access

When Motor Plans Must Change

• Think about how difficult it is when you’re faced with typing into an ABC keyboard rather than a QWERTY?

• Turning on and tuning the radio in a rental car vs. your own...

We can take advantage of motor planning when:

• Each word has its own motor pattern due to consistent icon location

• Motor patterns don’t change

• Patterns build upon themselves as language grows - preserve relative location

Motor patterns don’t change

As language system grows...

Motor Plans are extremely important when...

• Teaching the use of core vocabulary and use of more abstract vocab/symbols

• When using multiple pages of vocabulary

• When symbol recognition is weak

PIC Core Vocab hidden buttons

Using Motor Planning to Our Advantage...

• Our lower-functioning students can generate multi-word phrases...

• ...across multiple pages

• ...using core vocabulary

We’re ready for Language Stage 3

Multi-Word Language Stages1. One word at a time

2. Two- and three-word phrases

3. Building sequenced phrases and early sentences - meaningful order, word endings (-ing, -s)

4. Learning grammar and sentence structure - question words, negative statements, irreg. past tense

5. Sentences with more grammatical endings - possessives, 3rd person present, reg. past tense

3+ wordsin length

Stage 3+ GoalsBeyond 3-word phrases...

• Visual sentence strip or message window

• Useful for the learner

• Useful for the

communication partner

Language Stage 3+ GoalsMeaningful word order

Adding more verbs and adjectives to requests

Describing phrases (Object+Action+Location)

Including word endings (-ing, -s)

• Navigation between multiple pages (Core vocab, actions, descriptors, multiple categories, etc.)

• Extensive icon library is a plus for abstract vocab

• Larger vocab: Synthesized (text-to-speech) voice

Full-Featured Communication

- Expanded, Word-based Vocabulary - Variety of Phrase Types - Multi-Word Language Construction - Intuitive Navigation - Grammatical Endings

SGDs Apps

Apps for Stages 3+ProLoQuo2Go

• $189.99

• The "rst, not necessarily the best

TouchChat HD

• $149.99

• Highly customize-able

• Unique features: Button Actions more varied, Copy and move pages between users, iShare mobile upload/download

• Language Stages 4, 5 -WordPower version $299.99

Other apps: Words For Life, Sonoflex, GoTalk Now, Talk Tablet

TouchChat Family of Apps• Full featured communication application for the iPad• Not interchangeable between iPad and iPod versions• 3 kinds to buy - Lite (no voice), HD, WordPower• Does not Scan

Today’s presentation:Students used customized

TouchChat HDvocabularies

• Different users: Different needs• Main key to success of a communication app -

VOCABULARY• Vocabularies set this app apart

TouchChat Starter Vocabularies

MultiChat 15

VocabPC • How it’s ...Organized ...Accessed ...Programmed in sentences and words• Pre-programmed navigation is often intuitive

• Vocabularies evolving for 10-15 years

• WordPower by Nancy Inman, SLP

- Makes words available through the process of creating sentences

• WP also available on other platforms

TouchChatHD WordPower Vocabularies

WordPower 80

WordPower 24

TouchChatHD Various Button Actions

TouchChat HD

TouchChat: Visual Scene Display

TouchChatHD - Invisible buttons

Two-Page Navigation (Play Video Button Action)

Download YouTube videos: Dvdvideoso2.com

4-button Sequenced Video Request, Multi-Chat 15

Word%Power%30%Sequencing%

One$Year$Free$Subscrip0on$

Let’s Wrap UpWe have talked about:

• Paving the way for lower functioning students to move beyond choice-making and requesting with the essential teaching strategies of modeling and demonstration

• Using motor planning so that even “symbol-blind” individuals can use a variety of vocabulary in visually-based, multi-page communication systems

• Our favorite, very robust communication app that out of the box makes it easy to teach additional functions, to use motor planning to our advantage and to generate multi-word utterances - TouchChat HD

• Monthly email blast - write to join socalaacnetwork@gmail.com

• Blog - www.scaacn.blogspot.com

Updated weekly with AAC-related news, materials, trainings, jobs

• Facebook - SoCal Aac Scaac-n

• Twitter - @SCAACN

• FREE Quarterly “support group” meetings, Pasadena, CA

Next meeting: Tuesday, 4/23/13

6:30-8:30 p.m.

Topic: TBD

Thank you!

Gwendolyn MeierVilla Esperanza Services

gmeier@villaesperanzaservices.org

Terry KappeSpeech and Language Therapy Services

terrykappe@gmail.com

CSHA 2013 AAC, the iPad and Autism: Moving Beyond Choice-Making (Meier, Kappe) 3.8.13

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