ATI 2014 Assessment to Outcomes G. Meier

AAC in ASD:Three Journeys from

Assessment to Outcomes

Gwendolyn Meier, SLP, MTSpeech Pathologist, Music Therapistgmeier@villaesperanzaservices.org

Wednesday, February 5, 14

Find the companion AAC Goal Bank and timeline handout at www.scaacn.blogspot.com

ATI 2014 page

Gigi Nicolas

Student photos removed for posting onlinein the interest of privacy

3 Students with ASD

• Assessment

• Goals

• AAC Therapy

• Progress

• Outcomes

GigiWednesday, February 5, 14

Communication Goals 2010-2011

1. Respond using picture communication book with phrases “I have ___”, “I see ___”, “I want ___”, “I am ___”

2. Indicate a need/want by constructing a phrase strip “I want ___ please” with attributes (color, numbers 1-5), concepts (big/little), travel, deliver message

3. Given the question “Is this a ___,” answer yes/no using her picture book

4. Identify emotions in a field of four pictures

60 min individual/

1st order of business: Picture Communication Book

30-day IEP, 5/20111. “I have ___”, “I see ___”, “I want ___”, “I am ___”

1. Given questions (What do you/ the girl/ character names/etc. have? want? doing?) respond using her picture book with phrases (agent+action) (action+object) (agent+object) with gesture prompts, 80% as measured by data/observation.

2. Indicate a need/want by constructing a phrase strip “I want ___ please” with attributes (color, numbers 1-5), concepts (big/little), travel, deliver message

3. Given the question “Is this a ___,” answer yes/no using her picture book

4. Identify emotions in a field of four pictures

4. Exchange or indicate a single symbol to direct the actions of others using 10 core vocabulary (e.g., open, in, out, what, go, stop, more, put, that, on, off, done, take, want)

5. Increase number of manual signs by adding 5 to her baseline for communicating wants & needs to control her environment

SLP Recommendations - 5/2011

• 60 minutes individual/week

• 60 minutes consult/month (for picture-based communication)

Requesting, Locating Vocab

*District-approved trial*

10/2011 - Progress

1. 2-word phrases (agent+action) (action+object) (agent+object)

2. “I want ___ please” for wants/needs and point to pictures as she delivers the message

3. Answer yes/no to “Is this a __”

4. Direct actions w/one symbol

5. 5 new signs for wants/needs

Proposed -10/111. Given prompting ? 3-component descriptive phrases (e.g.,

agent+action+object) using her picture book

2. Replace symbols in her communication book according to category

3. Search the pages of her book to find a named symbol card and complete a sentence started for her

4. Answer YES/NO to confirm or deny requests (Do you want this?) and label objects related to familiar vocational tasks

5. Create 2- and 3-word phrases to request or direct actions using 10 core vocabulary phrases (e.g., put in, put on, take off, open it, I do, you do, etc.)

6. 10 signs to her baseline for communicating wants & needs to control her environment

Annual IEP, 10/11

• AAC Evaluation requested by parent

• Assessment plan signed

• Conducted by an SLP in the assistive technology department of her district of residence

AAC Assessment - 2/12Statement of Need

• Hearing, Vision, Motor skills within functional limits

• Behavior - some history of repetitive movements, some mild self-injurious

Gigi’sGigi

Symbol ID Nouns in F:4-128

Categorization

Syntactic Performance- Sequence symbol phrases

Symbol ID Actions, Locations F:8

AAC Evaluation Genie - $9.99

Symbol ID Nouns6/6 from F:664/6 in F:128

Categorization16/16 Simple

(transportation, food, clothes, animals)

0/16 Complex(people, verbs, things, places)

Sequence Symbols into Phrases

(given a direct model)4/4, 2-word phrases0/4 3-word phrases

Symbol ID 7/8 actions F:8

4/8 adjectives & nouns0/4 (little, big, more, in)

Literacy Skills

Teacher report:

• Matches letters

• Copies words

• Some spelling during typing activities

Device Trials

• Tobii S32 Touch/Scan

• Springboard Lite 32

• iPad 2 with Proloquo2Go app

• iPad 2 with TouchChat with WordPower app

Tobii S32 Touch/Scan

• Features: lightweight, 32 locations, 192 overlays, digitized voice output, keyguard, scan accessible

• Not a match for her ability to scan 66+ locations, emerging literacy and categorization skills

Tobii S32 Touch/Scan

Springboard Lite 32

• Features: lightweight, 36 locations, dynamic display, pre-stored vocabulary, Unity Language System, focus on core vocabulary, digitized and synthesized voice output

• Not a match. Some difficulty with touch pressure, did not appear to understand Unity symbols and activity rows

Springboard Lite 32

Boardmaker PCSeat drink sleep

Unity Language System

Proloquo2Go

• Version 1.7 (released Nov 2011)

• Features: lightweight; customization options for number of locations per page, message window size, space between cells, border color; 7000 SymbolStix symbol library; 16-category locations with page links trialed

Proloquo2Go

• A match!

• Able to access screen through touch

• Produce requesting sequences (I want more) and sharing opinions (awesome! I like it) after a brief model

TouchChat with WordPower

• Features: Similar to PLQ2G 1.7 plus Customization options, SymbolStix, Vocabulary packages (MultiChat 15, WordPower 24 & 42), color coded cell backgrounds, cell location control, intuitive navigation, next word prediction

• Not actually trialed

AAC RecommendationGigi

Signs Tracking Sheet

Sign Tracking KeyS = Spontaneous

(initiation of the sign to request action or item with no prompt or following an open-‐ended question, “What do you want to do?”)

I = Independent (shown a visual of someone eating, learner INDEPENDENTLY signs EAT without a direct verbal prompt “eat”)

V = Verbal Prompt (shown a visual of someone eating, learner only enacts the sign EAT when given a direct verbal prompt “she’s eating” etc.)

M = Model (learner only enacts the sign EAT after you perform the sign)

H = Hand-‐over-‐hand (learner requires your touch in order to enact the sign)

VIDEO:Indep Multi-word Request

Listen to music

VIDEO: Augmented Input

uh oh...stop...I don’t like it

10/2012 - Progress1. 3-component phrases (agent+action+object) - MET

2. Replace symbols in communication book - EXCEEDED

3. Search to find a named symbol card - EXCEEDED

4. Answer YES/NO to confirm or deny requests - NOT MET

5. Create 2- and 3-word phrases - MET given MOD cues

6. 10 signs given minimal cues - NOT MET

Proposed - 10/12“Using her communication system...”

1. Appropriate greeting (i.e., Hi vs. Bye) with familiar persons including their name and facing the communication partner

2. 2- and 3-component phrases each in 2 different contexts (e.g., open it to refer to the cupboard and also the microwave) to direct the actions of others and/or describe actions

3. Functional communication statements or questions appropriate to the scenario (e.g., listen to music, something else, want water, need bathroom, take a break, etc.)

4. Given 3 rehearsal trials, navigate two screens to comment; including making an announcement (e.g., “time to go on a walk” or “I have a note for the teacher”), a single-button interjection (e.g., be careful, sorry, oh man!), or sharing an opinion (e.g., I like that, that’s funny, that’s gross)

5. ID 4 pieces of personal bio information

VIDEO: Core Words to Request

Put on pink

VIDEOL: Desribe to Request

Look funny dance

10/2013 - Progress

1. Greet using names - MET

2. Direct/describe actions - NOT MET

3. 8 functional phrases - NOT MET (only 3)

4. Making announcements & commenting - NOT MET (MOD cues needed)

5. Answering 4 bio questions - MET

Proposed - 10/20131. When asked “What do you want/need?”...retrieve her communication system and make a request

2. (continued) 2- and 3-component phrases: close it, put it away, turn it on, turn it off to direct the actions of others and/or describe actions

3. (continued) functional communication statements

4. Comment or answer questions about activities performed in the classroom setting (academics, cooking activities, vocational training, etc.)

SLP Recommendation

• 90 min/week indiv

• 540 min consult/year (9 hours)

Hide Mode

All students at Villa Esperanza Schoolon identical 42-

location vocabulary with hidden buttons

AAC System: Vocalization, gestures, sign, Sequencer, TouchChat 42 Phase 1Prompting: Independent for greeting, requesting, verbal prompt to retrieve device, visual picture-phrase cards for core vocabulary

VIDEO: Cooking with core vocab

Open it, take it out, more

Nicolas

Summer 2011

• Age 6:4, Kindergarten

• 20 Compensatory hours of NPA speech therapy

• AAC Assessment and Independent Speech & Language Assessment agreed upon in mediation with school district

Present Level - Communication

Verbal approximations for yes/no

• Primarily uses vowel sounds in his attempts to speak words

• Communicates by pulling or pointing

• 50 sight words, matches letters, some numeral ID

• Imitates (approx) of two word phrases

Behaviors that Impede Learning

Task avoidance• Non-compliance• Dropping to the floor• Touching/moving items not

related to lesson• Squeezing others’ hands• Running away from work areas• Eloping attempts (leaving

classroom)• Tantrum behaviors• Taking off shoes

Communication Goals(2010-2011)

1. Imitate/spontaneously produce the /m/, /t/, /k/, and /p/ sounds at the end of CV, CVC words with 50% accuracy (tactile/verbal cueing provided).

2. Sustain joint attention for a period of 5-7 minutes during a clinician directed task

3. Receptively ID common objects and actions (w/objects or pics - no more than 3 choices)

4. Use/imitate head nod/shake or verbal approximations for YES/NO when asked questions regarding personal preference (e.g., Do you want the balloon?) with 70% accuracy with mild verbal/gestural/tactile prompting provided

Barriers to Progress in Therapy:

Off-task behaviors are exhibited in transitions and without close attention (when parent and clinician are talking) including:• touch the clinicians’ face, run away, close and

lock doors, climb onto tables, drop to the floor or under chairs or tables, pull at or tear the clinician’s shirt, and remove his own clothing

Functions:

• negative attention seeking

• escape

Behavior Support Plan (Informal)

• Respond to maladaptive behaviors by asking “Do you need help?”

• If ‘yes’ (“ess”) provide assistance• If ‘no’ (“oh”) and behavior persists, inform

that “I’m going to help you” and physically assist him in keeping his hand in his lap

• Direct him “quiet hands” and ”tell me when you’re ready” while giving no eye contact or attention other than physical cue.

• Nicolas will indicate that he is ready and will again participate in the presented task.

AAC Assessment• Conducted by district independent

contractor (trusted colleague)

• Observed:

• Classroom, clinic-based speech, home ABA

• Extremely little productive work in classroom

• Attention seeking and escaping behaviors in all environments

• History of attempts at PECS in home ABA (played with Velcro) and speech (hit cards on his chin)

AAC Assessment• Fleeting attention and no engagement

with examiner

• No direct assessment due to non-compliance

• Ambulatory with adequate motor skills to access technology.

• Used both hands to access iPad screen (games)

• Exited apps often, no sustained attention

• Reported computer skills (Bailey’s Bookhouse)

AAC Recommendation• Maximize oral speech through intensive

instruction

• Strong behavioral program

• Visual Supports (Visual Schedules, Work Systems, addition of picture supports to language input)

• Links to Language program

• No augmentative communication system

Proposed Goals - 10/2011

1. Imitate 6 early developing consonant sounds (m, b, w, d, p, h) in CV and CVC syllables for a set of functional vocabulary words (e.g., mine, bye, want, don’t, please, hi, etc.) tactual-kinesthetic-proprioceptive cueing for oral motor placement

2. Anticipate and continue 3 of 3 steps within a predictable, motivating sequence or routine by producing a word or action spontaneously for 5 routines

3. Spontaneous requests, object or action label & visual gaze toward his communicative partner when the desired object or context for the action is visible in the environment

4. Respond verbally to confirm (i.e., speak ‘yes’)5. Refuse (e.g., “no” or “all done”), protest (e.g., “mine”), or

request an alternate activity (e.g., “ball” while working on a puzzle) total communication

6. Point to pictures in books to answer concrete WHO and WHAT questions

IEP Outcome

• Independent Speech Assessor NOT in agreement with AAC recommendation

• Recommendation for NPS placement (Villa Esperanza)

• Agreement that AAC systems will continue to be trialed in the NPS classroom and services

• 150-min/week individual (30 min daily sessions) to address articulation

AAC Trials @ Villa• GoTalk 9+

• GoTalk 20+

• iPad with TouchChat

Independent:

• 2- and 3-button messages (2-3 screens) to request items and activities

Emerging:

• Describe what he sees

• Give bio info in response to questions

TC - Initial vocab set, totally custom

AAC Trials (cont.)

• Passive communicator in any mode (sounds, gestures, iPad)

• Resistant to prompting/assistance (escape or lose interest)

5/2012, 6-mo Progress1. ARTIC - 50-70%

2. Sequence actions in routines - 2/3 steps MOD cues

3. Requesting w/ eye gaze - INDEP in iPad phrase composition, cues for eye gaze

4. Confirm w/approx. “yes” - MET In sessions

5. Protest, req. alternative - MET

6. Rec WH-questions (Who What) in books - MET

Impressions - 5/2012“Since his admission at Villa Esperanza Services’ Non-Public School...behavior and participation in the curriculum has improved dramatically, and has allowed him access to provided augmentative aids that incorporate visual and voice-output support for his communicative intent.”

1. ARTIC - goal continued2. Gain attention and greet others, using names 3. 2- and 3-word phrases to make requests within

daily classroom activities (e.g., I need pencil, where chair, do again)

4. Rec ID person in response to “Who” questions (e.g., Who do you want to work with?, Who did you work with? Who is sitting with you? Who do you see?)

5. ID 5 items of personal/biographical information6. ID10 common actions 7. ID appropriate modifier (e.g., color, size, action, adjective)

and noun to describe pictures8. * Follow a verbal instruction delivered to the

class as a group (e.g., everybody line up, it’s time for music, etc.)

9. ** 3 new oral motor movementsWednesday, February 5, 14

SLP Recommendation - 5/2012iPad 2 with the TouchChat HD app

• Protective case• Across all daily environments (school-home)• Continue150 minutes of individual/week (30 per

day) • Add 720 minutes of speech and language

consultation/year

• Programming, training (classroom, home), implementation support

Answering “Who?”

Moved up toWP24-ish

VIDEO: 2/13 Intro to Social Scripts

5/2013 -Progress

1. ARTIC - MET for /p,b,m,h/ NOT MET for /w,d/

2. Greeting using names - MET Independent

3. Request needed items - MET given prompting question “What do you need?”

4. Answer “Who” questions about familiar persons - PROGRESSING needs MOD

5. Bio questions - EXCEEDED, mixes “...brother” and “...father”

6. Labeling actions - EXCEEDED in pics

7. Rec ID modifier - MET for colors, big, little, open,close; PROGRESSING for good, bad, yummy, gross, cool, clean, dirty, hot, cold, pretty

8. * Follow group instruction - MET

9. ** Non-speech oral motor movements - MET added suck, blow for 2-3 seconds, close lips on tongue depressor

Triennial Testing - 5/2013

• Expressive, pragmatic, and articulation skills were assessed informally

Triennial Testing - 5/2013• Uses eye gaze alone when needing help

• Requires verbal prompt “What do you need?” to initiate requests

• Agent + action sentences

• Uses he/she accurately

• Picked up plural -s

• Recently started scripts for errands

• Cues for pragmatics in interaction

1. ARTIC - mastered sounds in CVCV reduplicated syllables

2. Sentences using he, she, they and present tense is verb-ing

3. Answer simple WH type questions (“What is it?” “Who is eating?” “Where are they?”) regarding books and/or his activities

4. Use 3 social scripts, 3 turns in length in interactions around campus, including non-verbal skills

5. GROUP - Use name, direct turns, label and comment

6. 5 new location prepositions (under/over, top/bottom, in between)

SLP Recommendation - 5/2013

• 120 min/week individual

• 30 min/week group

• 360 min/year consult (denied)

VIDEO: Group!

VIDEO: Social Scripts Today

AAC System: Gestures, eye gaze, simple 1-syllable words (buh), TouchChat WordPower 42

Prompting: Model required for greetings, very responsible with device, independent with phrase-based scripted interactions (jobs on campus), verbal prompt to use device to request, very independent with navigation, some self-taught morphology

Different roads

Destination: Communication!

ATI 2014 Assessment to Outcomes G. Meier

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