“Your child is too young for assistive technology” . . .

and other myths about communication in early childhood

Molly Heck, BS-SLPA Deanna Hughes, PhD, CCC-SLP

Larissa LaPine Ferill, MA, CCC-SLP

April 11, 2012San Diego Infant Development Association

Introduction

Assistive Technology (AT) vs. Augmentative Alternative

Communication (AAC)

Assistive Technology: an umbrella term referring to adaptive and rehabilitative devices for people with disabilities and the process for selecting and implementing

Augmentative Alternative Communication: a subset of assistive technology designed to replace or supplement verbal language

Maintaining a PerspectiveTechnology Should Never Replace Play,

Engagement & Interaction

Stages of Early Communication(Ingersoll & Dvortcsak, 2010)

Pre intentional

Pre linguistic Intent

First Words Two Word Combinations

Smiling Communicative Intent

One word can have varied meaning

Rapidly expanding vocabulary

Crying Non verbal Varies rhythm of speech

Increased awareness of listener

Gazing Point Requests, responds, protests

Talks about concrete topics

Grasping Show item to adult

Labels, greets Repairs communication breakdowns

Pre-

intentional

Pre-linguistic

Intentional

First Words

Two-Word

Combos

Early Syntactic-Semantic

Later Syntactic-Semantic

Communicative Competence

Stages of Early Communication(Ingersoll & Dvortcsak, 2010; Searcy, 2011)

Early Stages of Play(Ingersoll & Dvortcsak, 2010)

Exploratory Combinatorial Cause & Effect

Functional Self Directed Pretend

Other directed pretend

Symbolic

Touches Nests objects Pop up toys

Pushes Car

Pretends to eat

Feeds parent

play food is “yummy”

Mouths Puts objects in containers

Musical toys

Catches ball

Pretends to talk on phone

Dresses doll

Pretends blocks are cars

Smells Lines up toys Wind up toys

Puts people in cars

Pretends to sleep

Puts bear to sleep

Makes dolls walk

Request objects and items Continue an action Stop an action Request social interaction Express a feeling Make a choice Initiate and terminate an interaction Request assistance

(Gamel-McCormick & Dymond, 1994)

Functions of Communication

Assessment

Receptive/Expressive Communication

Cognitive Skills

Motor Skills

Visual Skills

Auditory Skills

Physical Health

Consider Profile of Individual Child

Ability of typical communication partners

Settings where the communication is used

Child preferences

Family and caregiver preferences

Durability and Portability

Potential for growth

Projected rate of growth

Other AAC Considerations

Amount of training for families and caregivers

Implementation: consistent use across settings

Low-tech vs. high-tech

Permanency of the disability

Age of the user and caregivers

Existence of prior knowledge vs. new learning

Cost effectiveness

Even More Considerations

Selecting a Device

Given the breadth of assistive technology available, much can be adapted for very young children

Developmental stage of child must be considered before including some features (e.g., symbols versus pictures to represent language)

Children and infants are often already exposed to abstract forms of assistive technology (e.g., prenatal sound machines and cause:effect toys)

The question is not "Can my child use AT?" but "What AT can my child use?"

Both a challenge and liberty of AT is that can be continuously adapted to meet the needs of

specific individuals, including:Language skills and needs

Visual/hearing complicationsSensory integrationPortabilityAccess (can be activated by feet, fingers, whole

hand, eye gaze, head, etc.)

Children Need to Have Good Motor Skills to Access AT

With increased experience, it becomes easier to creatively adapt AT so that it can be accessed appropriately

Teachers and therapists can use household objects to adapt AT (e.g., utility belt to enable a child to carry an AAC device)

Rapidly Changing Technology Offers More Options

Common Myths

iPads can offer financially reasonable solutions to families, but it is important to consider all options

specific skills are necessary to use iPad applications (ability to isolate and activate buttons, scroll, categorize, access "home" and/or "back" button)

although many apps target language and pre-literacy skills but pre-requisite abilities must be considered

adults can provide live adaptations to enable interaction with a device

• example: if child taps his hand on the floor, adult can push a button to activate preferred,

animated response (on iPad or computer)

An iPad Will Help All Children

If a child is not effectively able to use verbal language, another communication modality must be identified

Teaching children with (or without) language delay to augment communication with adapted sign language or AAC, frustration can be decreased, while enabling the development and use of communication

Similar to 'baby sign', AAC may increase verbalization, and provide a concrete and consistent verbal model

Verbal Children Will Not Benefit From AT

While editing applications and AAC devices can be difficult to learn, they tend to be similar and can become familiar overtime

Once the "lingo" and concepts for one device are acquired, it becomes easier to problem solve, program other devices, and communicate to others using them

Most companies offer live tech support that can help with any issues

Communication Devices and Applications are too Complicated

for Most Parents to Edit

With an assessment completed by a Speech Language Pathologist,

funding for AT is available through:

Insurance Companies

School Districts

MediCare and MediCal

There is no funding for AT

Focus of ALL therapy should be:

Engagement and play skills

Interaction with adults and others

Language development within the activity

Goals for young children should target successful transition to Kindergarten

Despite language and/or cognitive abilities all children will benefit from activities which

are engaging and promote language development

Some children are too "low functioning" for AT

AAC devices have changed dramatically in recent year

Many AAC devices look just like the iPads and iPhones that all children use

An AAC device will stigmatize a child

AAC provides a bridge for functional communication by reducing frustration and sparking language development

Current research reveals increased verbal skills in children who are exposed to symbolic language, such as icons, gestures and pictures

AAC will prevent my child from learning and using verbal language

AAC

Do’s and Don’ts

Have a plan: how and why technology will be used in your intervention

Be able to articulate your rationale with families: why are you getting paid to play with your iPad?

Acknowledge that families may have more technology savvy than you or none at all: collaborate with families

Use technology as a concrete support for parents that may require minimal training: help parents find a

way to play successfully with their children

Technology Do’s

Be prepared: be sure that equipment is charged; have knowledge of applications and programs before introducing them

Incorporate other, more familiar tools: visual timers, alerts, camera, video, and alarms in addition to applications

Understand and appreciate how technology is typically used in the family’s home: (e.g., distracter; entertainment for the child; reinforcer) Know professional standards: American Academy of

Pediatricians and ASHA

Technology Do’s (continued)

Never use technology as a substitute for good therapy: it must enhance interaction, not replace it

Technology must never be used as a time-filler or distracter: use it for functional communication requests and to provide visual representation of language

Block access to self-stimulating activities on the device: e.g., limit scrolling and access to repetitive videos

Maintain control of the device: avoid tug-of-war

Never assume one technology is right for every child

Technology Don’ts

Never narrow your choices to one specific type of technology

Avoid assumption that technology will hold the child’s interest

Never minimize the importance of face-to-face interaction

Never exclude use of natural gestures and modified sign

Never forget the power of engagement, and the role it plays in communication and

interaction

Technology Don’ts (continued)

iPad Applications for CommunicationAdvance March 19, 2012

AAC LANGUAGE

Proloquo2GoTouch Chat HDTap to TalkCustom BoardsGraceAunt Maggie’s RecipesACT Spell

Categories Learning CenterConversation BuilderEasy ConceptsFun and FunctionalFun with DirectionsImage SpinnerLanguage BuilderStory LineRJ Cooper’s Rad Sounds

Cookie DoodleGo Away Big Green MonsterIcebox DoodleMusic ColorsToca Hair Salon and Toca Tea PartySound TouchThe Social ExpressCinderella by Nosy CrowNoodleWords

Communication and Learning