“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
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