Practical Ways for Teaching Nonverbal Learners--Come Join Us!

   You are invited to join the conversation between Peggy Ployhar and myself on October 1, 2019 at 8pm (Central Time Zone). We'll be talking about ways you can teach your nonverbal children and teenagers. This conversation is directed at families who homeschool but is relevant to nonverbal learners in the school system as well. Bring your questions about adapting instruction and evaluation and we'll give them our best go!

If you haven't yet seen the awesome website SPED Homeschool sponsoring this event, it's a MUST SEE for families living with special needs. While the target audience is homeschooling families, all families living with disability will find a wealth of information and support at this site. There are articles and videos galore from experts with a wealth of information and personal experience. Many of the topics address issues extending outside the school day, such as incorporating therapy into the day or making religious instruction accessible to kids with a variety of special needs. If you participate in Facebook, SPED Homeschool sponsors some groups that sound pretty fabulous. Take a few minutes to browse the site and you will be impressed.

See you on October 1st!
Rose-Marie

One Easy Way to Increase Vocabulary on AAC Devices

How do we add vocabulary when a child is physically limited to a few keys on a screen?

In the world of AAC, conflicts and compromises abound. We sacrifice battery life for weight, screen size for portability, budget for specialized access modes. We sacrifice the size of the vocabulary set for the number of buttons a child can access.

When children begin to use an AAC device, motor or cognitive challenges may limit them to just a few words on a screen. How in the world are we going to help them transition smoothly into a larger vocabulary accessed with more—and smaller—keys?

The secret is to use motor automaticity to our advantage.

Let’s step back and take a look a motor automaticity. Motor automaticity is the ability to carry out motor patterns without thinking about the movement. We all do this, all the time.

For example, walking is a skill many of us can do successfully without thinking about. Many of us can even complete other tasks at the same time as walking, such as talking to a friend, carrying objects, or looking for a misplaced coffee cup.

But someone recovering from a brain injury or stroke who has lost that motor automaticity must concentrate hard on the movements needed to walk. All their cognitive energy must focus on moving their legs correctly; carrying on a friendly conversation or looking out for that missing coffee mug is too demanding during the task of walking.

Another example of motor automaticity at work is touch typing. A typist can concentrate on forming words on the page without having to think about which finger to move to spell out the words. Remember this example; we’ll come back to it again.

When kids rely on AAC to communicate, motor automaticity allows them to access symbols on a screen without having to think about movement. This greatly enhances their rate of expression and makes conversation much more accurate and fluid. Kids can focus on the meaning of what they are trying to say rather than the motor mechanics of finding and targeting a symbol on the screen.

Without motor automaticity, locating a target and touching or eye-dwelling on it can be very demanding work. Communication is slow, exhausting, and creates a frustrating number of mis-hits.

We support motor automaticity by keeping buttons in the same location as much as possible. Just as we keep letter keys in a consistent arrangement on a QWERTY keyboard, symbols located in consistent arrangements are easier for kids to retrieve. They can find the symbols and letters they want easily, without having to scan through many keys.

To maximize motor automaticity...

Introduce screens with the end result in mind.

How many buttons on a page will a child be able to access in the future? No one has a crystal ball, so you’re just going to have to make an educated guess based on your child. With semantic compaction vocabulary sets, it’s hard to access a full vocabulary in less than 45 or 60 keys. Category-based pages might allow you to communicate with 30 to 42 keys on a screen, but fewer than that is going to mean a whole lot of tedious page flipping. The more buttons per screen, the fewer hits are needed, whether you are accessing words through categories or semantic compaction.

“But,” you say, “my child can only handle 8 buttons on a screen right now...”

You could offer eight buttons that fill the screen. However, what happens in the future when your child is ready to add more vocabulary? You would have to shrink the buttons and shake up their order to make room for more words or categories. Remember motor automaticity? Your child would have to learn their locations all over again. How discouraging is that?!

How naturally do these 8 buttons...

...become this? (Sono Lexis 9 x 6)
Not very!

Instead, take the screen that is your end goal and hide all buttons except the eight starter words/categories your child is using. He still has access to the same eight selections as the large keys filling the screen. Yes, these buttons will be smaller, but they are surrounded by plenty of null space that won’t activate if he hits it. You might be surprised how fast he can learn to target the smaller button size.

With this end goal in mind (Unity 45, full hit)...

...we start with these few word combinations.

When it is time to add vocabulary, you UN-hide hidden words or categories. They won’t change anything your child has committed to motor memory; they simply begin to fill in void space.

Child begins with these words and category...

...and ends with this 9 x 6 Sono Lexis display over time.

Remember learning to touch type in your keyboarding class? You started with the home row of keys:  asdf jkl;. It wasn’t much; you were limited to words like “fad,” “ask” and “lass.” But after a few days (weeks?), the teacher introduced “e” and “i,” and that opened up a huge new world of words! Now you had command of “alike” and “fleas” and “skidaddle!” The good news is that you didn’t have to relearn where the home row keys were located; they stayed consistent while new keys were added. Eventually, you mastered all 26 letters of the alphabet, along with some punctuation and formatting keys. That’s at least 40 keys...more for the kids who mastered the number row and got an A in typing.

This same concept is what I am asking you to try.

·        Start with the board set you think your child might be able to manage in a few years.

·        Select a few important buttons—the same ones you would have made up into a smaller set with large buttons.

·        Hide all the buttons around these select few.

·        Give your child time to learn to target these smallish buttons in the middle of large null spaces; it may take awhile, but trust that it will happen.

·        Then, when it is time to reveal a few more buttons, your child will be able to move forward with great confidence.

Want more information on hiding keys to support motor learning? Check out this comprehensive training material from Prentke Romich Company or sign up for one of their Language Acquisition through Motor Planning trainings. Although these are geared towards Unity's semantic compaction, the principles can be applied to most other language access software programs as well.

Four Myths about Autism You can Safely Forget

Autism is getting a lot of press this month, what with April being Autism Awareness month and all. What of this information is fact? What of it is myth?


Ellen of the awesome blog, "Love that Max," has posted an interview with Dr. Gil Tippy on truths and myths about autism that you won't want to miss. In case you haven't heard of Dr. Tippy before (as I had not), he is the clinical director of New York City's Rebecca School for children with autism. He also co-authored a book with Dr. Stanley Greenspan (a name you probably have heard many times) called Respecting Autism. After reading this interveiw, I'm eager to get my mitts on the book!


Go ahead and read it; Dr. Tippy's interview will open in another window and you can come right back here to discuss it together.


Ah, you're back. Great! Wasn't that an interesting interview? Did you agree with his point of view? Did it clash with what you've thought about kids with autism?


Just to sum up, here are the four myths his interview addresses:

     1) Autism is a disorder of memory;
     2) Kids with ASDs are not interested in communicating;
     3) Kid’s with ASDs must be taught differently, by giving them a reward to get them what we want them to do; and
     4) Kids with ASDs tend to be intellectually disabled.


Now, I've always admired Dr. Greenspan and his approach to working with children having autism. It just seems so, well...respectful. He would have us honor children's efforts to communicate and interact and learn and then draw out a little bit more. It's a "whole child" approach, and that is something that has always resonated well with me. It's pretty much a structured variation to the natural, "whole life" teaching style we used with our daughter. She has Rett syndrome, a disorder in the Autism Spectrum that brings with it a number of severe physical disabilities as well.


I particularly appreciate Dr. Tippy's comments on behavior as communication. Kids with Autism Spectrum Disorders do try to communicate with us; they just lack our conventions and and we don't know how to interpret their uniquely expressed messages sometimes. That doesn't mean they have nothing to say. It means we need to figure out what they intend and help them find appropriate conventions to share that.


Let me illustrate with the story of a wonderful 9-year-old boy we'll call Marcos (not his real name) who was severely impacted by autism. One spring I took a long-term substitute position in Marcos' special ed classroom. For the first few days, Marcos screamed in his corner doing his discrete trial tasks while the other students met with me at the table for math. His paraprofessional did all she had been taught to try to extinguish his shrieking and clawing. Both Marcos and Mrs. S. were miserable and mentally bruised (ok...Mrs. S might have had some black and blue battle scars, too).


When I looked over at Marcos, I noticed his gaze steadily fixed on the other students, as if longing to be with them. When the paraprofessional would block his view with her body to help direct his focus to the task at his desk, his screaming and hitting would intensify. Between his gaze and his frustrated outbursts at having his gaze blocked, there was a clear message.


Much to the horror of the aides that had been working in the classroom all year, the following Monday I brought him to the table at math time. They must have feared terribly for the safety of the other kids. But he was telling us something important with his lashing out...


I gave Marcos communication cards to which he could point so he had a way to communicate with the group. He shocked us all with the amount of knowledge he had gained by eavesdropping on the group lessons. Even more, Marcos amazed everyone in the room with his quiet and well-behaved demeanor at the table. He didn't hit or bite, he waited while others took their turns, he answered questions at his turn (correctly, I might add). While he still needed Mrs. S. to cue him, this child's behavior was absolutely appropriate while at the table.


It seems Marcos' message had been clear; he only needed a way to express it appropriately. I gave him a "group time" symbol card so he now could request to join the others. His violent behavior nearly disappeared for the rest of the school year.

This story also underscores the deep-seated reservations about ABA (Applied Behavior Analysis) I've had since my earliest days of Special Education teacher training. Something just didn't add up for me. It seemed artificial and, in its purest form, suggested to me a lack of respect for the uniqueness of the person sitting at the other end of our cup of M&Ms or sticker chart or stack of tokens. It was VERY afirming to me to read Dr. Tippy's take on ABA. Seems I'm not alone in my hesitations.

After all, how does ABA support that child who lacks the physical ability to perform as directed? Or the child too distracted by some sensory confusion to perform? Or the child who gets the bigger picture and who wants to move on to rich and meaningful experiences instead of sticking to isolated performance tasks? What happens to a child's initiative when they come to us trying to express something they feel is important, and we stifle that for the sake of performance?

Do you see the common thread of performance running through those questions? This bothers me terribly.

Children are children, not circus monkeys. I don't want my kids to perform. I want them to feel valued, to love learning, to see connections with both the detailed eye and the grander view.


I'm not saying kids can't learn through ABA. They can and they do. I've met some pretty amazing kids that have learned heaps through ABA. There are some truly awesome ABA providers in this world who do believe the best of the children in their care. But, but, but...


But...do the children learn richness and beauty and feel appreciated for the unique and wonderful things they bring to the table? Do they thirst to learn more? Do they learn "how the world works?" I daresay that generalizing a skill should not merely be learning to perform it in a new environment, but rather understanding how that skill fits into the fabric of life.


Can kids having autism or other related disabilities learn through methods outside ABA? Absolutely! My own daughter is a testament to this. Her yearning for knowledge all through elementary and middle school is something she could only have gained through being encouraged to explore and discover and reason. Her imagination is rich for all the creative play and extensive reading of fiction. Mind you, the bulk of this was something we had to physically create and lead her through, but it can be done with kids having some pretty severe impairments (if you want some ideas for this, take a look at the incredible blog, Adaptions4Kidz).


"Marcos" is another testament. The discrete trial task he was protesting was one-to-one correspondance of objects to the correct numeral. Yet when brought to the table, he demonstrated that he had not only perfectly mastered this skill, but could count up correct change using real coins. This knowledge was something he had picked up through observing lessons directed at other students from a distance. He understood a much bigger application of the small skill that was being drilled and wanted a way to apply it meaningfully in a social context. 


I know Dr. Tippy's point of view--and mine--isn't going to sit pretty with some members of the ASD world. There are also some Rett parents who are staunch supporters of ABA who disagree. And that's okay. The important thing is that every child is given a method to learn that fits them. My guess is that there are a lot of children who could thrive on teaching methods that are naturalistic and respectful. We owe it to them to learn about these methods and provide whatever fits best.


So I'll jump off my soapbox...what kind of reaction has this discussion stirred in you?

Why Parents Must Never Make Assumptions

When our kids are non-verbal and unable to ask questions, it is easy to forget how much—or how little—they understand what is being said around them. It’s so important we check with them about what they understand!

Sometimes they know more than we think.

My daughter and I were talking about a specialty medical appointment she had a couple weeks ago. She liked the doctor and laughed at his jokes, but she seemed distressed after the meeting.

The doctor had mentioned that we need to have her brain scanned to rule out the possibility that my daughter might have a brain tumor. Not surprisingly, this bit of information was upsetting to her.

I don’t think the doctor realized she knew about brain tumors. I didn’t imagine she would know much about them either, nor did I expect the possibility to come up during the appointment so I could prepare her. But it turns out that she does know that they can be very serious, and the idea she could have one frightened her. Who knows where she’s heard about brain tumors? Who knows what knowledge or misconceptions she might have about them?

We talked and I tried to reassure her; she seems to feel more relaxed about things now.

But her reaction was a good reminder to me that our kids just might understand things we don’t expect them too.

At the same time, gaps in our kids’ experience may limit the understanding they have. Remember that the inability to ask clarifying questions is a HUGE limit to experience, too.

This means we must explore misconceptions our kids might hold...even when they don’t have the ability to put these misunderstandings or questions into words.

This is tricky, both for parents and professionals. We have to explain so that a child’s understanding is accurate and complete, yet without belittling what information the child may already have. It’s a delicate balance.

It isn’t like we can say “Tell me what you know about _____,” as we might with verbal children, when our kids have little or no expressive language. This is equally difficult if their ability to express themselves is limited to the choices we offer as “expression.” In fact, offering choices might actually add to their confusion and misconceptions.

So what can we do to promote understanding and expression?

Here’s what I can come up with; I’d love for you to add on your thoughts in the comments:

1. Presume your child may know more than you think. Many kids are sponges, picking up information from all around them. They hear things at school, on television, in stories...and you can’t be everywhere they’ve been to know what they’ve heard in these places. They may know just enough to have lots of questions and fears.

2. Add background knowledge. Sure, your child may have been exposed to an idea, but we don’t know if their understanding is complete. If they can’t ask questions, we need to provide answers to those questions they can’t articulate.

3. Keep information appropriate to your child’s level of understanding. When in doubt, consider what their age-mates would want to know and keep your information geared to that level.

4. Be truthful about your own fears. Can you imagine how lonely it would be to think you are the only person in the world experiencing a particular fear? By letting our kids know that we are afraid—but will be strong for them—then they know they aren’t alone.

5. Revisit sensitive topics. Sometimes more questions come up in time. We don’t have to beat an idea to death, but it’s good to ask our kids if they have any new questions or fears. I plan to go over the new concerns my daughter may develop as the date for her brain scan gets closer.

Do you agree that it is important for other adults in our kids' lives to refrain from making assumptions about what and how much our children understand? We (and I speak in the inclusive "we," meaning educational and medical professionals as well as parents) are in a position to educate them by example.

Thanks for reading, and thanks for your prayers for my daughter’s health. Not only do I look forward to health improvements for her sake, but also so I can get back to blogging more often. I really miss spending time with you here.

--Rose-Marie

What can kids say with wipe-off eye gaze cards?

LOTS!

Handy wipe-off word cards that we used to answer a homework assignment

For kids who read, whether proficiently or as fledgling readers, printed choices can be quick and efficient for indicating  thoughts. We tried dry erase boards for years, writing choices in the corners, with marginal success. For our daughter, the ability to adjust the spacing of cards within her field of view can be critical. This is especially true on those “off” days when she isn’t feeling her best.

Index cards are an option that let us space her choices to meet her needs of the day, but the cost of using them adds up quickly.

Over the summer, I tried laminating 3.25 x 5.25 cards cut from oaktag file folders. These have worked GREAT! We simply write choices on the cards with a dry erase marker as they are needed and wipe them clean with a dry cloth when we’re done.

Handwriting the words or phrases is so much faster than trying to locate symbol cards in a notebook and re-file them after we’re finished. Also, many of the words my daughter needs have no symbol counterpart.

Some speech therapists recommend using black dry erase boards for certain students, as they may be easier on the eyes. If this is true for your child, try laminating cards cut from black construction paper or heavy scrap book paper.

Our laminator is made by Purple Cows and the small hot pockets work especially well for this project. The laminated cards wipe clean and are holding up beautifully. I have a dozen of them at the ready, which allows me to have a nice stack of choices. I can also have answers ready several questions ahead if she is completing a homework assignment.

If your child is able to read at all, I suggest giving these laminated blank cards a try. You might find them to be a quick solution to the time-consuming problem of symbol storage and retrieval.

Join us at Bloom

Ah, summertime! I hope these summer months find you relaxing and enjoying time with family and friends.

I’m so excited and honored to have a post featured on Holland Bloorview’s special needs parenting blog, Bloom. If you aren’t familiar with Bloom, you are in for a fabulous treat. It’s a top-rated non-profit blog with outstanding contributors and one of the dedicated author/editors you will ever hope to meet.

Mosey on over to Bloom and look around—you won’t be disappointed! While you are there, please leave a comment. They are always appreciated!

Check this out: Kate Presents on Eye Gaze Communication

Did you catch Kate Ahern’s amazing presentation on eye gaze communication last night? She spoke to the Rett Syndrome Association of Massachusetts and shared with an even larger audience by streaming video. We are so fortunate that she shared the slides on her website because they are fabulous!!! Just take a look at this slideshow on Eyegaze for Education: Women and Girls with Rett Syndrome.

Be sure to check this out if you have an interest in eye gaze, whether or not your child has a diagnosis of Rett syndrome. Kate shares a wealth of outstanding information in them that is useful to anyone using AAC.

Unfortunately, the streaming video was not recorded for posterity. This is too bad because I’d love for you to see firsthand the commitment and passion Kate has for her kids. You would be inspired! Kate’s message is powerful, and thankfully she repeats it in the slides she has generously shared here.

Everyone have a lovely weekend!

Rose-Marie

The Role of "Yes"

If you interview 1000 parents of typically developing kids, 999 will say that their children learned the word “NO” before they learned the word “YES” (Anyone have the real statistic? I made up numbers to make a point, but then I have editorial privilege here). Because this is the typical pattern for learning these two words, I have long advocated that we teach these words in the developmental order of NO first, followed by YES. You can read about that here.

I still maintain that this is true. However, there is some interesting discussion going on in the AAC circles about this order right now.

Pati King-DeBaun, whom I greatly admire, is a long-time authority and advocate for children with severe communication needs. She posted an interesting discussion on her blog about “yes” on its own. You will find it here.

What Pati says is that acknowledging a child’s “yes” response gives them the ability to communicate through partner-assisted scanning. If you aren’t familiar with this communication procedure, it means that a partner lists off choices for the speaker, whether verbally or with symbolic choices (pictures, line drawings, or objects) or both. The partner indicates when the item of preference is offered. PODD, or Pragmatic Organization Dynamic Display, typically uses partner-assisted scanning.

Traditionally, we have asked kids during partner-assisted-scanning to tell us “no” for each of the non-preferred items and stop us with a “yes” (as in, “That’s it!”) when we reach the item of choice.

But Pati says “yes” alone will give the kids the ability to use partner-assisted scanning. She suggests kids don’t even need a “no” response to be able to successfully communicate using this system.

Does this conflict with my opening statements about teaching the word NO before the word YES? I say not. They are compatible practices and here’s why.

Pati is acknowledging the child's signal of affirmation of desire. This is innate in infants; just watch them. When baby sees Mama rustling up the ingredients to make up a bottle, he starts squiggling with anticipation. At another time, he reaches and kicks his feet when Daddy holds up a favorite toy. This occurs long before the child is developmentally ready to begin conventional word use.

This same baby will likely not respond when Mama gets out the cat food and can opener to feed Kitty. He has no interest. He does not yet pay attention when Daddy picks up the newspaper (give him a few months and that will change!).

These are the same innate reactions Pati talks about in her blog post. If we observe our kids, they have signals to affirm their desire for something. By ignoring what they don’t want, they are withholding affirmation and that is adequate for us to know they don’t desire it.

I really appreciate Pati’s thinking for several reasons:

            1) It allows children to communicate successfully before they have two consistent responses. All they need is an affirmation response. It is our job to observe what that response is. For kids with strong motor challenges, this need for a single resonse is such a gift.

            2) It saves a great deal of physical energy, since the child only needs to respond once out of all the choices offered. It also speeds the rate of communication…a LOT! Again, what a benefit to kids with motor planning issues.

            3) Developmentally, this is consistent with the ability to affirm desire before the acquisition of words (or, for non-verbal students, symbolic expression, including sign, picture symbols, etc). How wonderful that it allows kids to communicate before they are ready to leap into more complex developmental stages!

Now, all that said, I still maintain that when teaching the words yes/no expressively¸ “no” is most easily learned first. This is because word acquisition typically develops at the same time that autonomy rears its little developmental head. “No,” as a means of rejecting, is concrete and easily grasped and gives Little Miss Autonomous a way to voice her new interest. “Yes,” on the other hand, often represents more abstract concepts, such as things that are intangible (feelings, for example), future events, or simply agreeing with that Mother-Who-Threatens-My-Autonomy. And what toddler would want to agree with that awful lady?

For all the good things that acknowledging the affirmation of desire signal alone can do to help kids communicate through partner-assisted scanning, I am so grateful Pati opened up this discussion!

What do you think about this? Does signalling an affirmation of desire without a corresponding “no” work?

And if you haven’t read Pati’s post yet, please do. It gives us important things to think about.

* * * * * * * * * *

You might also be interested in reading "Yes, No, Maybe so..." 

Eye Gaze Technology: Language access software

Language access software—now that is a very exciting topic! Seriously, it truly is…and I hope you get as excited about it as I do.

Once kids are able to access a computer through eye gaze, what is it they are going to say? How are they going to say it? THAT is what the language access software is all about, and it plays a HUGE role in successful communication.

Little nuances in fit make all the difference in comfort,
even within the same size!

Getting a good fit between child and language access can’t be stressed enough. It’s like fitting a shoe…even within the correct size, there are nuances to the fit of a shoe that make it successfully comfortable…or irritatingly painful. It’s got to fit right or it just plain isn’t a good match.

The key to selecting the appropriate software is your student—her learning and internal organizational style, what she wants to say, how complex her communication abilities are (or have the potential to be), even what level you hope her to achieve 20 years from now since what she does today can help lay the foundation.

Another consideration is how many hits it takes to create the message she wants, because even eye gaze is very fatiguing. And we know with Rett syndrome or any other disorder involving severe apraxia, motor planning of any kind is extremely exhausting.

Last week we talked about the devices made by Dynavox, Tobii, and Prentke-Romich. All three manufacturers use programs with different methods of organizing language and retrieving vocabulary. While there is a learning curve with each system, it could be that the language organization on one clearly stands out during the trial period as a better fit for your student.

In addition to the software packages traditionally associated with these devices, there are third-party packages that can be installed on most any of them. These open up even more options to the user, but I’m going to stick to the programs typically used by each of the manufacturers to simplify the discussion. The same evaluation principles apply when looking at third party software, such as WordPower or Picture WordPower or PODD.

So that leads us to language organization. I apologize in advance if I'm covering what you already know; I've learned it's best not to make assumptions (sheepish grin).

Language is stored as letters, words, or phrases.

1) When it is stored as letters, we have an onscreen keyboard, typically with each letter taking a single hit to spell out a word. The number of hits to create a message depends on word and message length.

The benefit of spelling is that it allows an infinite number of novel messages. There are also word prediction and abbreviation expansion options that can cut down keystrokes.

But even with these options, the high number of hits to spell is fatiguing. Spelling also tends to be frustratingly s-l-o-w with eye gaze, so that back-and-forth conversation requires excruciating patience.

2) When language is stored as words, it allows for as much novel message creation as most of us are likely to use in a lifetime, although unique words will have to be added.

Words can be accessed through one-key hits or through key combinations.

Creating complete sentences is still slow, but doable. Most AAC users who opt for words have very "telegraphic speech."  That is, they might say "cookie" "please" instead of "Will you please get me a cookie?" After all, the motor demands make words expensive in energy output. Kids can still be very effective in communicating a message that way, though.

Usually a person needs more vocabulary than can be stored on a single page. So pages are created to categorize the words. This is the most familiar language organization strategy.

For example, to reach the word "zebra," you might need to navigate from Nouns (or Things) > Animals  >  Zoo  >  more Zoo words > zebra, taking 5 hits to access the word “zebra.” Sometimes going through the organizational tree can take more hits than just typing out the spelling, unfortunately.

A challenge with this system is that memorizing the placement of the buttons can be very difficult. Each page offers a new array of buttons that must be visually scanned, which can be a tricky task for eye gazers, since eye movements are being tracked by the computer. The programmer must work hard to maintain consistent placement of buttons to support motor automaticity.

Let’s talk for a minute about motor automaticity and why it is essential for eye gaze users.

Motor automaticity is when your body moves the way you want without you having to think about it. It is the skill that lets you reach the stick shift or turn signal lever in your car without having to look. Touch typists use this skill as they fly over the keyboard, hitting all the right letters without peeking.

Your body knows where the shifter or turn lever or computer keys will be through repeated practice. Touching these things becomes automatic; you don’t have to look or even think about it. They are always located where your body expects them to be.

People who use eye gaze can—and should—develop motor automaticity with their eye movements. Their eyes come to expect certain keys to appear in the same position each time.

By contrast, scanning with the eyes can cause unintentional mis-hits when a child’s eyes dwell a little too long during the scanning process. The sooner a child can learn motor automaticity, the more accurate his communication becomes.

Single words can also be retrieved through a process called “semantic compaction,” which aids motor automaticity. Each stationary key represents a concept, and the concepts are combined to create a single word. For example, if you hit "apple," which represents food, and "verb," you get the word "eat." Similarly, "apple" + "feelings" = "hungry." A large vocabulary can be accessed in 2-3 hits. The keys are static and their layout can be committed to motor memory.

Semantic compaction tends to require more learning for the adults supporting a child than for the child herself. I'll share my bias--I was highly skeptical at first but forced myself to learn the system and found it to be VERY slick! I'm a believer now. Several summers ago, I had the opportunity to meet an amazing woman with severe CP who can speak at normal conversational rates using a head mouse with this system. Impressive, let me tell you.

3) A third system of vocabulary organization is phrase-based. In this, a person navigates to categories for various situations and hits a key to activate a pre-programmed phrase. This can make for fast conversation, but the person is limited to saying only what is programmed on the device. 

Imagine going up to a friend. In one hit, you can ask "How are things going at work?" That's quick access! And sometimes, it meets your needs well. 

But imagine this friend has just lost his job... Suddenly, "How are things going at work?" is completely inappropriate. The likelihood that "Sorry to hear about your job situation" is programmed onto the device is pretty slim.

To address this problem, some programs include partial phrases, like sentence starters, or “slot fillers” (fill in the blank). Some are more elegant in their capabilities to do this than others.

The software programs on each of the devices combine options of choosing from letters, words, and phrases, which is a GOOD thing. No one wants to be stuck with just the phrases someone else decides are important! All three include some keyboard for spelling, so I won't mention that again.


Dynavox’s Vmax runs Windows 7 and uses InterAACt. This is a dynamic (meaning "changing" in this context, as opposed to static or stationary) page-based system for organizing single words and phrases. With it, you start with a page of broad categories and narrow down to smaller categories until you find the page with your word/phrase.

A plus to this is that it makes sense to the staff that programs the device. As an aside, the version of InterAACt I used six month ago desperately needed its programming design updated...taking many steps that should have been automated by now. It is possible that the newest version, 1.07, may have some improvements since that time.

Another plus to InterACCt is that it can hold a nearly infinite number of topic pages, which is nice for school.

The downside for the user is that chances for motor automaticity are very small--every page looks different. And every time a new vocabulary word is added, the page changes.

I find that it really doesn't lend itself to composing sentences--too many hits. For single words, it can be okay though. And for phrase-based conversation that will not change often, it works well.


PRC devices run Windows XP and use Unity, which is based on semantic compaction. The core vocabulary is offered in several sizes, with each supporting motor automaticity and few hits to access a huge vocabulary.

It also incorporates a dynamic activity row which changes automatically with the categories as they are selected, including phrase-based conversations. From the "apple" key from the earlier example is hit, the activity row will show food-specific words that would be cumbersome to memorize with key combinations.

It also has sets of pages of one-hit topic vocabulary that can be built for school subjects.

I find Unity easy and quick to program, although you have to fully understand the language structure to locate new vocabulary wisely…or you can foul up the logic if you program into the Core set poorly.

On the downside, the software is less elegant for creating things like quizzes for class. The key sizes are pre-defined and sometimes you would like to have creative license on that.

The other drawback is that staffs tend to perceive Unity as being overwhelming to learn, which is unnecessary, but sadly often the case. PRC in our area offers excellent training that can help overcome that fear. The kids tend to look at it like a super-cool secret code, so I have yet to meet a child resistant to learning it.


Tobii C-12 uses Windows Vista and uses Communicator 4 as a base set. It functions much like InterAACt but with state-of-the-art programming.

Equally important, they have an add-on package (included as part of the device purchase) called Sono Lexis that combines some of the best of the other two navigation systems.

It has rows of one-hit high-frequency core words (such as I, you, want, like, not) that are always accessible. There are stationary category keys that open additional rows of vocabulary above these core rows. It also has a category for phrases.

It provides more motor automaticity than Dynavox's InterAACt but less than Unity on the PRC devices. It's pretty well thought-out, fairly customizable (and I have requests in to the company for features that would make is moreso), and easily programmed.

You can step outside of Sono Lexis to make pages that look however you want, which is nice for classroom activities.

To be honest, I wasn't in love with Sono Lexis at first but the more I play with it, the more smitten I become.

The major complaints I have are that I'd like to be able to customize the core vocabulary and to solve the problem of arranging new vocabulary added to the category rows so that it is logically organized (alphabetizing isn't always the most logical, and inserting a new word in ABC order throws off the motor memory). I’d also love to see a “replace all” feature, but then I want it all!

The new Tobii C-15 will run Windows 7 and the Communicator 4/Sono products.

 

There you have the basic run-down on the Major Three software programs for language access. Each has strengths and areas that could be improved. They all can be simplified for children who need to start at a basic level. But it is important for you to look at the capabilities of each to get a feel for what each can offer at higher levels.

Any comments you might make on these systems to help others?

* * * * * * * * 

Here are some additional posts you might find helpful:

Eye Gaze Technology:  Looking at the hardware

Eye Gaze Technology:  Time for a trial! 

A Case for Exploration (AAC style)

Think, for a moment, about the value of simply exploring something new…

What’s the first thing you do when you get a new tool (a drill, for example)? Do you unwrap it and turn it over in your hands to look at it from every angle? Do you feel the weight of it and the texture of its “skin?” Do you locate and press all the buttons and turn all the knobs (before you turn on the power, of course!)? You might even—gasp!—read the manual (or not).

My guess is that you do. Unless you are already an expert with the drill, you probably familiarize yourself with this new toy before you create an heirloom woodworking project. Me? I’d need to do this even before just drilling a pilot hole in the wall to hang a picture.

Now think about our kids who need augmentative tools to communicate. They absolutely need time to familiarize themselves with the tools before they can use them efficiently and accurately. They need time to explore without pressure of performance. While this is important even with simple single switch voice output, it is critical with complex computerized devices.

What does exploration look like?

--Exploration is extended time with no pressure to perform.

--Exploration helps children understand the physical requirements of the device…where to touch, how much pressure to use, how long to dwell with hand or gaze.

--Exploration lets kids play with navigation between screens or activity rows. It lets them learn where vocabulary is stored and the key sequences to call up that vocabulary.

--Exploration lets children learn by trial and error without any penalties for those errors…and this can be highly motivating!

We also know from educational research that information that is “discovered,” rather than “taught,” is most easily retained. Letting children discover how to use their devices will help this learning stick. If, as they explore, they come up with questions and problems, the suggestions we offer will have much greater meaning and be more likely to stick as well.

Exploration doesn’t look like…

… being asked for responses to specific questions

… enduring endless prattle in the background

… being interrupted with comments or questions

…Mom/teacher/therapist breathing over your shoulder

…perfect grammar or syntax

It also isn’t “errorless,” in the sense that a child has no opportunities to make mistakes. It does allow the child to make errors but there is no penalty for “saying the wrong thing.” Instead, children learn what they did incorrectly so they avoid doing it again.

Thanks to an incredibly generous loan of a voice output device from a dear friend, our daughter has had the opportunity to explore without pressure. And the payoff is starting to come.

Remember awhile ago when I shared my concerns for my daughter’s communication shut-down? Since then, we’ve been giving her time each day, 30-45 minutes, to simply sit with this borrowed device and a reflective dot to activate the head tracker (not her best access method, but it’s what we have available right now). There are no questions to answer, no directions to “say this” or “tell me that.” The only thing we do is respond to what she says.

Some of her exploration finds her on a screen she may not have planned to go to, but exploration gives her freedom to make something useful of that screen. It brings to mind the old adage of “making lemonade out of lemons.” Certainly she learns plenty as she navigates her way out of this unfamiliar territory! We suspect that is how she managed to request that I call a friend of hers who lives out of state to send greetings. You can bet I called her friend’s house right away!

Days later she was able to create a deliberate message requesting that her caregiver come sit with her at the device. This even included a response after the caregiver promised she would. It was a very exciting morning, to be sure!

Exploration seems to be helping pull her out of her communication slump.

Do we expect perfection? No!!! This is a time to learn and work out navigation for herself. It’s not time yet to pressure her to perform…she has a lifetime ahead of her for that. Today it’s quite enough that she simply explore. The more exploration time she gets, the more meaningful the things are that come up on her device’s message window. Pressure isn’t going to improve that. Time is.

Just like that heirloom woodworking project where results matter, our kids’ communication matters. Let’s make sure they have the time to explore the tools they need before we expect them to produce meaningful results.

(Photo by Samuel M. Livingston at Flickr)

Building Blocks for Communication

Watch a loving parent interact with her young baby. Baby babbles “oooo” as mama picks up a teething biscuit. With great enthusiasm, mama responds “Yum, you want a cookie!” Baby gets that cookie and, even more importantly, she gets adoring interaction with one of the most valued people in her life.

"Yum! You want a cookie!"

Mama never doubts her little girl will learn to talk. Her hope inspires her to repeat scenes like this thousands of times over the next couple of years. The two go through this ritual of babbling in the context of an activity, pairing the babble with a word and a reward, and language naturally unfolds. Replay this scene over thousands of years, over millions of families. It is timeless, universal, and seems effortless because it is fueled by hopeful expectation.

Children without the ability to develop verbal speech deserve that same support as they develop alternative communication. The sad thing is, it rarely happens this way for them.

I don’t know why. Maybe people view non-verbal communication as “broken,” needing to be “fixed” rather than naturally caught. Maybe because it is not the way the adults naturally communicate; they feel it must be structured and purposefully developed. They’ve never seen it modeled. It may take planning to have materials ready…

True, something outside our experience may need more structure for us to teach. BUT that doesn’t mean we have to leave behind hope for communication or to impose unnatural strategies.

Perhaps even more than their peers with speech, our kids need the benefits of the kind of support illustrated in that mother-baby story setting the stage for our discussion.

What does the mother from that story teach us about building the foundation for effective communication?

1) Build relationship. We value the child, we express that value to the child.

We value their efforts. We pay attention to them. We notice when they are trying to communicate. For some of our kids, the motor effort is so tremendous that they simply haven’t the energy to repeat themselves. Eye gaze is a very quiet response mode; you have to be watching or you will miss that telling glance.

Teachers, therapists, even extended family that doesn’t see the child daily need to remember that it takes some time to build a relationship. If a child doesn’t try to communicate with you right off the bat, they are no different than many speaking children. It can take time to become familiar. Give yourself time to tune in to the child’s subtle cues. Give the child time to feel safe with you.

Relationships that nurture are those that believe the best in someone. We hold high hopes. We expect good things for them. We expect that they will progress and grow. All kids deserve this kind of expectation.

Our illustration showed mama cherishing baby’s stumbling efforts, shaping them with a loving model spoken correctly. We accept whatever our kids can offer, assign meaning to their efforts, and lovingly model a way they can express that idea more clearly. We expect that they will show more clarity down the road.

2) Build trust. The child has to trust that you are listening—really listening. And you have to trust that the child means what she says. We do this when we take what he says at face value. He knows we will act on his requests, honor his choices and opinions...just like we would for a speaking child. That is going to make him continue trying and learning.

He may make mistakes. He may touch the symbol for “asparagus” when he really wanted “ice cream.” That’s okay.

You don’t ask him, “Are you sure? Show me again.” That shows him you doubt what he has said, and doubt stands opposite of the trust you are trying to both show and to cultivate in him.

Nope, you offer him a bite of asparagus, just as he asked. He’ll purse those little lips in refusal. That opens the door for you to say, “But you told me you wanted asparagus. Have you changed your mind?” There—you have affirmed what he said, and you have given him a way to back out. You trusted him; you acted in a way that allows him to trust you.

You offer him the symbols again.  This time (hopefully!), he’ll touch “ice cream.” Over repeated practice in different situations, you can trust that this mix-up won’t happen again. You may never be able to get him to choose asparagus again (try steaming it ever-so-lightly...makes a big difference).

In our opening story, mama didn’t ignore the baby. She didn’t refuse her the cookie because her request wasn’t perfect. She didn’t pull a fast one, swapping out the cookie for a healthier snack. She is teaching her that she can trust mama to meet her requests, however budding they are right now.

3) Build conversation. Communication grows when people reach out to one another to share ideas. It does not grow out of drill.

One of my favorite mantras as a teacher was “Teach, don’t test.” A reasonable communication corollary would be “Talk, don’t test.”

We teach—we talk—by living life alongside our child. We give them natural reasons to listen and to express themselves.

If you want to teach colors, talk about the colors in your world. Marvel at the blue of the sky, the green of the trees, the red of the tomato as you point them out. Support him—both receptively and expressively--with the color words he needs. Give your child a choice between outfits/blocks/cars of two colors.

Don't hold up a banana and quiz her by asking what color it is. There’s the possibility she'll assume you aren't clever enough to figure it out yourself. And if you ask her to repeat herself over and over, she will give up trying to teach someone who simply cannot learn, no matter how many times she has tried to teach you that a banana is yellow.

Similarly, if the child tells you he wants the red crayon, give him the red crayon! Don’t ask him to repeat himself a dozen times! Sadly, this is a HUGE and heinous problem non-verbal communicators face. We do not do this to speaking children. Our non-speaking children deserve the same respect.

I can't tell you how many kids get branded as incompetent when it was the teacher who set them up for failure by 1) asking stupidly obvious questions that insult the child, 2) asking the child to repeat themselves ad nauseum, until finally 3) the child gives up (and is, at that point, saddled with all kinds of demeaning labels).

Our mama heroine did not demand that baby repeat her “word” over and over, and especially not  until it was pronounced with dictionary precision. She didn’t stand at the counter and ask her, “What’s this?” No, mama took baby's initiation and responded. She kept the conversation going even though the baby could not add anything more. This is a child who is not at risk of giving up.

Three simple, critical building blocks foster communication: relationship, trust, conversation. Our story illustrates all three. If your child's story doesn't illustrate them yet, how can you change that?

You might also like these posts:
Building Communication through Play
Let's Talk: Get the Conversation Started
"She Talks with her Eyes"

Photo by abbybatchelder.