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Sunday, February 13, 2011

Before We Jump to AAC...

So many affordable and glamorous choices are available these days for the iPod Touch and the iPad, that it is difficult for many to resist giving them a try. Previously, as stated in my prior article, parents or treatment/education teams had to go through a lengthy and comprehensive process to match the technology to the individual and to secure funding.
With the new availability, we are at risk for selecting electronic AAC too soon or for selecting electronic AAC solutions that are not appropriate for the child. Below are some of the factors we must consider before choosing to use an electronic AAC solution.
  •  Does the child show communicative intent? For example, does he or she reach to be picked up, wiggle or bounce to request continuation of a knee-bouncing song or movement activity, etc.? If no, do not begin AAC.
  • Does the child direct communication to a communication partner, or communicate "to the air?" A child who says an approximation of "juice," for example, may not intend it as a message to an individual, but rather may have learned that upon that utterance, juice appears. This is an example of a child who should not have electronic AAC. Picture Exchange Communication (Pyramid Educational Solutions) is more appropriate for such a child, as it teaches him or her to seek out communication partners.
  • What kind of system is needed to support language development? If the child has clear understanding of language structure and has sufficient receptive vocabulary, the choice will be different than for an individual who needs language development support. This question, to be answered correctly, really must be investigated and supported by a speech and language pathologist with experience in AAC.
  • What level of symbolic representation can the child comprehend? 
    • Does the child require object-based transition support? AAC, unless object-supported, is not appropriate.
    • Does the child comprehend photo-based representation? Line drawings? Boardmaker-type symbols? Text? Be sure to match the symbolic representation format to the level in which the child has fluent, automatic recognition. In other words, if the child's comprehension of a symbolic level is emerging, back down to a more concrete level (text may be paired at any point unless it is distracting). Do not use AAC or, for that matter, schedules, as a vehicle to teach a level of symbolic representation.
  • Are the individual's fine motor skills compatible with the device? Some solutions, such as those on an iPod are too small. If a child cannot modulate or coordinate touch, the iPod/Pad solutions are not appropriate. For example, some individuals tap, push too long or too hard, slide or miss the buttons altogether. Some individuals require a key guard or even a switch interface to support motor precision. An occupational therapist should be involved if there are questions regarding access.
  • Is the individual's vision sufficient to support the use of picture-based AAC? Are vision skills such as tracking appropriate to support efficient use of the technology? An occupational therapist should be able to assist with evaluating the efficiency of vision skills. An opthamologist should be consulted to test acuity, especially with children who are unable to participate in traditional screening activities.
  • What is the field (number of buttons) the child can manage? One thing at a time? Two? Multiple? How many? What size?
This is by no means an all-encompassing list, but should convince the reader of the importance of involving a speech and language therapist and either an occupational therapist or an AAC specialist before making the decision to use an electronic AAC device.

Tuesday, January 4, 2011

The iPad and Communication Apps

The iPad is without a doubt one of the most exciting developments for many individuals with varying disabilities. The greatest advance that the iPad has brought to us is the availability of a host of Alternate Augmentative Communication (AAC) apps. Systems that were once $7,000 are now available for the cost of an iPad and the selected app for $200 or less. The average individual can now purchase any number of apps to put in the hands of non-speaking and non-verbal individuals. 
With the sudden availability of augmentative communication apps, how does one choose? What should be considered before making a selection. Is AAC right for all children who cannot speak? Is the iPad the right hardware for any child? 
Once an app has been selected, then what? Where do you begin? What factors influence the success or failure of an application? How do you know if you have chosen the right app? The wrong app?
In the next few weeks, I will post a series of articles about this topic from the perspective of an autism specialist and special educator with an assistive technology background.

Thursday, December 16, 2010

Holiday Tips

To help individuals with autism, especially young children, to cope with the holidays, consider some of the following tips. Please add more if you can contribute.
  • Use a countdown calendar. An advent calendar might be particularly helpful for those who celebrate Christmas.
  • Instead of giving all gifts on the big day, begin giving one small gift daily in the days before and after "the big day." This helps ease the stress of anticipation, the overwhelming nature of getting a bunch of presents at once, and the ultimate let-down after the holiday is over.
  • If you are traveling for the holidays, ask the people at your destination to send you photograph that you can integrate into your social stories.
  • Create icons/words for schedules that correspond with the events depicted in the social stories.
  • Have a conversation with your hosts in order to establish a quiet place for the child to retreat. Also, if you have a trusting relationship with your host, help them to understand how autism affects your child and things that can help. Not only will this help your host prepare (food alternatives, putting dangerous items up, etc.), but he or she may be able to help buffer some of the criticisms that often come from family members who do not understand. Click here to download a customizable letter.
  • Consider establishing a pop-up tent hideaway for the young child before the big day. Place comforting and high-interest articles in the tent. When it is time to travel, bring the tent and place it in the location that the host has offered as a retreat.
  • If the child becomes overwhelmed by noise, consider bringing headphones and/or soothing music.
  • If you can afford it, a motel room is a good investment as an alternative to sleeping at the host home. You will want a retreat for yourselves as well as for your child.

Sunday, December 12, 2010

All children love holidays....right?

So many well-meaning people make the assumption that what is fun for "most" children should be fun for all children. It is often the child with autism who most clearly demonstrates how incorrect this supposition can be.

Parents who know their children with autism very well are often burdened with the additional chore of fending off unsolicited advice or criticism from those who do not understand.

Describe a dozen of the worst scenarios for a child with autism, each one challenging enough by itself, and you can bet that most of the items on that list actually occur at the same time around the holidays. In a nutshell:

On the 12th day of Christmas the world imposed on me...

12 guests a-talking
11 doorbells ringing
10 trips for shopping
 9 routines breaking
 8 strangers doting
 7 new foods cooking
 6 new loud noises
 5 "What-the-hecks??"
 4 broken rules
 3 shopping mauls
           2 creepy santas          
and a tree growing in the living room

Do you have tips and tricks to help people with autism cope with the demands of the holiday? Are you feeling anxious about how your child will handle the holidays? Do you have some great stories to tell?