Sunday, January 26, 2014

Why "Prove it with Low Tech First" Doesn't Work

I have student who is only able to use eye gaze for communication.  For years he used a low technology
eye gaze system from a field of two and consistently chose the item on the left.  He did somewhat better if you arranged his two choices vertically, but not much.  Fast forward five years.  He is now using a speech generating device with 25 buttons per page. He can hit the smallest targets I have ever seen on his device, buttons only centimeters in size.  Why can he communicate via eye gaze on an eye tracking device and not using low tech?

Who knows?  It could be that having a person in his space to hold up his choices distracted him.  It could be that he was bored with the two choices he was being given.  It could be that two choices being held up in space did not have a clear enough figure ground for him to visually distinguish them.  It could be because secretly he was saying, "I hate you and your two ridiculous choice cards!" I honestly don't know why he cannot respond accurately to low technology eye gaze choices yet he can communicate on a high technology system.  More over I am not sure it matters.  What matters is that his TEAM at the time, especially his parents and his augmentative and alternative communication specialist decided to try high technology eye gaze anyway.  And thank heavens they did!  AAC through high technology eye gaze changed his whole world.

Access to augmentative and alternative communication is not a hierarchy, though so many of us in the field want it to be.  We want to believe our students will work from using objects to photographs to picture symbols.  We want to believe we start with two choices and move to four and then eight and then sixteen before we try dynamic display.  We desperately want to believe less is more with emergent communicators.

The problem is what if we are wrong?  What if our stubbornness leads to us creating individuals who cannot communicate, not because of their disabilities, but because we never let them!  Because we never gave them the correct tools for them?   Living the least dangerous assumption means that we don't restrict our learners because of our own belief systems.  We assume that they can. We presume competence.  Using a hierarchical system of AAC is not living the least dangerous assumption.  It, instead, is making a very dangerous assumption.  It is assuming that the child in front of you is going to use a prescribed series of steps with mastery at each step sequentially to learn to communicate. (Which, I should note, is NOT how typical communicators develop!)  It also assumes that if the child cannot master a certain step then they cannot go beyond it - EVER. Additionally it assumes that low technology communication skills are transferable to high technology communication - which is not always the case.  Using partner assisted auditory or visual scanning is NOT the same thing as using auditory or visual scanning with a switch.  Using PECS or pointing to pictures or using a "Go Talk" is NOT the same as using a conductive touch screen with dynamic display.  Using eye gaze to look at objects or photos or picture symbols is NOT the same as using an eye tracking computer system. Just because a student can do one does not mean they can do the other and just because a student cannot do one does not mean they cannot do the other!

This hierarchy is our construction as professionals and sometimes it is right.  The worry is that sometimes it is very wrong!  We have so many more tools now that we did when I started in this field.  We have so much more research.  We have research that says that just one or three weeks of intensive aided language stimulation generally increases AAC skills (and we get to have 22 weeks with our students!  Why aren't we embracing this?).  Yet we still "drill and kill" with field of two choices for beginning communicators.

There is so much high tech can do that low tech cannot, such as:
  • be explored with visual and auditory feedback independent of a communication partner
  • be used to call for someone or say something when you aren't expected to (when your communication partner isn't standing at the ready)
  • get immediate feedback visually and auditorially
  • access highly motivating games and activities to train access skills
  • be completely consistent in response no matter where you are and who you are talking to
  • be precisely calibrated just for the individual and his or her best means of access
  • allow different means of access depending on the day and the student's status
  • be understood by unfamiliar listeners instantly
  • instantly create respect in unfamiliar listeners in a way low tech cannot
  • a "cool" factor that just can't be beat
There are, of course, many things low tech can do that high tech can't as well, but since I have never, ever heard anyone argue that all AAC users should "prove themselves" on high tech first I am not going to enumerate them here!

Long story short it is time for a new paradigm.  It is time to scrap the hierarchy that is so pervasive in AAC.  It is time to BELIEVE in our students.  It is time to give them a chance.  It is time to allow them a chance to try, really try, high technology AAC even if they haven't "proven themselves" with low technology first!  


  1. Dang...I guess I needed to hear that. I'm not a teacher anymore, but I have an ex-student (from years ago) I am looking to hook up with a communication tool. I was looking at low tech, just to see if it were possible for her to see over-sized graphics. With her low vision cortical blindness, we never figured eye gaze would work. The cost was prohibitive for a trial, and none of her teachers at the school were into it. I don't know if they saw her intelligence like I did.

    Have you seen the FREE eye gaze type system from Boston College? It doesn't have any of the bells and whistles at all...real bare bones, but for a trial, it's super.

  2. CameraMouse is wonderful but it is not an eye gaze system. It is a head tracker. Like SmartNav Boston College has an eye gaze system called Eagle Eyes but it is not free I don't think.

    1. This comment has been removed by the author.

    2. Let me try again. Deleted to add a question...

      Thanks, K...I am old and confused easily. I had even looked at the Eagle Eyes!

      But here goes the question: I tried to find something to make the tracker less likely to lose it's focus. I've been looking for a laser light, wondering if that would work. I tried reflective tape...not the best results. Has anyone used Camera Mouse and found a way to not have to keep recalibrating it?

  3. I recently found out that a high tech eye gaze system exists! your article has come to my attention at just the right time! I have a student who might benefit, in our world, it is more about whether the district has one or is willing to buy one, thank you! Paula @

  4. use the brains - do you mean that camera mouse is moving its focus from the spot you choose to something else? if so I find that the first thing you need to do is sit the user with their back to a wall or something plain as movement behind them causes the camera to "jump". I have found that a dot of aluminium foil head on with gluestick helps keep it focused. (FYI I'm Kate the blog's author)

    1. OH, lordie, it took me forever to get back here, I was hoping there would be an answer! Thanks, that makes sense. I'm trying it at home now before I present it to her mom. I look like an Indian Princess, ha!!

  5. This is such a vital concept; I hope it is becoming broadly understood and accepted!

  6. Thank you for this! This is so true and sadly many people still abide by the old way of thinking to the detriment of our students.

  7. Fantastic!

    -Dana (from Uncommon Sense)

  8. So wonderful to hear what I have known to be true. is there more information out there to support this? I would to gather info to support this idea to other professionals in the field.

  9. Great post, Kate! I'm surprised when I hear that they are still recommending this low tech first hierarchy in professional development workshops. I know that was the "old" thought process, but it just doesn't work because some students will never "get" communication books because they need the auditory feedback. Even if an adult says the word on a Velcro square, it requires the student to process "they are saying that for me because I handed them a picture of that item."
    Some students need the voice output as a direct result of pushing the button. I have met students who have spent years unsuccessfully using a communication book, but they're able to put words together immediately using high tech AAC. I have seen 21 year olds who never made it past the first rung of the hierarchy and left school with a communication board with 5 actual pictures as their entire communication system and the team's opinion that the students were "too low" to try high tech AAC because they "couldn't even use a communication book."
    Students should not have to jump through hoops to prove that they deserve a voice. We should give them a voice and prove to them that we believe they will be able to use it.

  10. Here, here... Finally common sense prevails. I have a student in my school that has been constantly forced to use PODD when he can't access or turn the pages of this 'phone book'. We have always argued this point, but have always been told 'low tech' is the way to go. I feel this has more to do with the low cost low tech provides, as opposed to the benefits high tech brings.


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