What is a robust vocabulary in AAC?

Robust vocabulary is one of those terms you encounter frequently in the Augmentative and Alternative Communication (AAC) community.  It is a term that isn't always explained. Here is an overview of what a Robust AAC Language System includes:

• Motor planning is supported by consistent vocabulary arrangement
• Expandable vocabulary allowing it to grow as skills improve
• Grammar is supported, including verb tenses, declensions and comparisons/superlatives 
• Alphabet is available for spelling including supports of letter/word/phrase predication and spelling correction
• Pre-programmed whole messages are available for fast moving social occasions and emergency situations 
• Core words are available and are large in number with all parts of speech/word types represented 

(Look! That's an acrostic for MEGA PC!  A robust system is a MEGA Personal Communicator!)

So what do is meant by these things?

Motor planning is the ability to learn to access your vocabulary through muscle memory.  Think of the entering numbers on a phone or calculator, touch typing or even pressing the "home" button on your phone or tablet.  You are likely able to do these things without looking or thinking about them.  You know where the keys are and your body is able to find the right buttons.  Or think about driving home from a location your frequently visit.  You go on auto-pilot to some degree, finding yourself reaching for your turn signal before the turn.  This is muscle memory.  A robust vocabulary has been arranged with motor planning and muscle memory in mind in the hopes that users will learn to access their language system without having to think about where common words are located.

Expandable vocabulary is the ability to add words to the language system as skills increase.  This goes beyond the ability to hide and unhide buttons (mask and unmask buttons) or add in a word here or there.  It's the ability to start off with less buttons per page and move to more buttons per page as vision, vocabulary or access skills increase without having to learn a whole new language system.  When systems do not allow for this they are essentially insisting those that need to start with less buttons at first because of vision or access issues must learn a whole new language when they are ready for more buttons.  Or the converse, when someone who is able to access many buttons per page looses some ability, as is frequent in some conditions that cause a need for AAC, the user must start all over again.   A robust system allows the user to increase (or decrease) the available vocabulary as skills change.



Grammar means the ability for the user to generate sentences that use correct and understandable grammar.  It is the ability to use all tenses of verbs and all declensions of nouns, pronouns, adjectives and adverbs.  Grammar is the ability to say, "Last week my brother and I went to a great restaurant and tomorrow we will go again" instead of  "Last week my brother and I go to a good restaurant and tomorrow we go again." A robust system has the ability to access grammar to make sure the user can say exactly what he or she means to say.

Alphabet access is the ability for the user to spell in an efficient manner and have supports to do so.  Those supports might be letter/word/phrase prediction, abbreviation expansion, and grammar and spelling correction.  The only way to be 100% certain that an AAC user can say everything they want to say is to give them access to spelling and teach them how to use it!  There is no such thing as putting "All.The.Words!" as many AAC supporters like to advocate on a device.  That is because their are about 1,025,109 words in the English language!  Even if you limited a device to the approximately 750,000 words in active use without their various forms (which adds about 10,000 more words) there is no way to fit all those words into a word based language system!  Compare that to the about 6,000 words in Unity 84 Sequenced or 12,000 in Proloquo2Go (set to advanced Crescendo with all buttons available).  Suffice it to say "All.The.Words!" means spelling.  A robust language system has access to the alphabet and the supports to use it well.  



Pre-Programmed Messages are phrase or sentence based messages available for playing back in very specific situations.  They are helpful in fast moving situations, places that follow a certain script or times when communication partners may not know or be able to wait for a message to be created.  An example might be at the pharmacy.  An AAC user picking up medication at a pharmacy will likely follow a certain script.  "I am picking up a script for _______.", "My address is _________." (Or birthdate, depending on the pharmacy) and "Thank you."  There are a few things that might be needed for trouble shooting "There should be X prescriptions." or "My co-pay should be X".  Having these messages ready means faster service, not holding up the line and getting on to errands that may be more fun.  Pre-programmed Messages are also useful in social situations such as passing time in the hall at school.  They are also necessary in emergencies.  Examples might be, "I am having an aura.  I am going to have a seizure.  My emergency medication is in my bag in the outside pocket.  Call 9-1-1 if it lasts longer than 5 minutes." or "I am lost.  Please call my caregiver's cell phone at XXX-XXX-XXXX and give them this location."  Sometimes the see-saw of AAC heavily leans towards core words, and they are vital, but pre-programmed messages are also a key part of a robust AAC system.



Core Vocabulary has been the a strongly advocated basis of AAC Systems for many years.  Core vocabulary words make up 80% or more of what we say.  They are the recyclable words of our language able to be used and reused again and again in many, many situations.  A robust language system has a base of core language.  A lot of core language.  Some experts say at least 300 words.  Core words are the center of a robust language system. 

For information on robust AAC systems and teaching a robust language system see these links:

• Linguistically Robust AAC Systems
• Robust Vocabulary Instruction
• Five Reasons to Use the High Quality Vocabulary Included in Your AAC System  

Yes, And?

I am just sitting here thinking about how random some AAC device activations can seem when they aren't. Two examples from a child today:

1) at the park the child pointed at her friend and then said "win basketball". No basketballs in sight. It took me a minute and I never would have figured it out if I didn't know the friend and her mom. My student's friend's basketball team had recently won the championship.  It would have been easy to ignore or tell her that there weren't any basketballs around. And though this student has some excellent and emerging AAC skills she doesn't yet know how to repair. So, had I dismissed her comment she would have just gone along with it. It terrifies me a little how much power the communication partner, in this case, me, has in interacting and learning with an AAC user.  "Win basketball"? Spot on. 

2) later we were tired and sitting in the student's living room, she had just asked for her one of her favorite AAC activities - FaceTime. Luckily my relatives, a few friends and the student's grandmother are very willing to oblige her desire for a sometimes very distracted video chat. So we reached my cousin on the FaceTime and at the end of the conversation the student says "dishcloth" twice. I told her I didn't understand and it was time to say bye, essentially dismissing her comment as a random activation. We hung up and the student hands me something she had accidentally put in her mouth while her aide hands her, you guessed it, a nearby dishcloth! The student wiped her hands and I felt like a jerk. It wasn't obvious or anything, I didn't feel like a jerk for missing what she might of meant. 

I felt like a jerk for forgetting the first rule of improv, which is also the first rule of chatting with an emergent AAC user as well - "yes, and?" In improv you always go with what is said, you don't shoot anything, down you are flexible and you go with it. Now your improv partner is barking like a dog? You don't say "Wait, we were pretending to be in a bank" you say, "Oh no! The bank robber hypnotized you! I knew I recognized him!" Or just about anything else to keep the exchange going. And in chatting with an AAC user you don't say "Dishcloth? I don't know what that means." (And then change the subject.) Instead you say, "Oh, a dishcloth? What about a dishcloth?" Yes, and?

P.S. All of the rules of improv, especially the first five, are powerful in working with early, beginner and emergent AAC users:

Rules of Improv

1) Say “yes’and!”

2) Add new information.

3) Don’t block.

4) Avoid asking questions- unless you’re also adding information.

5) Play in the present and use the moment.

Rethinking the AAC Prompting Hierarchy in Severe Apraxia

Prompting Hierarchies have been a staple in special education, behavioral methodology andcommunication therapy for some time. However, when it comes to children with severe apraxia, with or without coexisting anxiety, (Rett Syndrome, Angelman Syndrome, ASD, etc) the commonly used prompting hierarchy can complicate instead of simplify teaching augmentative and alternative communication.

Many studies now support aided language stimulation or direct modeling as a primary intervention that should be ongoing and intense with child who are learning to use AAC. Given this knowledge we should move modeling from a step in the hierarchy to the umbrella that covers all of the other steps in AAC teaching.

Another flaw in the commonly used prompting hierarchy in AAC is the use of direct verbal/requesting a response/giving a command as a "cue" or "prompt". Telling a child what to "say" with their talker isn't a cue or prompt. It is a command and usually it is testing. When we equate communication with testing we lose out on what drives communication (and humanity, when it comes down to it) - an inherent desire to connect with another person. Sometimes that connection is about meeting a need or want and sometimes it is about sharing information, being polite or socially being part of an interaction. But we negate that when we command child to say something specific. Furthermore, such demanding/testing type interactions increase anxiety (fear of getting it wrong, fear of disappointing, etc), oppositional behavior (the child's desire to prove that the he or she has power) and apraxia.

Apraxia is a neurological disability that impacts the child's ability to follow a direction in spite of the directive being understood, a desire to follow the directive, the physical ability to follow the directive and sometimes, a previously shown ability to follow the directive. In short, the more the child WANTS to do something the more apraxia stops them. This is neurological, NOT a behavior. Anxiety and demands increase the apraxia. So the child might still be working through the previous levels of cues you have given but then you make the demand "show me_______" or "say_________" and all bets are off! It will be nearly impossible for the child to do as you say at this point. Creating a amicable bond, sometimes even an almost conspiratorial connection is much more likely to enable a child with severe apraxia to be able to communicate. Non-directive and non-confrontational is the way to go in apraxia if you want results!

Finally there is the issue of "hands-on" cueing. What does "hands-on" cueing really mean? It basically means we MAKE the child press or activate buttons on their devices. (The child actively taking your hand is different than you taking the child's hand.  Yet, this should still be faded as soon as possible.)   Hand-over-hand and hand-under-hand both are hands-on.

What does a hands-on, full physical "cue" this tell the child? It tells them that A) we have the right to manipulate their bodies or make them touch or do things whether they want to or not and B) that we have the right to force them to say things just because we want them to say it. It teaches them that if they don't comply with a directive (regardless of if they understood it or if apraxia stood in their way) we will make them comply with the directive.

Our students are some of the most vulnerable human being anywhere. Consider this statistic:

More than 70 percent of those with disabilities polled said they had been abused and over 60 percent of family members indicated that their loved one with special needs had been mistreated. (http://www.disabilityandabuse.org/survey/survey-report.pdf)



Or this one:



More than ninety percent (90%) of people (both male and female) with developmental disabilities will experience sexual abuse at some point in their lives. Forty-nine percent (49%) will experience ten or more abuse incidents. (Valenti-Hein, D. & Schwartz, L. (1995). The Sexual Abuse Interview for Those with Developmental Disabilities. James Stanfield Company. Santa Barbara: California)



Now tell me again how is it ok to teach children who have significant disabilities that they should allow others to make them do things with their hands and that they should allow others to "put words in their mouths"? We have almost a sacred duty to do everything in out power as educators, therapists, caregivers, parents to prevent abuse of our students - now and in the future. And this starts with teaching them that they have the right to be respected in what they do (and don't do) as well as what they say (and don't say). It might be the most important thing we do. We must take it seriously. We must make it a priority. And that means finding new ways to teach and "cue"/"prompt" (it definitely isn't a prompt if it is hands-on). We are an intelligent, creative and compassionate field, certainly we can find other ways?



Additionally a "full physical" or hands-on situation, where we make the child "say" something with the device, teaches the child that language/words are something put upon them by others.  If we want our students to see the power of their AAC systems we must let them see, in both our modeling and in how we teach and respond to their AAC, that the power of language/words is that it comes from INSIDE us and can affect those OUTSIDE us.  Children can't learn that if we are constantly putting them in a position where the words come from someone else who is physically making them access their communication system.  In teaching AAC we are setting the child's attitude about using their speech system for the rest of their life.  It is so much better that we teach them the value of their system from the beginning instead of having to combat a negative attitude about their communication system that is created by how we taught them in the first place.



So we must rethink the prompt hierarchy. We make modeling a setting event that happens ALWAYS. Then we use the expectant pause, indirect gestural cue (body language), direct gestural cue (pointing), indirect and partial verbal cues (phonemic cue, hinting) and then we return to modeling and move on.



Why don't we force the issue until we get the device activation we want? Because communication isn't a test and nothing is so important that we put our hands on and make them say something. Instead we increase the motivation of the child (through preferred activities, child led sessions and our own demeanor), we increase the modeling of the AAC device or system and we move out of the way and let the child come to an understanding of their communication system and the power it has through repeated meaningful experiences.

Join us on Facebook at https://www.facebook.com/pages/Teaching-Learners-with-Multiple-Needs/179671874000.

Rare Disease Day

February 29th is Rare Disease Day
So many of the children I work with and adore have rare diseases. I hope today doesn't just increase awareness of those who rare diseases and the need for research into improving their quality of life today and finding treatments and cures in the future but also the potential in each of these amazing individuals. I learn far more for the children I work with than they learn from me. They all have something to offer the world and we all have something to learn.

The children I work with have many syndrome and disorders among them Rett Syndrome, Angelman Syndrome, Cockayne Syndrome, Pitt-Hopkins syndrome, forms of muscular and leukodystrophies, various Mitochondrial Diseases and more recently identified rare genetic disorders with only genetic names CDKL5, GRIN2B, FOXG1 Many of these disorders are life limiting still for many a cure may be on the horizon. Our job as educators is to keep our students ready educationally, emotionally and physically for that cure, whenever it may come. Our jobs are vital, to see in each rare child the potential that is inherent but hidden to many.

Wearing Your Words

Jabber Jas Harness

Custom ChatBag

Wearing your words is essential when you are an ambulatory AAC user.  You need to be able to access your AAC at all times and you can't do that if gets left in another room or is in your backpack.  AAC users who also use wheelchairs or strollers face different issues in terms of mounting their AAC systems but sometimes it is even more of a challenge if the user is running around and active.

Parents or schools should implement a means to carry/wear AAC systems at the same moment they acquire the "talker" itself.  However, it is never too late if you are already using a mobile talker.  Some children do just fine with a shoulder style carry bag that is open to the screen and allows the talker to be flipped up and used without removing.  Others will try to remove or throw such a system and need a harness style carrying system that is more tamper proof.  The goal is to find the least invasive system that allows full access without risk of losing or throwing the talker.  Custom designs can increase appeal and "buy in" where as off-the-shelf, commercial solutions may look more "typical" and be less expensive.  The draw back to commercial solutions is that they may not be fitted for children or teens and may not be as durable.  It might be important for certain features to be available for example the ability to attach a bluetooth speaker, to block access to various ports or to charge without removing the carrying case.  Another consideration is any orthopedic issues or potential for future orthopedic issues from carrying 1-2 pounds over the shoulder or in a harness. If this is a possible issue consult your OT or PT. A waist belt with flip up attachments can be created in a DIY manner if over the shoulder(s) is not a good solution.
Please see this list to assist with feature matching.

Jabber Jas

If you are starting off you child in wearing his or her words and you need to help them understand how important it is some ideas include: you wearing his or her words as well, social stories about wearing your talker and using pictures of other children wearing their words such as in this Pictello book in PDF form (or get through sharing server with this  code which is good for 100 days 9658-4211).  You can also check the #seemeseemyaac find photos. 

Custom Made

Shoulder Strap Style

• ChatBag*

Harness Style

• Gab and Go Harness

  

  Gab and Go Harness

• Jabber Jas Harness

Commercially Made

Shoulder Strap Style

• iBackFlip Somersault*
• Strotter* 
• RoadTrip Luggage

Harness Style

• SetWear iPad Radio Harness*
• FlipCase*

 *has one handed use option

The Real Cost of Premium AAC Apps

This blog post from October 2014 has been updated.

Some prices have changed, some apps added and some removed.  The premise of this post is that in making all things equal in terms of assuming customers need a robust vocabulary, a premium TTS voice and a means to back up and share files we can compare the real cost of premium AAC apps over time. 

The most expensive app both for one and five years remains TouchChat/TouchChat HD.  Some app companies have realized that schools and health insurance reimbursement requires apps without add-on purchases and have started offering all inclusive versions of their apps.  Perhaps the most interesting development in the field is some apps offering premium TTS voices included in the cost of the app (Proloquo2Go and Clicker Communicate, for example) or for a minimal price and others have higher price points for the same voice (TouchChat and Go Talk Now offer a premium voice for $11.99, while Speak for Yourself offers the exact same premium voice for $24.99).

Of course price point isn't the only  reason to choose an app, which is why this chart seeks only to compare oranges to oranges price-wise and not to examine any of the other reasons why you would choose one app over another for your student, client or child.
Direct Link
PDF Version 

Presume Potential

- Posted using BlogPress from my iPad

Eye Gaze Activities for Emergent Eye Gaze Users

Resources

• Tobii's List of Resources
• Opportunity Foundation of America List of Online Activities

Free

• Eagle Eyes Activities
• Horse Harmony
• Jackson Pollock Painting
• Mouse Follower
• Cause and Effect Lightbox
• Remember to try activities meant for those learning to use a mouse!

Subscription

• Ginger Tiger is a collection of games and activities for eye gaze, mouse and switch users
• Help Kidz Learn is another collection of games and activities for eye gaze, mouse and switch users 

Purchase

• Eye Can Fly 
• HKL Activities Bundle
• Inclusive Eye Gaze Attention and Looking
• Inclusive Eye Gaze Exploring and Playing
• Inclusive Eye Gaze Choosing and Learning
• Look to Learn 
• Scenes and Sounds add-on for Look to Learn 
• Timocco

• Sensory Eye FX

Zingo! Core Word Race

Today I was defeated 3 to 0 playing Core Word Race. To play each player must have a robust AAC system. It is ok if different children have different systems, as long as they have a robust system.  To play use the Zingo Sight Word card dispenser and dispense a word card, this happens to be a good time for some incidental literacy teaching!  Next, say "on your mark, get set, go!" (You can record this on a sequential message switch if you want!) And race to fine the word on your talkers. First one to say it with their talker wins!  Variations include having peers in inclusion find the word in a dictionary, a speed version where each player takes a turn while the others watch and the object of the game is to find as many words as you can in three minutes and playing with the Zingo! Think Fun version (or anyone that dispenses letters) to race to find a word, any word or a word in a particular category, that starts with the dispensed letter.

5 Reasons to use the high-quality vocabulary already included in your AAC system:

The post below applies only to high quality augmentative and alternative (AAC) systems with robust vocabularies and a well researched effort behind how the system works. For example (but not limited to): Proloquo2Go 3 or even better 4 with Crescendo Vocabularies using at least 15 buttons per page, TouchChat with Word Power 42+ or Pixons, Compass with Word Power, Gateway or PODD, Avaz, LAMP Words for Life and other Unity based lanugage systems, and PODD books created and used according to PODD training. In general, a robust vocabulary means at least 100 words organized in an understandable, predictable manner (categorically, pragmtically, or semantically) using a consistent and meaningful symbol system. If you are wondering if your system qualifies as a well researched AAC System with a robust vocabulary please check out Jane Farrell's AAC app evaluations (3 stars or bust!) or the Does Your AAC App Measure Up handout and YouTube Video. If you aren't using a robust lanugge system with your students you should be!

Proloquo2Go 4 Core Words

1) The work is done for you!
Teaching a child to communicate via augmentative and alternative communication (or to repair unintelligible speech with AAC) is a labor intensive task. Designing and programming a robust and well-researched vocabulary system is also a labor intensive task, but, with the right system, it is a task that has been done for you! Hurray!  You will likely need to do some basic customizing like adding the users personal information and user specific frequently used words and phrases. However, the rest of the work has been done for you!  Now you can focus on sharpening your language teaching skills, modeling, developing descriptive classroom labels, making low tech versions of high tech displays, training peers, parents and teachers and so much more. You have enough to do without recreating the wheel.

2) It isn't too much!
I know looking at any robust system is overwhelming at first.  So many words, so many colors.  Maybe it isn't like the other systems you have taught. You are overwhelmed and you fear your staff, the parents and the child will be overwhelmed. You can't wrap your brain around this new system. You try to make a sentence and can't find the words you want. It's frustrating. So you think, maybe I will make something myself. Wait. All new languages are overwhelming at first. You have just landed in the airport in a country where you don't speak the language. The answer isn't to get back on the plane and leave and it isn't to hide in your hotel watching Netflix in your native language while just gesturing and pointing to clarify your wants and needs to the hospitality staff. The answer is to learn the language. Get in there! Make mistakes. Practice. Learn. Language is messy! 

Use just the basic single words at first. Build up to two word combinations and longer phrases and sentences. Then keep doing it. Soon it won't be too much - not for you and not for your user.  Someday you will find yourself saying, "I never thought we would be worrying about word order!"

3) Choice Boards aren't communication!

Choice boards have their place. They belong alongside robust communication systems for quick, in the moment, decision making. They cannot replace communication robust systems. And if you make your own vocabulary on a speech system there is a decent chance you will, probably, create choice boards. Remind yourself that AAC is for ALL the functions of communication. Not just wants and needs. Not just choices. If you feel like your student isn't ready for "the big time" of using a robust application thing about this: when a child needs to learn to ride a bicycle we don't send them back to practice on a Big Wheels. We put them on a bike! We add supports like training wheels that we quickly fade. We stand beside them and help them learn, running, out of breath, to keep up. We realize they need to be on a bike to learn to ride a bike. And we realize they need to have a robust communication system to learn to use a robust communication system!

4) Evidence Based Practice/Research Based are the words of the decade!
Robust AAC systems have research behind them. Well done, core language based systems, have been researched to show the most frequently words used regardless of the grid size chosen. They attempt to keep symbol placement consistent across pages. Color Coding is deliberate and usually matches either the Fitzgerald Key or Goosens, Elder and Crain color coding.  The high quality AAC systems - be they paper based, on a dedicated device or an app - have SLPs and others whose specific job it is to move research into practice. They agonize over whether to allow activity pages (which are not research supported for teaching long term language skills) or how to arrange less frequently used verbs or adjectives. They spend their days and nights deciding on features and grammar access and so much more so that you don't have to and their systems align with best practice/research. In some ways the SLPs and their teams at the companies that make high quality, robust systems are the unsung heroes of the AAC world. They keep current on the research, keep in touch with parents, teachers, therapists and users and somehow put all of that into their language systems.  Using their work is working smarter, not harder and guarantees you can defend the vocabulary should the need to do that ever occur. 

5) Stuff Happens
Let's face it stuff happens. That kid you spent months creating a vocabulary for might move. And the new district may or may not keep using your work. Or they may go to adult services where all your carefully programmed academic and/or choice making vocabulary is rendered useless. Or the device may crash and you might not have backed it up. Or your hard drive with all the back up crashes at the same time! Or maybe since you are programming so much the next teacher or SLP will as well creating a perfect storm of "too many cooks in the kitchen". (I have had to restart AAC teachingSO MANY times because of "too many cooks in the kitchen").  Stuff happens. Using a robust, high quality AAC system "out of the box" with only changes for personalization increases the chances that your user won't have to learn a brand new system some day. Learning a system with standardized symbols, color coding and organization now will make it easier if he or she DOES need to learn a new system someday.  Using the high quality, robust vocabulary that comes with the system supports the user in the future as well as the user you have now. 

Descriptive Teaching Model (DTM)

"You are working too hard!" I frequently tell teachers and SLPs when I am called in as a consultant to support them and their AAC users.  So many professionals think they need to program every word that the AAC user will need for an academic lesson, field trip or other occasion.

As most of us know core words are the words that make up 80% or more of our speaking and writing.  Words like put, go, help, like, it, that, why, then.  With core words we can communicate, without them, not so much.  And fringe words give us context.  They are the reasons why we communicate.  We need fringe words to talk about things like soccer, Disney World, our new bicycle.  Important fringe words that are used frequently in the lives of our students belong on their devices for example pudding, blanket, My Little Pony, awesome, seizure, WWE or sensory table. Deciding the fringe words to program involves interacting with the child, understanding his or her interests and the interests of peers and siblings and figuring out what fringe words are salient and necessary to the child.  

Rarely are science vocabulary words like magma or magnetic pole going to be salient and necessary. Or what I like to call "recyclable", they will be used just once and never again. Other non-recyclables are Battle of Little Big Horn, peninsula or the names of all of the characters in the months shared reading.  How then do we teach, talk about and assess? (Which is only 20% of what we do - right? We teach and talk and THEN assess!)

Well we need to create a paradigm switch in our own heads and that of other professionals and paraprofessionals.  We need to start asking questions that allow our students to answer using the words they already have on their device.  This serves multiple purpose (beyond saving us the hours and hours of programming), the most important purpose is our AAC users learn how to be creative and use the words they have to say what they need to say.  AAC is usually a life time learning process for our students and being able to communicate about topics when they don't have the specific words they need is an essential life skill.

For example, I was chatting with my friend Owen at Camp Communicate in Maine.  He was trying to
tell me his idea.  After a few miscommunications and much frustrations he was able to say "tiny plays" and he had previously given me the hint that the word started with 'S'.  Skits!  Owen was able to use his communication repair skills and practice with using descriptive language to help me understand.

Gail VanTatenhove invented the Descriptive Teaching Model to address this issue.  She explains that teachers typically us a referential style of teaching, "What land form is surrounded by water on three sides?" and the students answer in a single word with a very specific fringe word, "peninsula".   This doesn't work well for our AAC users.  So instead we can ask questions they can answer using the words that they have, "Tell me about the water around this peninsula?" and the student can answer something like "not all around" or "almost all around" or "around most of it".  Does the child know what a peninsula is?  Clearly he does.  You could ask some more, follow up descriptive teaching method questions if you needed to be more sure he understood.  Similarly if you are teaching about the British Army during the revolutionary war you could just say, "Tell me something you know about the British Army."  All sorts of answers would be appropriate, "they wear red", "they are mean", "they fight", "they have horses", "they hurry" and so on and so on.

Here are some resources to help you learn about and begin to use the DTM. 

• Power Point Handouts from Gayle VanTatenhove on Aided Lanuage Stimulation and DTM
• Start Talking in the Classroom Handouts
• One page DTM handout from RAST Resources
• Addressing Content Vocabulary with Core via ASHA 
• Descriptive Classroom Labels 
• Beyond Calendar Time
• Teaching with Core Words Blog Entry

Age Respectful vs Age Appropriate

Age-appropriate has long been a mainstay of special education and related fields.  On one hand it is an important concept; since it means treating everyone as the age they are (no baby talk, no rubbing people's heads, etc). On the other hands it puts us in then position of deciding what interests and hobbies our students are "allowed" to have. And who are we to judge? Would it really be the end of the world if a young adult carries a Tinkerbell backpack or a teenager wears a Mickey Mouse shirt? Why is it an individual without a developmental disability can do those things but a person with a developmental disability can't? (Have you seen the men's T-shirt section in Target?)

It is time we all embrace a new way of looking at this. Let's think about age respectful instead of insisting on age appropriate.

What is age respectful?

Age respectful means that when something is our choice we choose items, activities and interactions that are respectful of the age of our student in our setting.  We choose typical and adapted books that will be motivating and are respectful of the students age (an adapted version of Huck Finn in middle school instead of a Brown Bear, Brown Bear, for example). While at the same time we allow choices made by the individuals themselves to reflect their tastes and interests.

Age respectful means we offer and teach how to do new activities and use new materials while never judging the student for choosing to return to old activities or materials.

Age respectful provides multiple meaningful opportunities to expand exposure to new ideas, activities and experiences because we like what we know.  We do this not to replace "age inappropriate" choices but to augment and expand our students' horizons. If we wish to be truly successful at this we try to stay just one step beyond current tastes and interests.

Age respectful re-frames (formerly "age inappropriate") interests as legitimate hobbies, collections and interests . Meaning that an interest in Elmo including collecting Elmo items can and is a hobby for many people of all abilities.

Age respectful means that we teach our students manners. All of our students. Students who love Barney learn that one really needs to ask and gage the interest of others before sharing about that hobby enthusiastically. Students who don't share that interest need to learn how to politely redirect the conversation.

Age respectful means that the rules apply evenly. If bringing toys to class is unacceptable then it is unacceptable for ALL students from the student with the Star Wars collectibles to the student with the Big Bird toy.

Age respectful is about making choices that respect our students while age appropriate is about assuming we can and should make choices FOR our students.

Not there YET!

Often times I share success stories about students I work with - the girl with Rett Syndrome who is reading, the boy with Cerebral Palsy and multiple disabilites who writes stories with his communication book, the teenager with Angelman Syndrome who received a speech device a year ago and saw a massive decrease in agressive behaviors.  These stories, true and meant to inspire and illustrate often have a very different result.  One result I commonly hear is educators, therapists and parents who think that there is something exceptional about the child in the story. Some gift or ability that their student with a similar disability does not posess.  This leads the educators, therapists and parents to believe that their student, client or child can't possibly achieve the literacy, communication, self-regulation or other skill examined in the story.

The problem is that the comparison being drawn is often between a child who has had specfic intervention and a child who has not.  This is like comparing a "before" makeover picture of one person with the "after" makeover picture of another.  The girl with Rett Syndrome, while wonderful and smart, did not suddenly begin reading because she has something others with Rett Syndrome don't have.  She learned to read because of a concerted long term effort by her TEAM. This included not only excellent instruction by a multi-disclinary TEAM but also faith that even if we never got to independent reading with comprehension our efforts were worth it. The boy with CP and other disabilities who writes stories (usually about superheros) with his PODD communication book isn't an exception he is simply a child who's family decided to focus on what he can do,  to set high expectations and to hire homebased TEAM members to teach him the communication and literacy skill he needs to learn at grade level in school. The teenager who finally got a communication system at 13 and learned to use it to help regulate her anxiety and behavior doesn't  have the genetic mutation that leads to a less challenging form of her diagnosis, there is nothing that makes what she can do somehow singular or  or "higher functioning". The reason she has those skills is a year of intensive three to five hours a week of specific intervention to teach her how to do those things with family follow through at home.

All of this is to say that when we hear about children similar to our students, clients or own children who are doing things our kids aren't,  we shouldn't  assume that our kids will never get there... Or that the other child possess something ours doesn't.  We should realize they just aren't there YET!

Video Modeling for AAC

Video Modeling is an evidence based practice in special education.  Entire new companies have
popped up claiming their way of doing it is magical even!  However, it doesn't take much to do effective video modeling for any skill, including Augmentative and Alternative Communication.  Essentially all you need is the child's communication system or a duplicate of it and a way to record video - which can be your phone, a tablet or a camera.

The purpose of video modeling is to create a video representation of a skill that can be watched and imitated.  Video modeling doesn't replace instruction, visual supports or interaction.  Instead it reinforces skills taught and, for some learners, can act almost as a video encyclopedia where they can "look up" how to perform a skill.  Video modeling in AAC allows students to have additional aided language stimulation outside of instruction or interactions.  It can also be a way for the student to review vocabulary they have learned.  Video models of AAC can be used instructionally or students can self-select watching them during leisure time. 

There are quite a few resources online to guide the process of selecting what to target for video modeling, creating the video and collecting data on video modeling effectiveness, such as this one from the National Professional Development Center on Autism Spectrum Disorders. There is also much to be found on Google Scholar to provide as evidence that video modeling is best practice. 

In general I use a more relaxed approach to video modeling for AAC with the following in mind:

• When possible involve the student in the making of the video or the selection of the vocabulary or skill to be modeled.  This creates "buy in" and many students like to see themselves on the screen.  Some of my students who have helped to choose topics for video modeling learn ask to have a video when they are having trouble finding certain vocabulary!
• Be sure the video focuses on the skill/vocabulary you want to teach.  Plan out ahead of time what you will model.
• Make sure the video is engaging and motivating, especially if the student will be encouraged to self-select watching the video.  Using puppets, music or other motivating topics can be useful. 
  

  

  Porkchop the Pig Puppet Modeling AAC

• Keep the videos short.  Under a minute is usually good, but under 3 minutes for sure! 
• Create an easy way to select and access the videos for parents, aides or the student him or herself.  This can be using an app like Pictello, Go Talk Now, Niki Play or Word Toob on an iPad or similar apps on other tablets.  It can also simply be uploading the videos to YouTube, creating a playlist and bookmarking or copying a shortcut to the desktop. 
• Consider creating playlists where the video models are a "commercial break" between preferred other videos.  The Therad app allows for this to be done on the iPad but it can also be done using YouTube or any other means of creating a playlist.  This is especially effective for kids who are "video junkies!
• If you happen to catch good samples of effective communication by the student or aided language stimulation on video during sessions you can add these to the playlists as well.

Sample Video Models
Video model of how to say stop.


Video Model of Drink with a Puppet


This video shows a model of how to find the word "parade" after the student asked for it. 

Here is a video of a student who got herself into a situation where she needed help.  (She insisted I make the video before I helped her! Just so you think I didn't leave her stranded!)

Video Model Sample from Other People
Asking for More While Shredding

What I Wish I Knew at 22

Congratulations new special needs teachers!  Here are somethings I would tell myself, the young teacher, at 22, if I could (and if I thought I would listen - because I doubt I would have).

• 
  All you can do is your best, and you need to do it every day.

• What you have now is passion, what you will have in 15 years is experience, if you want to make it through the journey from one to the other then you need to take care of yourself, keep learning and make it about the kids.

• Do the next right thing.  That is how you will be able to sleep at night when push comes to shove.

• It is doubtful you will ever really write another lesson plan, task analysis or paper but you will write evaluations, IEPs and progress notes.  If you can't learn to love them at least learn how to get through them and do them well.  A moment of great pride will be when someone tells you that you "really captured the child" in an evaluation, strive for that, see these items as ways to celebrate the gifts of each child.  (Remember there is a chance people will be cutting and pasting from your work until this child is 21 - make it something worth cutting and pasting!)

• Don't cut and paste the narrative parts of any evaluation or IEP.  The child deserves your full attention for that part.  If you are going to cut and paste anything else be sure you don't forget to change the gender, name, etc.  You may know that the statement about, say, the reason the child requires a special vehicle, is the same from IEP to IEP but the parents don't.

• It absolutely is possible to frame everything you need to put in a report or IEP in a positive manner.  "Jane is a wheelchair user who depends on others for propulsion" is a better choice than "Jane is unable to walk or push her own wheelchair".  Take the time to find the positive.

• When it comes to Velcro designate a pair of scissors, "Velcro only" and remember "Soft Stays, Rough Rides" or "Hard on the Card" (the fuzzy/loop part goes on the wall/board/book and the hook part goes on the thing you will be removing and replacing). Trust me this is good advice and will save many headaches! Also "Soft Stays" means you can use felt or Veltex or your sweater or a cubicle wall to stick your cards/items/misc too. 

• You are paid in stories, you are the one who gets to decide what kind of stories they will be.

• Teachers' rooms can be pits of despair (yes, like in the Princess Bride) avoid them if the crowd who is there when you are is negative or complains a lot.  Try to surround yourself with people who love being a teacher.

• School picture day might be a bit of a hassle for you, but for parents it is a view of who their child is at school.  Take time to ask if parents want glasses or a bandana on or off, wheelchairs under a drape or not or a clean shirt put on.  It matters.  Then do whatever it takes to coax a smile and charm the photographer into taking a few more shots if needed.

• Don't terrify parents about whatever the next transition is (be it from EI to pre-school or to adult services), that doesn't help anyone, instead help them know what to look for to know things are going well.

• Parents need to have the information you have about learning, communication, socialization and more.  Try to find a way to share it with them.  Your 30 hours a week for 44 weeks of a school year pales in comparison to their time to teach their child.  Help them be their child's best teacher.

• As my grandfather would have said, "You catch more flies with honey than you do with vinegar -- but if you really want to catch those flies consider a little BS."  (I'm still terrible at it but learning to "play the game" is a valuable skill.  It might feel like you are being manipulative but it is really being strategic.  It's a fine line.)

• You will have bad days, you will go home crying, you will find yourself worrying about work.  That means you care.  Find ways to get through those days that reinforce your passion. 

• Enjoy teaching, seriously, have fun.

Some Angelman Tips

After about five months using a robust system Samantha can order cake!

It is unlikely that any student can make you feel more appreciated than one with the social gifts often
present in a child with Angelman Syndrome. Angelman Syndrome or AS occurs in about 1 in every 15,000 births.  The child with AS is likely to have motor, balance and coordination issues that affect both fine motor skills and gross motor skills.  Medically, seizures occur in many cases and feeding issues may occur in infancy. Problems with sleep are common. 

Children with AS tend to be social, have a happy disposition and may have stereotypical hand movements like flapping.  Apraxia of speech affects all children with AS and most have only a few spoken words or communicate only using alternative methods like facial expressions, gestures, adapted sign language, and augmentative and alternative communication.  Like all children who are non-speaking sometimes behaviors act as communication if no other means is provided and taught.  Many children with AS are attracted to water and enjoy swimming, bathing and water tables. It also is fairly common for children with AS to be attracted to media such as music, videos and interactive electronic games and devices. 

Students with AS may have vision issues including cortical vision impairment, ocular albinism and other problems.  They may also have problems with auditory processing.  Many children with AS have much fairer complexions their the rest of their families.  Most learners with AS are "consistently inconsistent"  they should be measured by their best days not by the days when seizures, a disorganized sensory system or sleep issues are impacting them.  Children with Angelman Syndrome, like children with many other genetic and acquired disabilities who can not be formally evaluated, are almost always underestimated.  High expectations and a presumption of competence are essential in teaching these (and all) children.

Some tips:

• Remember what apraxia (a key component of Angelman Syndrome) is:
  
  
• a inability to perform a task, especially speech even though:



Cracking jokes!

• the request is understood
• there is willingness to do the task
• the muscles work properly
• the task may have already been learned

• This means
• you can't assume a child with AS doesn't understand, is "acting out" or "refusing", is physically incapable or that he or she has forgotten what was learned
• you can assume that the more the child wants to do or say something the harder it will be and he or she is inevitably more frustrated than you are
• the child with AS will be consistently inconsistent, not because of intelligence or behavior but because of apraxia
• a burst of strong emotion may override apraxia 
• Also since you can't measure the child's knowledge fully because of the combination of fine motor challenges and apraxia of speech, plus possible vision and auditory processing issues, even using high technology, you must assume that the child is competent to avoid causing an developmental disability through educational neglect

Thanks for the gifts.

• Introduce robust Augmentative and Alternative Communication early

• but it is never too late (the student in the picture to the right started using a robust AAC system at age 12 and is able to communicate many thoughts, ideas and feelings with her system)
• remember you have to have words to use words - hence the robust system
• don't get stuck in the request rut, requesting (manding) is an important skill but it doesn't need to be the first or only thing you work on in AAC, furthermore a child who is only able to request will appear to have severe developmental disabilities even if he or she does not because requesting is such a tiny part of communication and social connection.  Imagine a conversation if you were only able to request.



Masked buttons aid learning

•  "Hi!" "I want iPad."
• "How are you?" "I want drink.
• "I see you have your red shirt on today" "I want outside"
• masking (hiding) some vocabulary on high tech devices is one way to build motor patterns as language increases
• intensive aided language stimulation is very effective in teaching use of communication systems or devices to people of all ages with AS (as it is in nearly all AAC learners)
• video modeling is extraordinarily useful in AS, children with AS love to watch videos of themselves and favorite people modeling communication, life skills and academics on a computer, tablet or television screen - even mirroring a live stream of a classroom lesson or aided language stimulation can be a great tool

• include the ability to communicate about favorite people, places and things as well as favorite past events in the AAC system along with the core vocabulary and student specific fringe words, talking photograph albums are a great way to do this! 
• social media is an amazing inspiration to get kids who turn to faster methods like adapted sign and gestures to practice using their AAC systems - sending video texts, using Skype or FaceTime or just making and emailing a video to Grandma can create some AAC miracles 
• avoid forcing communication use when students could be independent one their own (i.e. don't force to ask for each bite of food if they can self feed; don't force them to ask for a book or to turn the page of a book if they can just do like all the other kids and go get the book or turn the page), however these situations are perfect for modeling language on the AAC system 
• consider alternative access methods if pointing is too difficult this can include using a

  

  1 for talking and 1 for playing!

  stylus, whole hand pointing, a head pointer, a flashlight, a pointing splint, partner assisted scanning and even, for some children with AS and very complex bodies head tracking or eye gaze run systems (the One Little Finger song is great for working on pointing!)
• remember to be mindful of vision, auditory processing and sensory needs as you choose an AAC system, as well as when you design and implement instruction  
• Remember the child needs someone to talk with, something to talk about and something to use for talking this often means a tablet for playing with and one for talking about what you are doing!
• perceptual salience is key in AS, you must talk about and model how to talk about what is grabbing the child's attention at that moment - even if you ignore it they won't!  Name it and then you can move on, better yet name it and use it to inspire communication teaching!
• embed AAC instruction into highly motivating activities

•  Inclusion is a great way to ensure peer relationships and high expectations

• full time inclusion is ideal
• but some inclusion is better than none!
• inclusion should include inclusive instruction (not just "specials" and lunch)  See Erin Sheldon's research on this topic for more.
• consider inclusion in social rites of passages like birthday parties, religious ceremonies, sleep-overs, dances, prom and graduation and start teaching skills to be part of these things well ahead of time 
• video modeling is a great way to teach both academics and social skills in the classroom and peers are often eager to help with video creation projects  

• All Behavior is Communication!
• Create a communication glossary that shows images or videos of the child using

  

  Owen's sign for "yes"

  adapted sign, gestures or other communicative behaviors so everyone will understand them.  You can then pair the glossary entries with videos of how to say the same things using the AAC system as a teaching tool.
• Use visual supports frequently such as visual schedules, social stories and visual rules
• Be careful not to interpret vision, auditory or sensory issues as negative behaviors
• Remember learning cannot happen until sensory needs are met, be sure to offer sensory choices appropriate to the child's current state of arousal and teach self-regulation.  Work with OT and PT to ensure the child get enough time to move, is properly positioned when seated and has the sensory tools he or she needs at the time he or she needs them
• Build positive behavior supports and self-talk into AAC systems.  Respecting a child's communication that she "Does not feel safe because there are too many people" is better than having your hair pulled and allowing a child to cue himself to say "I can have safe hands" is better than creating a reliance on an adult to do that for him
• Be careful not to socially reinforce something that might be cute or funny the first time but won't be the 300th time.  Remember that it is easier not to socially reinforce something the first time it happens than it is to replace that behavior later!
• In the same vein be sure to socially reinforce appropriate communication as it happens, individuals with AS tend to be socially motivated and skilled at figuring out how to get their social needs met

• Reading is a Life Skill!


• and so is writing!  Be sure to offer access and instruction to traditional writing tools as well as alternative pencils. 
• Create a print rich environment
• Provide motivating books and writing prompts - if you can't find any make them yourself using Pictello and other tools
• Once you have done these basic be sure to watch Carolyn Musslewhite, Gretchen Hanser and Erin Sheldon's seminars on AS and Literacy on YouTube - Prepare tohave your teaching change for the better!
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