Miraculously, since before this week I hadn’t posted anything new since June (which is also when I started this blog!), I do still seem to have some followers who’ve been checking in over the past few months. Since then I have switched from a full time position in Early Intervention (EI) to a full time position as an AAC and AT Specialist, though I’m continuing to work in EI 1 day per week. So, lots of changes and exciting new experiences lately, but I’m hopefully just about ready to start updating again!
One of the things I’ve found most valuable about my experiences working in Early Intervention has been the ability to have family members integrally involved in intervention with the infants and toddlers on my caseload. Over the past several years, the principles of effective practice in Early Intervention have been modified to reflect an increased focus on family involvement and on embedding interventions into children’s daily routines (read: real lives). We know from research within the fields of child development, psychology, and education that young children learn best in context and with experiences that are repeated many times. In addition, young children’s understanding of the world is embedded within their relationships with family members and their role within the family unit.
One thing that’s important to note when involving siblings in intervention and when discussing families’ daily lives is that the siblings of children with disabilities have specialized needs and experiences of their own that require awareness, compassion, and support on the part of family members, teachers, and other caring adults. While working with infants and toddlers with severe disabilities, I’ve encountered preschool and school-aged siblings with a wide range of feelings and behaviors towards their brothers and sisters. Some children may feel jealous and resentful towards their siblings because of the increased attention they often receive from parents and other adults (including EI therapists, who they’re told come in specifically to play with/ teach their siblings) and the ways in which their daily lives are changed by their siblings’ needs (e.g., having to attend medical appointments, not being able to travel to certain places or do certain things if the sibling is medically fragile or can’t tolerate certain environments). Other kids may dedicate themselves to their younger siblings fully, even to the point of mistrusting therapists and viewing themselves as their younger sibling’s primary protector and teacher. Most kids will fall somewhere in between, or move back and forth, depending on the day. I’ve seen multiple young children with dramatically different perspectives and interaction patterns with their sibling with a disability even within the same family. It’s important to ensure that parents have access to information about the needs of siblings of children with disabilities as well as relevant resources, such as sibling support groups. The Center for Parent Information and Resource’s website has a ‘sibling issues’ page with quotes from siblings of children with disabilities, links to other articles discussing siblings’ needs, and links to local support groups. If you live in Massachusetts (like me), the Massachusetts Sibling Support Network website is a great resource for finding local sibling groups and services. I also found this post from M&L Special Needs Planning helpful in it’s discussion of signs of sibling stress as well as resources for supporting siblings.
In terms of involving siblings in AAC & AT interventions, I’ve seen a few different types of strategies work depending on the age and personality of the sibling and the child with the disability. The ways in which I’ve had success in increasing sibling involvement can be broken down into the following three categories: Siblings as (Mini) Interventionists, Cooperative Play, and Little Caregivers.
The “Siblings as Mini Interventionists” approach encourages siblings to be “teachers,” “helpers,” (or even speech/ occupational/ physical (etc.) therapists, if the children know these words) for their (typically younger) siblings. I’ve found this approach to work really well with early school-age children (often aged ~5-10) who have a strong interest in and protective/ caregiving feelings towards their brother or sister. This also works well if the sibling has a strong interest in/ bond with the EI therapist, and is eager to please/ be helpful/ gain attention from the therapist by being his/ her “helper.” I’ve had success with this approach for involving siblings in the following types of tasks:
- Gathering materials: Have the sibling collect and set up their brother or sister’s favorite toys and books and AAC tools (e.g., picture communication boards, voice output devices) at the start of the therapy session.
- Taking photographs: Let the sibling use an iPad, phone, or digital camera to take photographs of their brother or sister’s favorite toys/ foods/ books, or have the sibling collect these materials and place them on a black background so that an adult can take the picture).
- Assembling materials: Have siblings cut/ attach Velcro to/ laminate (with close supervision) materials for low-tech communication boards
- Presenting picture choices: Teach the sibling how to hold up two photographs/ picture symbols in the air or present a communication board, then bring the selected item to their brother or sister once a choice has been made.
- Selecting Messages: Ask the sibling to help you brainstorm messages that their brother or sister might want or need to communicate. Since siblings are closer to the child’s age, they may be even better at this than parents, therapists, or teachers :).
- Recording voice output devices: I know a (then) 6-year-old girl and a (then) 5-year-old boy from different families who both immediately learned to record sequences of messages on Ablenet’s Step-by-Step with Levels on behalf of their 10-month old and 1.5-year-old siblings. I also worked with a 2-year-old boy whose 6-year-old twin brothers helped their mother to record messages on single-message Talk Blocks from Learning Resources (which are, sadly, no longer available) in order to make the messages sound more like a little boy, in terms of voice, intonation, and phrasing (so for example, they recorded things like “Mama, get over here!” in a horror movie-esque fake voice instead of “Come here please, Mommy” like maybe an adult would’ve recorded :P).
- Aided language input: If you don’t know what aided language input is, check out this introduction to aided language input Youtube video for a simplified explanation, and search “aided language” on the PrAACtical AAC blog website for research evidence and implementation ideas. Basically, though, aided language input refers to the concept of using a child’s AAC system to talk to him/ her in order to teach the child how to use the system to communicate expressively. Even toddlers and preschoolers can be taught to model aided language using a child’s AAC system by making selections on a communication device, signing key words, or pointing to pictures. And seeing older (or younger!) siblings using the system will help motivate the child to use it, since we all know toddlers want to do everything their brothers and sisters are doing!
- Training other family members/ caregivers: The five and six-year-old children I described above have both been amazing advocates for their younger siblings. The little girl frequently told nurses, new therapists, etc., “that’s how my brother talks” in reference to his AAC system, and she was able to train caregivers to use it appropriately. The little boy reminds others to immediately reinforce his sister’s picture choices and teaches new ASL signs to family members regularly.
The “Cooperative Play” approach focuses on siblings as play and communication partners for the child with the disability. Many sibling sets will end up using a combination of the “Mini-Interventionist” and “Cooperative Play” approaches. Cooperative Play is also helpful for engaging younger (even infant) siblings, siblings who may be reluctant to engage with their brother or sister with a disability, or siblings who are feeling envious of the toys/ attention afforded to their sibling (which is a perfectly normal and appropriate reaction that they should not be made to feel ashamed of). Some ideas for using the “Cooperative Play” approach are as follows:
- Blowing bubbles: The child with a disability can turn on and off a switch-adapted bubble machine, and siblings can share in playing with the bubbles and even take turns operating the switch. I’ve seen this work well even with a preschool boy who normally was not very interesting in playing with his toddler brother. Another option is to have the child with the disability use a voice output device, speech-generating device, or picture communication board to direct play with bubbles (e.g., say “go” to tell a sibling to blow the bubbles, choose whether the bubbles should be blown up or down, popped or stomped on, etc.).
- Music: The child can use a switch to control a radio or tape player (with a switch control unit, as discussed in my Environmental Control for Toddlers post), or operate a switch-adapted musical toy. Siblings could play “freeze dance” by freezing whenever their brother or sister turns the music on or off. The child can also use AAC to select a song to sing or play or an instrument to play. For example, I’m working with a baby who is learning to make picture choices, and a few weeks ago we practiced having her choose a song, then having her 6-year-old brother play that song for her on his guitar while we sang.
- Giving Directions: While siblings might not love being bossed around, there are many typical preschool and early school-age games that involve one person giving directions. The child who uses AAC could activate a sequential-message voice output device to give directions for games such as “Simon Says,” “Red Light Green Light,” “Mother May I,” “Fishy, Fishy, May I Cross Your Ocean,” etc. This will give the child a sense of control while letting the siblings be actively involved in the play.
- Board Games: As children reach the preschool and school-age years (or for some children, even late toddler years), participation in early board games may be a great opportunity to engage in cooperative play with siblings. There are a variety of adapted dice and spinners available (e.g., dice domes that may be easier to press such as this dice dome from Learning Resources, switch-adapted dice rollers such as this dice roller from Enabled Solutions, switch-adapted spinners like the All-Turn-It spinner from Ablenet, etc.). Additionally, Ablenet makes a version of the Step-by-Step called the Step-by-Step Gameplay that includes “randomization,” “random elimination,” and “choice-making” modes to support participation in a variety of board and card games. I also love adapting the game Zingo with pictures of relevant vocabulary (e.g., Boardmaker symbols for core words, pictures of family members), as this game is already easier to access than most because of the large, easy-to-operate chip dispenser.
- Computer/ iPad Games: With a switch and compatible switch interface, there are many switch-accessible games available on the iPad and online.The HelpKidzLearn website and HelpKizlearn iPad apps are excellent sources of many switch-adapted activities. Some of these games support dual switch access and can be played as 2-player games, such as the “Bumper Cars” game.
The third and final type of sibling play I’ve seen in Early Intervention- what I’ll call “Little Caregivers”- has occurred when the child with the disability is the older sibling and has a younger infant brother or sister. In this case, it’s often appropriate to use some of the Cooperative Play suggestions, such as having the child with the disability blow bubbles or play music for their infant sibling. If the child has a propensity for caregiving towards the younger sibling, some of the following suggestions may also be helpful.
- Toy and Book Choices: The child could use a speech-generating device or low-tech picture communication system to choose a toy or book for their infant sibling.
- Story Time: The child could use a switch-adapted storybook app, such as Pictello, a recordable story book, or a sequence of messages recorded on a sequential-message voice output device to “read” to a younger sibling.
- Lullabies: The child could use a sequential-message voice output device to sing to an infant sibling, especially if the sibling is fussy.
In my own practice, I’ve worked with some amazing older siblings who’ve been incredibly passionate about helping their younger brothers and sisters to communicate more effectively and access play activities. I’ve also worked with some toddlers with disabilities who were themselves passionate caregivers for their infant siblings. I’ve found assistive technology to be an incredibly helpful tool for increasing children’s opportunities to engage meaningfully with their brothers and sisters and be included in family routines.
Feel free to share other suggestions for sibling play using assistive technology below!