Posted in Communication, Play, Literacy, and Learning, Self-Help and Self-Regulation

AT for the Holidays! Part 1: Halloween

Right now, my living room features ghost-shaped flashing string lights, a daybed with Halloween-themed throw pillows, and about 7 pumpkin and/ or oddly-shaped squash directions. The first week of October, I made my roommate decorate a light-up Halloween tree, which arguably isn’t even a thing. ¬†And I’m currently wearing Nightmare Before Christmas socks. So I can tell you that we (OK, so it’s mostly me) absolutely love holidays in this house.

Because of this, one of my favorite ways to incorporate assistive technology into the lives of young children and their families is by helping children to participate in their own family holiday celebrations and traditions. Many times, families experience stress about how their own traditions with their extended families, friends, and/ or communities will be experienced by their child with disabilities. In general, while in some areas of AT we obviously want to stress skill acquisition, in terms of holiday celebrations my primary focus is just on making sure that the child with the disability is an active participant, just like the rest of the family, and is able to make meaningful memories and build social connections during these family traditions.

Since it’s October, I’m going to be focusing on Halloween-related examples in today’s post, but check back in in a couple of months for some winter Holiday themed editions! ūüôā

Halloween Stories: Listening to and telling stories has always been a huge part of the Halloween experience for me. While toddlers and preschoolers aren’t going to be ready for classic “ghost stories,” there are a number of Halloween-themed board books and audiobooks designed for young children. Below are some ideas for adapting Halloween story-reading activities for children with disabilities.

Adapted Board Books: One toddler I worked with was a huge fan of the “Halloween Jack” book by Roger Priddy, which features a series of rhyming lines about various “spooky” characters (e.g., witch, robot, vampire). Several of the popular toddler/ preschool board book series, including Pete the Cat, Little Blue Truck, and Llama Llama, also offer Halloween editions. Board books and other picture books can be adapted using page fluffers, spacers, or turners, which are objects that are attached to the pages to help separate them/ make them easier to turn for children with disabilities. I usually do this by attaching Velcro to the corners of the pages, but there are a variety of strategies you can try. Carole Zangari’s Page Fluffers and Spacers post on PrAACtical AAC¬†offers some great alternative suggestions; just be careful to supervise babies and toddlers when reading these adapted books, as some items (e.g., pom poms, foam stickers) may present a choking hazard.

Story Boxes:¬†If you aren’t familiar with the concept of story boxes, check out my “story boxes” overview post¬†from June. The¬†Paths to Literacy for Students Who are Blind or Visually Impaired website, run by Perkins, has a post about creating a Halloween story box for the book, “The Little Old Lady Who Was Not Afraid of Anything.”¬†Other Halloween stories can also be paired with custom story boxes by collecting a variety of objects with multisensory components (e.g., tactile, auditory, even olfactory) pertaining to each story and encouraging children to explore these objects while listening to their corresponding stories.

Audiobooks: Audiobooks are another great way to make literacy activities accessible for children with disabilities, particularly children with vision impairments (or, as kids get older, children with print disabilities such as dyslexia). Sparkle Stories is a subscription-based original audiobook service designed for children; they offer some fall and Halloween-themed story options that may be appropriate for older preschoolers. Audible also offers some Halloween-themed stories.

Arts and Crafts/ Sensory:¬†WonderBaby,¬†by Perkins school for the Blind, has a great post about Halloween-themed sensory activities for children with vision impairments. I particularly like their “accessible coloring book” and “grow a pumpkin in a pumpkin” ideas! Most Halloween-themed sensory table/ bin ideas, such as those on this Halloween sensory activity list from Kids Play Box, can be easily adapted for children with motor disabilities using easy-grip scooping tools (e.g.,¬†the O-Ball scoop bath toy) and adapted seating/ positioning solutions (e.g., standers/ walkers, adaptive seats). Switch-adapted pouring cups, such as this adapted pouring cup from Enabling devices,¬†can help children with disabilities to take a more active role in creating sensory/ slime activities. If making edible slime or playdough, using a Powerlink to switch-adapt a blender or food processor as described in my¬†post about Environmental Control for Toddlers,¬†could also help children with motor impairments to participate more actively in creating sensory materials. Pumpkin decorating traditions can also be made more inclusive for children with disabilities by encouraging children to paint the pumpkins with easy-grip paint rollers and sponges, use multisensory decorating materials like puff paint, glow paint, or tactile foam faces, use easy-scoop cups to help scoop out a pre-carved pumpkin, or use picture communication boards or communication devices to direct an adult in decorating the pumpkins.

Choosing a Costume:¬†Low and high-tech picture choice boards can be used to allow children with complex communication needs to select their own costumes from an array of choices. Children’s sensory and mobility needs may also play a role in costume selection. The Mighty has an article about sensory-friendly Halloween costume solutions¬†for children with sensory sensitivities/ sensory integration disorder. In addition, there are many excellent posts and Pinterest boards regarding building Halloween costumes that incorporate children’s wheelchairs or other mobility equipment. There is a non-profit called Magic Wheelchair¬†that donates costumes to children over 5 who use wheelchairs, and there are many DIY resources for parents seeking to create their own costumes for their children who use mobility equipment, such as this “Wheelchair Halloween Costume Ideas” article from Parents Magazine.¬†

Switch-Accessible Music and Decorations: Although in recent years many toys are being built with increasingly complicated internal switchboards and thus are more difficult to adapt for switch access, holiday decorations often continue to operate via a simple on-off switch with a single function. Many battery-operated decorations such as talking skeletons, string lights, or my light-up Halloween tree (pictures to come) can be adapted for use with a switch by inserting an inexpensive battery interrupter into the battery compartment. Simple decorations that plug into a wall outlet are often usable via a PowerLink or other switch control unit. In addition, cassette tape players or radios can be adapted via a PowerLink and used to play Halloween-themed music, or you can use a bluetooth switch, like the Blue2 Bluetooth switch from Ablenet, to adapt an iPhone or iPad for switch access and play Halloween music that way.

Communication While Trick-Or-Treating:¬†Trick-or-treating often involves communicating with strangers, who may not be aware of the child’s communication needs. A sequential-message voice output device (such as Ablenet’s Step-by-Step with Levels) or multi-message voice output device (such as Attainment Company’s GoTalks) can be programmed with Halloween-related messages, (e.g., “Trick-or-Treat,” “I’m a dinosaur,” “Thank you!”), or a Halloween-specific communication board can be created within a communication app or printed and laminated for use as a low-tech AAC strategy.

Sharing About Halloween Experiences:¬†In the days and weeks after Halloween, kids often want to talk to each other and their teachers about their experiences trick-or-treating, attending Halloween parties, or handing out candy. Messages related to kids’ Halloween experiences can be recorded on a single or sequential-message voice output device, or pages can be created within a personalized photo album (as described in my Personalized Photo Album post) to allow children to share about their holiday experiences.

Teal Pumpkin Project: Finally, though not directly related to assistive technology, I wanted to take this opportunity to talk about the Teal Pumpkin Project. The Teal Pumpkin Project is a movement run by Food Allergy Research and Education (FARE) to promote awareness of food allergies and the provision of allergen-free treats at Halloween. Since many children with disabilities may have very specific feeding needs or may not eat by mouth, many of the principles of the Teal Pumpkin Project (e.g., providing small toys to trick-or-treaters instead of or in addition to candy) may be applicable/ helpful.

I’m planning on adapting many of my own decorations for switch access and/ or use via electronic personal assistants (e.g., Amazon Alexa, Google Home) in the next week or so, so check back in for updates, and I hope you all have a happy Halloween!! ūüôā

 

 

Posted in Communication, Play, Literacy, and Learning

Universal Design at Circle Time: AAC and AT During Group Singing Activities in Toddler and Preschool Classrooms

Recently, I’ve had many toddler and preschool teachers ask me how the children in their classrooms with complex communication needs (CCN) can be better integrated into classroom routines. One routine that I’ve worked on a lot has been the “circle time” or “group time” routine. I LOVE when I have the chance to work with my kids during circle time because it’s a time of day that can be very easily modified to offer so many naturalistic and motivating opportunities for communication across a variety of communication modalities (e.g., speech approximations, signs, picture choices, voice output devices, speech-generating devices). It’s also usually a high-engagement time for many of the kids I see, as most of them are highly motivated by singing and/ or reading activities.

When working on integrating kids with disabilities into childcare and preschool classrooms, I try to use a¬†Universal Design for Learning (UDL) approach whenever possible. If you haven’t heard of Universal Design for Learning, it’s worth checking out¬†the CAST website’s Universal Design for Learning pages¬†as well as online resources from the National Center on Universal Design for Learning. UDL comes from the architectural concept of “universal design,” which refers to the concept of designing and constructing buildings with the access needs of people with disabilities in mind from the beginning, rather than first constructing a building with only the needs of people without disabilities in mind and then adding accessibility features after the fact. The idea is that if the needs of people with a diverse range of abilities and accessibility needs are considered from the beginning, accessibility features can be better integrated and time and money can be saved. Universal Design for Learning is a similar concept; the philosophy is that curriculum activities and classroom routines should be planned with the needs of all children in the classroom, including those with disabilities, in mind. This helps teachers and peers to include children with disabilities in activities more easily and naturalistically, rather than requiring teachers to plan special, separate activities for the children with complex needs while simultaneously trying to meet the needs of the rest of the children in their classroom.

The framework of Universal Design for Learning uses the key principles of “multiple means of representation,” “multiple means of action and expression,” and “multiple means of engagement,” (National Center on Universal Design for Learning at CAST, 2012). This basically means that information should be presented in multiple ways so that children who have difficulty perceiving information (e.g., due to vision, hearing, cognitive, or language needs) can access it, and that activities should include multiple ways of participating and demonstrating knowledge so that children with disabilities can be active participants and demonstrate their skills. Below are some examples of how these 3 key principles can be incorporated into singing/ music circle time activities with toddlers and preschoolers.

Multiple means of representation:

The most common way that information is presented during circle time singing activities is auditorily, via speech and singing. Some children with disabilities, particularly children with hearing, receptive language, or cognitive impairments, may have difficulty understanding information presented via speech alone. One easy way to modify circle time activities to be more inclusive to children with disabilities is by pairing speech with signs and gestures. I will often recommend that daycare and preschool classrooms begin by implementing a “keyword signing” approach. The Kid Sense Child Development Website’s Keyword Signing overview¬†is a good resource for learning about this approach. Basically, “keyword signing” refers to the concept of signing the “key” (main) words in each sentence while simultaneously speaking the sentence. To use keyword signing at circle time, try introducing the activity by signing along with speaking. For example, you can say “it’s time for circle” or “it’s time for music” while signing the keywords “time,” “circle,” and “music.” Keyword signing can be incorporated into songs by signing the key words within songs. Below are some keywords that I focus on modeling signs for during popular toddler/ preschool songs as well as links to “baby sign” videos for each keyword from the Baby Sign Language Dictionary website:

Wheels on the Bus: wheel, bus, go, baby, Mommy, Daddy, I love you, Up, Down, door, open

Itsy Bitsy Spider: spider, up, water, down, rain, wash, out, sun, dry, again

Old MacDonald Had a Farm: old, farm, on, cow, pig, horse, chicken, dog, cat, sheep

Multiple means of action and expression: 

In many classrooms, toddlers and preschoolers express themselves during circle time by using spoken words to request songs. Children who do not yet speak also benefit from opportunities to make song choices in order to practice requesting and increase their symbolic communication skills. There are a wide variety of ways that children can do this, but some of my favorites are as follows:

Sign Language: If signs are being modeled during songs, some children who cannot speak but have adequate fine motor skills for signing may be able to use signs to request favorite songs or fill in words within songs.

Pictures: Photographs and/ or picture symbols or even drawings can be used to represent each song (e.g., Spider for Itsy Bitsy Spider, Bus for Wheels on the Bus, Star for Twinkle Twinkle Little Star) as well as specific lines within songs (e.g., pictures representing wheels, wipers, doors, lights, horn, etc. for Wheels on the Bus). These photographs and picture symbols can then be used to allow children to make song choices. Depending on the motor skills of the children, space constraints in the classroom, and preferences of the teachers within each setting, picture choices can be presented either by holding the choices in front of each child or by presenting them on a wall-mounted felt board and having each child come up to the board to make a choice on their turn. For children who cannot move their hands, pictures can be presented on an eye gaze board (i.e., clear piece of plexiglass or a cardboard frame held in front of the children at eye level to allow them to look at pictures in order to select them.) For children who benefit from voice output, photographs and picture symbols with corresponding recorded/ synthesized messages representing song choices can also be programmed into mid-tech voice output devices and high-tech speech-generating devices.

Objects/ Tactile Symbols:¬†For children who don’t seem to understand or can’t see photographs or picture symbols, objects can also be used to represent songs and parts of songs. For example, a toy bus or steering wheel can be used to represent “Wheels on the Bus,” a plastic spider can be used for “Itsy Bitsy Spider,” a toy boat or boat paddle can be used to represent “Row Your Boat,” etc. Children with vision impairments should be encouraged/ helped to feel these objects with their hands in order to make a selection. If needed, objects can be presented one at a time, and children can be taught to give a “yes” response (smile/ vocalization/ eye contact/ tapping object with hand) to make a selection. To increase comprehension, it may be helpful if these objects are also used as props during the song (e.g., all children get a toy/ cardboard steering wheel to use during Wheels on the Bus, and then one of these wheels is used as the symbol to represent the song when it’s time to make a choice). Both object and picture symbols can also be used for “multiple means of representation” by presenting these symbols to children with disabilities to help them understand the choices made by other children in the classroom.

Multiple means of engagement: 

In many classrooms, children’s¬†engagement during circle time largely occurs by sitting together on the floor, visually attending to the teacher, and filling in words or singing entire lines within songs. Some children with difficulties with attention, impulse control, and comprehension may have difficulty sitting and attending to activities. Additionally, children who do not speak may not have the opportunity to participate socially by singing along to songs. Below are some ideas for providing multiple means of engagement during circle time music activities:

Flexible Seating: The “flexible seating” movement is currently popular within elementary school classrooms as a way of redesigning classrooms to meet children’s diverse learning needs by providing a variety of seating options (rather than requiring all children to sit at desks or tables). Toddler and preschool classrooms generally have a greater variety of seating options throughout the day than classrooms for older children, but there are not always multiple options available during circle time.¬†Children with atypical muscle tone, sensory integration disorder, or difficulties with attention may benefit from a variety of seating options beyond sitting directly on a rug or mat. Having adaptive floor seats like the Special Tomato Floor Sitter¬†or¬†Firefly GoTo and Floor Sitter accessory, ¬†as well as sensory-friendly options such as beanbag chairs, floor cushions, or Wiggle Seats¬†may be helpful for meeting children’s diverse seating needs. Some children with vision or cognitive impairments as well as many typically-developing children may benefit from anything tangible that marks a defined seating area, such as an individual rug or mat for each child (maybe even with a photograph of that child attached to it). However, be sure to work closely with physical and occupational therapists to determine the best seating needs for each child with a disability in your classroom.

Instrument or Prop Play:¬†Most young children have difficulty sitting and attending passively to activities, as this is not yet a developmentally appropriate expectation for one to four year old children. To be honest, passive attention to activities is a skill that even I haven’t totally mastered yet :). Some kids may attend better and be more willing to participate in circle time activities if given instruments to play or props to use during each song. There are a wide variety of instruments that are accessible to children with disabilities, including switch-adapted musical instruments such as the adapted instruments available from Enabling Devices.¬†The new Skoog device from SkoogMusic is also an instrument with amazing accessibility features for a wide variety of disabilities. Hand bells that strap to children’s wrists, large maracas that can be loosely grasped, and bongo drums may also be accessible to many children. I’ve found that many kids with significant physical disabilities are also still able to strum my ukulele, as it requires significantly less pressure to strum a ukulele’s plastic/ nylon strings than a guitar’s metal strings.

Simple Voice Output Devices:¬†I love using single-message voice output devices like the¬†BIGMack by Ablenet¬†and sequential-message voice output devices like the Step-by-Step by Ablenet¬†or BigTalk Triple Play by Enabling Devices¬†to allow children to fill in parts of songs. Inexpensive, simple single-message recordable devices are also available online and at times in toy stores, such as these Recordable Answer Buzzers from Learning Resources. Key lines or words from songs can be recorded onto these devices, and children can activate the buttons to “sing” parts of each song. This can be useful for increasing social participation, practicing switch timing skills, and working on turn-taking, initiating, and language comprehension. I find it works especially well to record lines that are repeated frequently within songs (e.g., “EIEIO” in “Old MacDonald,” “all through the town” in “Wheels on the Bus,” “ah-ah-ah-ah-ah-ah-ah-ah-ah” in “If All of the Raindrops,” etc.). I also like to record high-excitement, high-interest lines, such as the scream at the end of the “alligator” version of “Row, Row, Row Your Boat” (“and if you see an alligator, don’t forget to scream!”). For children who cannot use their hands to activate a voice-output device, these devices can be attached to switches mounted by a child’s head, foot, finger, etc. Ablenet’s QuickTalker S¬†may also be useful for children with particular types of motor impairments in that it is activated by proximity rather than pressure, meaning that the child just needs to get their hand (or foot or other body part) close to the button in order to activate it rather than exerting pressure to push down on it. The therapy team for individual children (SLP, OT, PT) should be consulted to determine the best access method for children who have difficulty activating simple voice-output devices directly.

With the right resources and a little planning, circle time can be a fantastic opportunity for children with disabilities to be active participants and to practice and show off their communication skills across a wide variety of communicative modalities. Check back in a few weeks for a follow-up article addressing AAC and AT during group reading activities, too, and feel free to comment below with your own ideas about circle time engagement and universal design for learning!

 

Posted in Communication, Play, Literacy, and Learning, Self-Help and Self-Regulation

“Can I Play Too?”: Involving Siblings in AAC/ AT Intervention

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!

 

Posted in Communication, Play, Literacy, and Learning

Personalized Photo Albums

Personalized photo albums allow infants and toddlers to participate in telling stories about their favorite people, favorite activities, and daily lives. These albums provide opportunities for building pre-literacy skills, which are the skills that children need to learn in order to read well when they are older. Some important pre-literacy skills that kids can learn from personalized photo albums include book orientation (holding the book right-side up), book navigation skills (e.g., turning pages from left to right), increased comprehension of narrative language (the type of language used to tell stories), and increased vocabulary. Objects with environmental print can even be incorporated into the books to build early print recognition skills (e.g., an empty, clean piece of an apple sauce pouch with the label visible could be attached to the page to allow the child to share information about favorite foods).

Personalized photo albums can also increase young children’s opportunities for participation in activities with other children and adults, and can build social and turn-taking skills. For example, if a preschool classroom typically has a “show and tell” time, ¬†children who have speech delays or disorders could use a personalized photo album to take their turns and share about things that are meaningful to them. If the childcare or school classroom teacher is willing and able to take photos and either print them out or import them into the child’s iPad, then personalized photo albums can be used to allow children to share information with their parents about what they did at school.

There are many different ways to create personalized photo albums for your child. One option is to create these books on the iPad using a photo album app. These apps allow you to import your own photographs, type text to go along with the photos, and record yourself speaking a message for each page. There are several apps that do this, but some good ones to try are Pictello ($19.99), Story Creator (free), and Book Creator (free limited version, or upgrade for $5). Keep in mind that if your child has a physical disability and has trouble using his or her hands, Pictello has the most options for supporting your child’s access (it is switch-adaptable, and the pages can also be turned by tapping with a full hand anywhere on the iPad’s screen for children who cannot point and swipe). You can also create electronic story books on the computer in Tar Heel Reader.

Physical recordable photo albums, meaning photo albums that let you record auditory messages, are available both from companies that make products for individuals with disabilities (e.g., Talking Photo Album by Attainment Company) and sometimes commercially on Amazon or in regular stores.

You can also use a regular photo album or a baby book with spots for adding photos (like the Sassy Look Book here: ) to meet the same goals! In addition to photos, you can try adding things like wrappers from favorite foods, kids’ drawings, stickers from a visit to the doctor, ticket stubs, or objects from nature as reminders of family events and daily routines. One way to do this is to make a “Baggie Book” by putting pictures or drawings in Ziplock bags and stapling them together (e.g., see this description of Baggie Books on Dr. Jean’s blog).¬†Just supervise very closely if you use these with young children, since staples can be sharp and/ or a choking hazard and Ziplock bag zippers can come off and be accidentally swallowed.

Personalized photo story books are a great early learning and communication activity for any baby or toddler- even children without delays or disabilities. They can help your child to build close relationships with others, express concepts, learn about their world, and practice early reading skills. And they are good practice for kids who are learning to use photos for communication!

Posted in Communication

Other Websites for Early Childhood AAC

I wanted to compile a list of other web resources for families who might be seeking information about AAC use with infants, toddlers, and preschoolers.

Websites and Blogs by AAC Professionals:

Early Intervention for Young Children with Autism, Cerebral Palsy, Down syndrome, and Other Disabilities by Janice Light- This is an amazing resource that family-friendly explanations of how to use AAC with very young children. It also features many videos of infants and toddlers with significant disabilities using AAC in real-life functional contexts such as participating in songs, reading with parents, and playing peekaboo. This is a completed web resource rather than a blog; it is not updated regularly.

PrAACtical AAC by Carole Zangari- PrAACtical AAC is an absolutely amazing blog that covers AAC use across the lifespan, but primarily focuses on children. I would say that the bulk of the posts pertain to school-age children, but there are definitely over 100 posts, videos, etc. that discuss AAC use with infants and toddlers as well. The blog allows you to search by tag; search tags,¬†“Early Intervention,”infants,” “toddlers,” and “preschool” all bring up many posts that are relevant to this age group. There are new posts several times per week as well as weekly summary posts and videos.

There are many, many other blogs by professionals that have tons of great information about AAC, but I wanted to highlight those two to start, as they very consistently have excellent information that is relevant to this age group. I also find them to be relatively easily to navigate and accessible to parents. Janice Light and Carole Zangari are also both leading researchers within the AAC field.

Blogs by Parents of Children who Use AAC:

Uncommon Sense by Dana Nieder- This blog tells the story of a child with an undiagnosed (until this month) rare genetic disorder and her journey with AAC. Dana Nieder began her interest in AAC because of her daughter, and has since also started grad school for speech-language pathology. Her daughter, Maya, uses Speak for Yourself on the iPad as her primary form of AAC.

Star in Her Eye by Heather Kim Lanier-  This blog is written by the mother of a little girl, Fiona, with Wolf-Hirschhorn syndrome. Fiona also uses Speak for Yourself on the iPad to communicate.

Fighting Monsters with Rubber Swords by Rob Rummel-Hudson-¬†Rob Rummel-Hudson is the father of a teenage girl with bilateral perisylvian polymicrogyria named Schuyler. In addition to running a blog about his daughter’s life and experiences, he also wrote a novel about Schuyler’s life called Schuyler’s Monster (St. Martin’s Press, 2009). Schuyler uses a dedicated communication device made my Prentke-Romich Company to communicate.

We Speak PODD by Karen Owens-¬†This is actually a Facebook page rather than a blog, but Karen posts several times per week with updates on her children’s communication journeys. Karen has adopted four children with severe disabilities who all use PODD (Pragmatically Organized Dynamic Display) communication books and/ or apps (depending on the child) to communicate. She regularly posts videos, photos, and descriptions of AAC use by the whole family in real life daily contexts.

Assistiveware, the company that makes the Proloquo2Go communication app as well as additional assistive technology software, posted a list of additional family-run blogs featuring AAC on their website here: 5 Fantastic Family AAC Blogs.

Websites from AAC Device Manufacturers and App Developers:

Although sometimes developers/ manufacturer websites can be biased towards their own products, there are many that provide excellent information.

Tobii-Dynavox Implementation Toolkit-¬†¬†Tobii-Dynavox is one of the biggest manufacturers of dedicated AAC devices and has also designed several AAC apps. The Tobii-Dynavox website includes their Implementation Toolkit, which has some information that is specific to operation of Tobii-Dynavox devices, but also has a variety of general introductory AAC information. I would recommend going to the “Learning Paths” section (included in the link above) and looking into the AAC 101 and AAC Myths Revealed sections if you are new to AAC. There are also some helpful handouts in the Tools for AAC Users section, and there’s a specific section on AAC and Autism that provides summaries of relevant research and some implementation ideas.

AAC Language Lab by Prentke-Romich Company (PRC)- .¬†PRC is another one of the largest/ most well known AAC device manufacturers. Their “AAC Language Lab” includes separate pages for speech-language pathologists, parents, and educators as well as a blog page. Some information is free, while there are other sections that can only be accessed via a paid ($84) annual subscription. Within the AAC Language Lab free resources section, the “Getting Started with AAC” and “Choosing an AAC Device for Your Child” documents have some helpful introductory information for parents.

There are many, many more resources: I will continue to update this over time. Just wanted to get a partial list out there to start! ūüôā

Posted in Communication

Why Use Augmentative Communication?

When babies and toddlers have speech that is absent, delayed, or hard to understand, they benefit from the addition of other forms of communication, including signs, pictures, and voice output (buttons or computers that “talk”). These additional forms of communication are referred to as augmentative and alternative communication, or AAC.

Sometimes, parents are afraid that if other ways of communicating are added, kids might not learn to talk as early or as well. However, research has shown that introducing AAC increases speech 89% of the time and never decreases speech (meta-analysis by Millar, Light, and Schlosser, 2006).

Parents and some therapists also might wonder if it’s too early to introduce AAC to a young child. However, a systematic review (a professional article that summarizes the results of many different research studies) of AAC in Early Intervention (Romski, Sevcik, Barton, Hulsey, and Whitemore, 2015) showed that AAC had lots of benefits for babies, toddlers, and preschoolers. The research included in that systematic review showed that introducing AAC helps to improve young children’s language skills in the following ways:

  • Increases expressive vocabulary (Adamson¬† &¬† Dunbar,¬† 1991;¬†¬†¬†¬†¬† Barton,¬† Sevcik,¬† &¬† Romski,¬† 2006;¬† Bondy¬† &¬† Frost,¬† 1994;¬† L√ľke,¬† 2014;¬†¬†¬†¬†¬† Wright,¬† Kaiser,¬† Reikowsky,¬† &¬† Roberts,¬† 2013)
  • Increases multi-‚Äźword combinations¬† and grammatical¬† skills ¬†¬†¬†(Binger¬† &¬† Light,¬† 2007;¬† Harris,¬† Skarakis¬† Doyle,¬† &¬† Haff,¬† 1996).
  • Increases the functions¬† for¬† which¬† children communicate¬† (Light¬† et¬† al.,¬† 1985¬† a,¬† b,¬† &¬† c)
  • Increases children‚Äôs conversational¬† turns ¬† (Light¬† et¬† al.,¬† 1985¬† a,¬† b,¬† &¬† c)
  • Increases the number¬† of¬† back- and- forth¬†¬† interactions¬† between¬† children¬† and¬† their¬† parents¬† (Pennington¬† &¬† McConachie,¬† 1999;¬† Light,¬† Binger,¬† &¬† Kelford¬† Smith,¬† 1994).
  • Increases¬† language¬† comprehension¬† (Brady,¬† 2000;¬† Drager¬† et¬† al.,¬† 2006)

Other research has shown that introducing AAC can help kids with their behavior and self-regulation skills. For example, studies of found the following benefits of introducing AAC:

  • Decreases negative behaviors caused or worsened by difficulty communicating (e.g.,¬†¬† in¬†¬† combination¬†¬† with¬†¬† functional¬† communication¬†¬† training¬†¬† (Durand,¬†¬† 1993,¬†¬† Mirenda,¬†¬† 1997)
  • Improves transitions between activities (e.g.,¬† Dettmer,¬† Simpson,¬† Myles,¬† and¬† Ganz,¬† 2000)

Overall, if children are having trouble communicating because of a speech delay or disorder, using AAC strategies like sign language, pictures, and communication devices can help kids to talk more, develop stronger language and social skills, and improve their behavior. It’s a good idea to start using some of these strategies as soon as possible to keep kids from becoming too frustrated or falling too far behind.

References:

Adamson, L. B., & Dunbar, B. (1991). Communication development of young children with tracheostomies. Augmentative and Alternative Communication, 7, 275‚Äď283.

Barton, A.,Sevcik, R.A., & Romski , M. A . (2006). Exploring visual-graphic symbol acquisition by pre-school age children with developmental and language delays . Augmentative and Alternative Communication , 22 , 10 ‚Äď 20.

Brady, N.C. (2000). Improved comprehension of object names following voice output communication aid use: Two case studies. Augmentative and Alternative Communication, 16, 197 ‚Äď 204 .

Binger, C. , & Light , J . (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC . Augmentative and Alternative Communication, 23, 30‚Äď43.

Bondy, A.S., & Frost, L.A. (1994). The picture exchange communication system. Focus on Autism and Other Developmental Disabilities, 9, 1‚Äď 19. Dettmer, S., Simpson, R.L, Myles, B.S., and Ganz, J.B., (2000). The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15:3, 163-169.

Drager, K., Postal, V.J., Carrolus, L., Castellano, M., Gagliano, C., & Glynn, J. (2006). The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism. American Journal of Speech;Language Pathology, 15, 112 ‚Äď 125.

Durand, V., (1993). Functional communication training using assistive devices: effects on challenging behavior and affect. Augmentative and Alternative Communication, 9:3, 168<176.

Harris, L., Skarakis Doyle , E., & Haaf, R . (1996). Language treatment approach for users of AAC: Experimental single-subject investigation. Augmentative and Alternative Communication, 12, 230‚Äď243.

Light, J.C., Binger, C., & Kelford Smith, A. (1994). Story reading interactions between preschoolers who use AAC and their mothers . Augmentative and Alternative Communication, 10, 255‚Äď268.

Light, J.C., Collier, B., & Parnes, P. (1985a). Communicative
Casey Bryn McCarthy Benefits of AAC for Young Children, 2015 Light, J.C., Collier, B., & Parnes, P. (1985b). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part II ‚Äď Communicative function Augmentative and Alternative Communication, 1, 98 ‚Äď 107. interaction between young nonspeaking physically disabled children and their primary caregivers: Part I ‚Äď Discourse patterns. Augmentative and Alternative Communication, 1, 74‚Äď83.

Light, J.C., Collier, B., & Parnes, P. (1985c). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part III ‚Äď Modes of communication. Augmentative and Alternative Communication, 1, 125 ‚Äď 133.

LuŐąke, C. (2014). Impact of speech-generating devices on the language development of a child with childhood apraxia of speech: a case study. Disability and Rehabilitation: Assistive Technology, 0, 1‚Äď9.

Millar, D.C., Light, J.C., and Schlosser, R.W. (2006). The impact of augmentative and alternative communication on the speech production of individuals with developmental disabilities: a research review. Journal of Speech, Language, and Hearing Research, 49, 248-264.

Mirenda, P., (1997). Supporting individuals with challenging behavior through functional communication training and AAC: research review. Augmentative and Alternative Communication, 13:4, 207-225.

Pennington, L., & McConachie, H. (1999). Mother‚Äďchild interaction revisited: Communication with non-speaking physically disabled children. International Journal of Language & Communication Disorders, 34, 391 ‚Äď 416.

Romski, M., Sevcik, R.A., Barton-Hulsey, A., and Whitmore, A.S. (2015). Early Intervention and AAC: what a difference 30 years makes. Augmentative and Alternative Communication, 31:3, 181-202.

Wright, C. A., Kaiser, A. P., Reikowsky , D. I. , & Roberts , M. Y . (2013). Effects of a naturalistic sign intervention on expressive language of toddlers with Down syndrome. Journal of Speech, Language, and Hearing Research, 56, 994‚Äď1008.