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! 🙂

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!! 🙂



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: wheelbusgobabyMommyDaddyI love youUpDown, door, open

Itsy Bitsy Spider: spiderupwater, down, rain, wash, out, sun, dry, again

Old MacDonald Had a Farm: oldfarmoncowpig, 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) InterventionistsCooperative 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 Play, Literacy, and Learning, Self-Help and Self-Regulation

Environmental Control for Toddlers and Preschoolers: Switch Control Units

Anyone who works with toddlers, has a toddler… or has ever seen a toddler in passing knows that a desire for control is a fundamental characteristic of 1-3-year-old children. Erik Erikson, one of the most influential early developmental psychologists, developed a theory of psychosocial development that included 8 primary developmental phases, each with a defining “conflict” at the center of emotional development (see Kendra Cherry’s Psychological Stages article on VeryWell for a good overview of Erikson’s psychosocial stage theory). According to Erikson, between the ages of 18 months and 3 years, children’s psychosocial development is defined by the conflict of “autonomy vs. shame and doubt,” where toddlers strive to prove to themselves and others that they can do things on their own and make their own decisions. Although the field of developmental psychology as a whole and our understanding of young children’s social-emotional development in particular has advanced considerably since Erikson developed this theory, and we now know that psychosocial development is a lot more complicated, the drive for autonomy continues to be a defining component of toddlerhood, at least within many Western cultures.

Environmental control is an area of assistive technology that addresses the ability of individuals with disabilities to operate equipment within their environments. This includes the ability to control lights, appliances (e.g., fan, remote control, microwave, dishwasher), entertainment technology (e.g., TV, radio), communication technology (e.g., phones), and security equipment (e.g., alarms, door lockers/ openers, security cameras). Recent innovations in this area, including the expansion of integrated “smart home” technologies, have dramatically increased opportunities for people with disabilities to live independently and/ or increase their independence in many aspects of self-care.

Many environmental control units (ECUs) are actually mainstream devices used by people with and without disabilities. For example, TV remotes and personal assistant devices such as Amazon Alexa and Google Home are widely used regardless of disability status.

While typically-developing toddlers are probably not normally in charge of turning on the air conditioning or monitoring the security cameras (but who knows- I don’t know your kid), they do have plenty of opportunities to begin to “control” their environments. I know many 2-year-olds who are obsessed with light switches and love pushing the buttons on TV remotes. I even worked with one 18-month-old who seemed to prefer turning the air conditioner in his bedroom on and off over playing with his toys (which for obvious reasons, we worked on redirecting 🙂 ). In addition, typically-developing toddlers practice influencing their environments through spontaneous play, experimentations with early mobility, and by communicating with others (for example, when asking for something from a parent or bossing around a sibling).

Toddlers with severe/ multiple disabilities often have decreased opportunities to experiment with and explore their environments. In addition, sometimes families and childcares have a hard time helping children with disabilities to be active participants in daily routines and special celebrations. Adapted environmental control activities can be incredibly useful for increasing children’s opportunities for cause-effect experimentation and social participation within their daily lives.

Switch control units, such as the PowerLink 4 by Ablenet, are an incredibly effective means for allowing young children to experiment with early environmental control. These units connect to a capability switch and have a set of outlets which simple, standard electronic appliances can be plugged into, allowing children with physical disabilities to turn on and off simple appliances such as lights, fans, radios, blenders, etc. Below are some ideas for using the PowerLink (or a similar switch control unit) and a switch to help a child with physical disabilities to participate in daily routines. (Note: I’m going to refer to the PowerLink for the rest of this post because it’s the most common switch control unit, in my experience, and the one with which the most professionals are familiar. But I’m in no way affiliated with Ablenet, and I think you should use whatever similar device you have available to you 🙂 ).

Music and Stories: The PowerLink and switch can be paired with a radio or cassette tape player to allow the child to turn music on and off. If there are siblings or classmates present, the child could direct a game of “freeze dance” in which all children “freeze” whenever the music is turned off and resume dancing when it is turned back on. In addition, if you happen to still have a cassette tape player, the PowerLink can be paired with it to allow a child to turn on and off music or cassette tape audiobooks (maybe they could lead a story time activity?).

Temperature Control: Many of the children  that I have worked with have had significant trouble regulating their body temperatures. The PowerLink can be connected to a personal fan, which a toddler can be taught to turn on and off to gain increased control and self-help skills related to maintaining a comfortable body temperature. In a preschool or elementary school setting, a small desk fan or space cooler could be secured to a child’s wheelchair tray or desk and connected to a switch to allow the child to regulate his/ her own temperature (note that an outlet in the room would need to be available so that the PowerLink could be plugged in, however).

Lights: Floor lamps, table lamps, plug-in nightlights, etc. can all be connected to a PowerLink to allow a child to turn them on and off. I used to work with a toddler whose home health nurse had set up Christmas Lights in the shape of a tree on his bedroom wall. We then connected these to the PowerLink to allow him to turn them on and off.

Cooking: If you like to involve your kids in cooking, the PowerLink is helpful for allowing young children with disabilities to take an active role. Simple appliances with a wall plug and on-off switch, such as a blender, hand mixer, etc., can be attached to the PowerLink and turned on and off by the child. Just be sure to take all appropriate precautions to avoid any risk of cuts/ burns when involving your toddler in cooking activities.

Get Creative!: There are a lot of different ways in which switch control units can be used to give toddlers and preschoolers more independence in play and self-help activities within their daily lives. For example, a professor of mine in an Assistive Technology for Infants and Toddlers course that I took as part of the University of Illinois at Chicago’s Assistive Technology Certificate Program suggested attaching a hair dryer to the PowerLink, then helping a toddler with motor disabilities use it to blow down blocks in a tower. If you come up with any non-traditional ideas for using the PowerLink of your own, definitely share them in the comments section below!

Ultimately, as with all assistive technology, switch control units can help toddlers to increase both their self-help skills and their opportunities to connect and engage with others. It’s never too early to teach children that they have a role in controlling their own environment, and it’s never too early to incorporate them into family traditions and routines :).

Posted in Play, Literacy, and Learning

Story Boxes

Story boxes are collections of toys and objects that correspond to specific books and can be used to help tell a story. When using a story box within literacy activities, objects corresponding to each part of the story can be provided to the child for tactile/ visual/ auditory exploration and play while the story is read aloud. This can help to reinforce the storyline and concepts within the book. Story boxes are most often described in the context of interventions for children who are blind/ have vision impairments. In addition, story boxes are also extremely useful for making stories more cognitively accessible to children who might have difficulty attending to and comprehending the stories without more concrete, physical representations. Even typically-developing infants and toddlers can benefit from the use of story boxes, since at this age children are concrete learners and are just beginning to develop symbolic understanding (the realization that one thing can stand for another, such as a picture standing for a real-life object or a word standing for a concept).

The WonderBaby blog sponsored by Perkins School for the Blind describes Story Boxes and their benefits for children with vision impairments in this post: Story Boxes: A Hands-On Literacy Experience. They also include some example story boxes corresponding to popular books for young children. The Paths to Literacy website, also by Perkins, provides further suggestions about how to make and use story boxes, particularly for children with vision impairments. The Texas School for the Blind website also provides additional story box examples: What Is a Story Box? by Texas School for the Blind.

Here’s an example of a story box that could be created for the popular board book Little Blue Truck along with explanations of how to modify the activity for different types of access needs:

Little Blue Truck by Alice Schertle, Illustrated by Jill McElmurry:

  • Toy little blue truck and dump truck: You can use any blue toy truck + toy dump truck. Or consider adapted options to meet kids’ motor/ sensory-perceptual needs.
  • Play “muck”/ mud. You could use kinetic sand, brown Play Doh, etc.
  • Something to represent the animals in the story: sheep, cow, pig, chicken/ hen, baby chick, goat, horse, duck, and toad. You can use plastic animals, beanie babies, stuffed animals, animal finger/ hand puppets, animal form puzzle pieces, felt animals for a felt board, etc. The types of animals you may want to use are going to depend on your specific child’s access needs. For example, for a child with significant vision impairment, you will likely want animals with a tactile component (i.e., touch-and-feel animals with different textured surfaces that kids can feel and explore) or auditory component (i.e., animals that make sounds, such as by pressing a button to hear a recorded sound or manipulating a crinkle toy). For a child with motor impairments, you will want animals that are easy to grip and manipulate, or that can be moved around without picking them up (e.g. switch-adapted or remote control animal toys). Some examples are described below; I have not purchased/ used all of these options, but I’ve used some and others just look promising. Note: I don’t benefit financially from the sale of any of these products and have no affiliated with the companies listed (despite the ridiculously high number of examples of Melissa and Doug products that I listed). These examples are informational only.

Tactile animal options:

Large Soft Touch Animals from Discount School Supply (includes pig, cow, sheep, and horse). These are large plastic animals with soft, textured surfaces.

Melissa and Doug Farm Animals Touch and Feel Textured Wooden Puzzle (includes sheep, cow, duck, and horse). The wooden puzzle pieces each have different textured cloth surfaces that cover part (but not all) of each piece.

Auditory animal options

Melissa and Doug Take-Along Baby and Toddler Play Mat (includes cow, pig, chicken, duck, sheep, goat, horse, and 2 farmers). This is a cloth play mat that folds up into a carrying case and includes small soft animal toys that crinkle, squeak, and/ or rattle when manipulated.

Melissa and Doug Meadow Medley (sold separately; available animals include cow, pig, duck, lamb, frog, horse, and more) Meadow Medley Cow, Meadow Medley Piggy, Meadow Medley Duck, Meadow Medley Lamb, Meadow Medley Frog, Meadow Medley Horse

Easy grip animal options

Learning Resources Jumbo Farm Animals : Large plastic farm animals that are easy to pick up. Includes horse, pig, cow, goat, sheep, rooster, and goose.

Fisher-Price Little People Farm Animals: Like all Little People toys, these farm animals are easy to grip and hold. Includes cow, pig, duck, horse, sheep, chicken, goat, and more.

Switch-adapted animal toys

Switch-adapted animals from Ablenet: Includes horse and pig options.

Switch-adapted animals from Adapted Tech Solutions: Includes cow, pig, frog, lamb, duck, and more.



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!