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, 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 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 ūüôā ). 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 ūüôā ).

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 :).