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 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!