Transcript Supporting Students with Communication Deficits Across Routines

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Supporting Students with
Communication Deficits
Across Routines
Jaime Lawson, M.S. CCC-SLP
Meredith Laverdure, M.S. CCC-SLP
Maggie Jarvela, M.S. OTR/L
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Sharing Your
Experiences
What are your experiences with
alternative and augmentative
communication?
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What is AAC?
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“Augmentative and alternative
communication (AAC) refers to using
a form of communication to
supplement or replace spoken
and/or written words. AAC may
include using signs/gestures,
pictures, or an electronic device to
help a person share his or thoughts”
(McDaniel, 2012).
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The Occupational Therapy Practice
Framework states:
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Why should OTs
care about this?
…because you’re nice people. And
also…
“Occupational therapy practitioners
use their knowledge of the
transactional relationship among the
person, his or her engagement in
valuable occupations, and the context
to design occupation-based
intervention plans that facilitate
change or growth in client factors…
and skills (motor, process, and social
interaction) needed for successful
participation. Occupational therapy
practitioners are concerned with the
end result of participation and thus
enable engagement through
adaptations and modifications to the
environment or objects within the
environment when needed.” (AOTA,
2014).
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AAC and Engagement
“A word devoid of thought is a
dead thing, and a thought
unembodied in words remains a
shadow.”
Lev S. Vygotsky
“Not having heard something is
not as good as having heard it;
having heard something is not as
good as having seen it; having
seen it is not as good as knowing it;
knowing it is not as good as
putting it into practice.”
Xunzi
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What is Language?
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Language is made up of socially shared rules that include the
following:
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What words mean
How to make new words
How to put words together
What word combinations are best in what situations (ASHA, 2016b)
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“Language is the system that allows us to understand and
produce speech and writing.”
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“Vocabulary is only one element of language.”
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“Language is how vocabulary fits together to create meaning
and communication” (Baker, Witkowski, Navrotski, & Kovach,
2015).
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Core and Fringe Vocabulary
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Core vocabulary
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Small, commonly used vocabularies
Does not change across environments or between users
Core shows a 90% overlap from preschool through adulthood and
does not vary demographically with any language (Baker,
Witkowski, Navrotski, & Kovach, 2015)
A child can communicate a variety of topics across multiple
settings using a set of core vocabulary (Nevers, 2010)
Fringe vocabulary
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Based on individual preferences
Changes with environments and activities (Banajee, 2015)
Lacks varied parts of speech with heavy use of nouns (Nevers,
2010)
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Core and Fringe Vocabulary
(Nevers, 2010)
Characteristic
Core Vocabulary
Fringe Vocabulary
Number of Words
Small number of words
Very large number of words
Frequency of Use
High frequency
Low frequency, occur
infrequently
Applicability Across
Environments
Applicable to all
environments
Applicable to limited
environments, lack
versatility
Applicability Across
Topics
Applicable to all topics
Applicable to limited topics
Types of Words
Includes a variety of parts of
speech
Includes mostly proper
names and other nouns
Usefulness in a Single
Message
Approximately 80% of the
words in a 100-word sample
will be core, but many core
words will be used
repeatedly, so the number of
different words is small.
Approximately 20% of the
words in a 100-word sample
will be fringe. Number of
different words will be
large, as fringe words are
repeated with much lower
frequency than core words.
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Core and Fringe Vocabulary
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Limitations of fringe
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Core and Fringe Vocabulary – You
Decide!
Eat
Help
Bathroom
Name
Toaster
Yes
My
What
Frisbee
Game
Go
Open
Cup
Spoon
Up
School
Mom
Milk
Sit
That
Seat
Some
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Vocabulary Research
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Banajee, DiCarlo, & Stricklin, 2003
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Researchers studied the vocabulary of 50 toddlers between the
ages of 2-3 years old.
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26 core words made up 96.3% of everything the toddlers
said/produced.
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Which of these words have
you seen on a
communication
board/system?
Which word are you
surprised to see?
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Vocabulary Research
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Marvin, Beukelman, & Bilyeu, 1994
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Surveyed the language of 10 nondisabled preschoolers at home
and at preschool
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Detected similar vocabulary-use patterns at home and at
preschool
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Vocabulary Research
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Balandin & Iacono, 1999
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Surveyed the language of 34 non-disabled adults
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347 core words made up 78% of the language sample
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Our Example
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https://youtu.be/6J1MqrQ8uxg
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Our Example
Word
Freq.
Word
Freq.
Word
Freq.
I
14
Of
2
Sadie
1
And
10
See
2
Have
1
This
10
Rainbow
2
A
1
The
9
Watermelon
2
Food
1
Colored
7
Fighting
2
Fight
1
That
4
Here
2
Want
1
Not
4
Over
2
Tell
1
These
3
Hamburger
2
You
1
Did
3
Know
2
Made
1
Um
3
Hi
1
Let
1
Color
3
My
1
Me
1
One
3
Name
1
Three
1
To
2
Is
1
Four
1
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Our Example
Word
Freq.
Word
Freq.
They
1
Ice cream
1
Are
1
Do
1
Those
1
Who
1
Cat
1
But
1
Candles
1
Bottom
1
Windows
1
Almost
1
About
1
Fall
1
Off
1
Well
1
Legs
1
Donuts
1
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Our Example
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Your Turn
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Name common routines frequently addressed during therapy
sessions.
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As a group, brainstorm core vocabulary that is appropriate
for a child’s communication system for these routines.
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The Spectrum of Communication
Systems
Visual
Supports
No-tech
systems
Low/midtech
systems
Hightech
systems
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Things to Consider (Nevers, 2010)
Line drawings,
photographs, text,
etc.
Vocabulary,
messages,
organization,
layout, etc.
Format
Device, book,
board, pictures,
signs, etc.
Access
Point, switch, eye
gaze, etc.
Symbols
Content
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Visual Supports
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An aid to facilitate a desired action or behavior during an
activity
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Benefits
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A visual representation of a desired outcome
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Decreasing the amount of verbal bombardment and increasing
input of expectations
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Multimodality input for an activity
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Visual Support – Incorporating
Core Vocabulary
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Use the picture to demonstrate the target action or specific
task while using the written direction to provide core
vocabulary exposure
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Repetitive use of core vocabulary in the directions will allow
for increased acquisition of the target vocabulary across
multiple tasks. It does not result in the simplification of the
task.
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Visual Supports - Examples
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First, then board
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Choice boards
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Visual Supports - Examples
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Sequencing strip
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Transition visuals
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Visual Supports - Examples
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Visual Schedule (Van Tatenhove, N.D.)
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Visual Supports - Examples
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No/Lite-Tech Communication
Systems
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A static communication system that teaches preliminary
communication skills, such as cause and effect as it applies to
communication.
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Paper-based systems (Grandbois, 2012)
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Emphasizes the exchange of information from one person to
another (Grandbois, 2012)
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Benefits
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Decreases the expectations given to the user to manage a dynamic
display
Allows for tactile manipulation of targeted responses, such as putting
together a sentence strip
Provides a consistent visual prompt of targeted responses with
decreased requirement of verbal bombardment/prompting
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No-Tech Communication Systems –
Incorporating Core Vocabulary
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Utterances are generated using applicable core vocabulary
through a system that can be used across activities.
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Due to ease of manipulation, it can be used across activities
and settings easily, increasing opportunities to learn and
produce core vocabulary in various activities.
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Within each activity, associated fringe may be presented.
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Again - repetitive use of core vocabulary in the directions
will allow for increased acquisition of the target vocabulary
across multiple tasks.
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No-Tech Communication Systems Examples
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Sentence strip
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Core communication boards
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No-Tech Communication Systems Examples
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PASS software with Unity
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No-Tech Communication Systems Examples
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In the classroom
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Low/Mid-Tech Communication
Systems
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Portable, inexpensive, voice output communication system
typically with a static display (Grandbois, 2012)
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It may require caregiver/educator involvement to change overlays or
voice output settings.
Benefits
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Can be used with a no-tech communication system to pair core and
fringe vocabulary across settings
Exposes the user to voice output and expanded field sizes
Can create opportunities for repairing communication breakdowns
Cost efficient and more availability within the school system
Multiple access options
Provides tactile feedback upon access, giving the user increased
awareness of access
Varying field sizes depending on which system is introduced, starting
a field of one, going up to field sizes of 32
Scanning capabilities
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Low/Mid-Tech Communication
Systems – Incorporating Core
Vocabulary
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Static overlays can be used to prioritize core vocabulary use,
teaching the user its application across activities.
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Allows for vocabulary to remain in the same location, which
improves motor planning and automaticity
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Low/Mid-Tech Communication
Systems - Examples
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Minicom and Sequencer Switch
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Rocking Switch
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Cheap Talk 4 and 8
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Low/Mid-Tech Communication
Systems - Examples
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Big Mack and Little Mack
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Quick Talker
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Go-Talk 9, 16, and 20
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Low/Mid-Tech Communication
Systems - Examples
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32 Communicator
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High-Tech Communication
Systems
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Speech generating devices, typically with dynamic display,
meaning the user can change the vocabulary screen by
pressing a button (Grandbois, 2012)
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Most often dedicated systems, meaning that the device is for
communication only
Benefits
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Access to larger field sizes with minimal caregiver/educator
involvement
Capabilities to modify field sizes with ease depending on various
user factors, such as vision, motor access, and communication
needs
Scanning capabilities
Variety of access modifications
Vendor representative and tech support resources
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High-Tech Communication
Systems – Incorporating Core
Vocabulary
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Home/Core page is programmed with high frequency core
words to produce a variety of utterances with limited
navigation
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Fringe vocabulary is linked to its associated core word
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For example, foods are linked to ‘eat’
Allows for vocabulary growth and language expansion over time by
hiding and showing vocabulary as deemed appropriate
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Decreasing opportunities of feeling overwhelmed by having all of
the core vocabulary shown at one time initially
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High-Tech Communication
Systems - Examples
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Tobii/DynaVox
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I-12 and I-15
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T7, T10, T15
Prentke Romich Company
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Accent 800, 1000, and 1400
Saltillo
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Nova Chat 5, 8, 10, 12
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High-Tech Communication
Systems - Examples
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Talk to Me Technologies
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Wego 10A, 7A, 10W
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eyepeak
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Zuvo
iPad
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Proloquo2go
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Verbally
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Sono Flex
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Descriptive Answers
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Emphasizes the use of core vocabulary (Baker, Witkowski, Navrotski, &
Kovach, 2015).
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Users provide a definition or description of a word using core vocabulary
Teaches students to use permanent words in flexible and meaningful ways
Talk “about,” “how,” “where,” etc. (Nevers, 2010)
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Not “what”
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Targets longer sequences of symbols (Nevers, 2010)
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Prioritizing the use of high frequency vocabulary virtually eliminates the
need to program a revolving vocabulary of curriculum words (Baker,
Witkowski, Navrotski, & Kovach, 2015).
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Benefits (Baker, Witkowski, Navrotski, & Kovach, 2015).
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Students are given opportunities throughout the day to learn language skills
Students receive ongoing practice in using high frequency vocabulary in a variety of
contexts
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Descriptive Answers
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For example –
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Ocean: biggest water
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Teepee: where they live
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Hunting: way to get food
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YOUR TURN!
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Applying Core Vocabulary
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As a group, select 3 daily routines across 3 different age
demographics.
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1. Playdough
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2.
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3.
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From the set overlay, select 8 core vocabulary words and
write in 8 fringe vocabulary words that are suitable for all 3
activities.
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Demonstration
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Motor Automaticity
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Related to the development of motor patterns associated with specific
symbols
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Makes communication effective and efficient
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Automaticity is possible with (Adkins, 2012):
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Habitual movements become subcortical
Cortical areas can be put to better use (Adkins, 2012)
Consistent icon location
A small icon set (immediate recognition)
Predictable transition from one icon to the next
Automaticity is not possible when (Adkins, 2012):
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Significant navigation is required
An AAC user must continually refocus and reorient to the communication
system
 Requires a consistent layout and symbols that don’t move (Nevers, 2010)
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Motor Automaticity
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“Normally speakers have no conscious access to language encoding or
articulation. For most speakers, language production is relatively
effortless.” (Schlosser, 2003 as cited by Adkins, 2012)
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Motor Learning Stages (Adkins, 2012)
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Cognitive stage
 Learner must attend to the process of learning a motor action
 Highly variable performance
 Needs guidance to detect and correct errors
Associative stage
 Refining skills
 Able to detect and correct errors
Autonomous stage
 Result of much practice
 Not concentrating on the movement and can attend to other aspects of the
activity
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Motor Automaticity (Baker, Witkowski,
Navrotski, & Kovach, 2015).
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Cognitive component: Awareness of general situation,
identification of icon and position in sequence, knowledge of
its location
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Physical component: Knowing how to access an icon, having
a motor plan for a particular icon sequence
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Linguistic component: Knowledge of existence of a link
between an icon and word, knowledge of the semantic role of
the word
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Conclusion
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Core vocabulary is applicable to all communicators, all
situations, and all communication functions.
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“True communication is spontaneous and novel…
Communication requires access to a vocabulary of individual
words suitable to our needs that are multiple and subject to
change” (ASHA, 2016a).
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The best opportunity to target true language development is
when a child is fully engaged and motivated.
Questions?
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Contact Us
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Jaime Lawson – [email protected]
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Meredith Laverdure – [email protected]
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Maggie Jarvela – [email protected]
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References
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Adkins, J. (2012, June). Language acquisition through motor planning. The Center for AAC and
Autism. Retrieved from http://doepartnership.fmhi.usf.edu/archive/SumInst_2012/Handouts2012/Adkins/Adkins_LAMP_Color.pdf
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American Occupational Therapy Association (AOTA). (2014). Occupational therapy practice
framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl.
1), S1-S48.
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American Speech-Language-Hearing Association (ASHA). (2016a). Augmentative
communication: A glossary. Retrieved from
http://www.asha.org/public/speech/disorders/AAC-Glossary/
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American Speech-Language-Hearing Association (ASHA). (2016b). What is language? What is
speech? Retrieved from http://www.asha.org/public/speech/development/language_speech/
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Baker, B., Witkowski, D., Navrotski, D., & Kovach, T. (2015, December). Picturing language: A
“how-to” workshop. Paper presented at Pittsburgh AAC Language Seminar, Pittsburgh,
Pennsylvania.
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Balandin, S. & Iacono, T. (1999). Crews, wusses, and whoppas: Core and fringe vocabularies of
Australian meal-break conversations in the workplace. Augmentative and Alternative
Communication, 15, 95-109.
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Banajee, M. (2015, December). Vocabulary selection. Paper presented at Pittsburgh AAC
Language Seminar, Pittsburgh, Pennsylvania.
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References
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Banajee, M., Dicarlo, C., & Stricklin, S.B. (2003). Core vocabulary determination for
toddlers. Augmentative and Alternative Communication, 19, 67-73.
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Grandbois, K. (2012, November). Augmentative and alternative communication. Autism
Speaks. Retrieved from
https://www.autismspeaks.org/sites/default/files/augmentative_alternative_communic
ation_webinar.pdf
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Marvin, C. A., Beukelman, D. R., & Bilyeu, D. (1994). Vocabulary-use patterns in
preschool children: Effects of context and time sampling. Augmentative and Alternative
Communication, 10, 224-236.
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McDaniel, J. (2012). No-tech and low-tech AAC for children with autism spectrum
disorders (ASD): A guide for parents. Vanderbilt Kennedy Center. Retrieved from
http://kc.vanderbilt.edu/kennedy_files/AACChildrenwithASD-April12.pdf
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Nevers, M. (2010, December). Getting started with core vocabulary. Retrieved
fromhttp://www.uvm.edu/~cdci/at/webinars/core_vocab_12-152010/files/core_vocab_full_page_slides.pdf
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Van Tatenhove, G. (N.D.) Using visual schedules to expose and reinforce core
vocabulary. Retrieved from
http://www.minspeak.com/teachers/documents/Visual%20Schedules%20CorePixons.pdf