CD 5672 Week 3

1. CD 5672Week 3 Augmentative and Alternative Communication Interventions for Individuals with Developmental Disabilities Summary of Chapters 12, 13 and 14 In Beukelman, , & Miranda, (2005). Augmentative and alternative communication: Supporting children & adults with complex communication needs (3rd Ed.) Baltimore, MD: Brookes Publishing.

2. CHAPTER 12 - LANGUAGE LEARNING AND DEVELOPMENT

3. WHAT WE KNOW ABOUT LANGUAGE DEVELOPMENT IN AAC USERS • Regardless of the cultural, cognitive, social, and other factors that influence language development, all languages are composed of 5 domains: • Pragmatics • Phonology • Semantics • Morphology • Syntax

4. Pragmatics • It is not unusual to find reports that AAC users have impaired pragmatic skills, especially in conversational interactions • During interactions with speaking partners, people who use AAC tend to occupy a respondent role; • they seldom initiate conversations • respond primarily when obliged to do so • produce utterances that are only as long as they need to be to get a message across • However, when two people who use AAC interact with one another, their conversations are much more “equal” than when they interact with natural speakers • The phenomenon of conversational asymmetry appears to be a function of an imbalance in conversational “power” rather than of pragmatic deficits per se in people who use AAC

5. Phonology Although some individuals with SSPI (severe speech and physical impairments; e.g., cerebral pals) are able to analyze and manipulate phonologic information successfully, they score well below control participants on research tasks, regardless of whether other language problems are present At least some potential AAC users are at risk for delays in the area of phonology, in the absence of intervention

6. Semantics • Young AAC users often experience delays in semantics because: • They cannot select their own lexicon for their AAC displays and rely on adults to make those selections, thus, a child’s external lexicon (i.e., the words on his or her communication display) may not reflect his or her internal lexicon (i.e., the words in his or her head) • They may be talked to less than children who do not have disabilities, for a variety of reasons • There is an asymmetry between language input and output such that children “receive” and process words in one modality (i.e., speech) but communicate through another (e.g., manual signs or graphic symbols) • As they select words from their communication displays, they do not receive symbol feedback from their partners, particularly if they overextend words (e.g., if they use the symbol COW to refer to a dog, they might be told the correct word verbally [“No, that’s not a cow, that’s a dog”] but they are unlikely to be shown the correct symbol on their display, even if it is there) • There may be less “convergence” between semantic and conceptual organization in come graphic symbol sets (Blissymbolics) and systems than others (e.g., Picture Communication Symbols) • The challenge for AAC teams in building semantic knowledge is primarily one of providing individuals with sufficient access to new vocabulary via some type of symbol system and then providing ongoing input to build semantic knowledge through the use of that system • Some individuals who use AAC are able to fast map, despite moderate to severe cognitive impairments

7. Morphology • Individuals who use AAC experience marked difficulties with grammatical morphology. • It is not clear why people who use AAC regularly experience problems with morphology, five explanations are possible: • No experience using them, the symbols the AAC user need to indicate (e.g., plural, possessive, or past tense) are not available on his or her communication display • Chooses efficiency over accuracy as a strategy for enhancing the speed of communication • Not yet learned the morphological rules that apply to the situation • AAC modality itself influences output and precludes the need for conventional English morphemes.

8. Syntax Syntactic difficulties of individuals who communicate with graphic symbols: • A predominance of one- or two-word messages, both in spontaneous and elicited conditions • Use of constituent orders that differ from the individual’s spoken language background, regardless of the AAC modality used • Omission of words that appear frequently in the individual’s language, such as verbs and articles, even when available on the communication display • A prevalence of simple clauses, with limited use of complex structures such as questions, commands, negatives, and auxiliary verbs • Extensive use of multimodal combinations (e.g., gesture + symbol, vocalization + symbol), word overextensions (e.g., dog instead of cow), and other linguistic strategies that compensate for a lack of necessary symbols Three primary explanations • Deficit hypothesis: most individuals who use AAC systems have underlying deficits, a notion that has since been disabused • Compensation hypothesis: the atypical “graphic symbol utterance structures reflect constraints involved in aided communication” • Modality-specific hypothesis: between what individuals who use AAC hear (i.e. spoken language) and how they communicate, and are a function of the differences between the two • It is probable that both the compensatory and modality-specific hypotheses contribute to the differences seen in the language patterns of persons who use AAC

9. In Summary… • We can make several statements about language learning and development in individuals who communicate through AAC • Many of these individuals show evidence of both receptive and expressive language impairments, however, it is important to note that many individuals who have never been able to use natural speech have written and spoken eloquently about their experiences and their lives using AAC • Language difficulties experienced by many individuals who use AAC are undoubtedly influenced by the fact that their language-learning experiences are so very different from those of individuals who can speak

10. INTERVENTIONS TO SUPPORT LANGUAGE LEARNING & DEVELOPMENT Graphic Symbols and Language Instructional Strategies and Language Learning Message Units: From Sentences to Morphemes Teaching Strategies

11. Graphic Symbols and Language *One of the challenges in representing any language system for persons who use AAC and do not (yet) know how to read involves how to “translate” spoken language into a visual form without losing specificity and flexibility, the answer depends on whom you ask...* • Blissymbolics • DynaSyms • Minspeak • Manual Signing

12. Blissymbolics: The use of this pseudolinguistic system allows users to learn about the rules of morphology, syntax, and message construction • DynaSyms: A symbol set used on some dynamic display SGDs, including grammatical markers and symbols that allow representation of tense, plurals, possessives, and other grammatical forms • Minspeak: AKA: semantic compaction, a technique to support language which has been debated and derived two main questions: • Is Minspeak a language? • Does Minspeak promote language development? • Minspeak is not a language. It does not have an established rule system, set of icons, or set of meanings associated with particular icons, rather, it’s an iconic encoding technique whereby “symbols are organized so that they can be joined together to access a vocabulary with a minimum of keystrokes” • Some believe that Minspeak does promote language development because of the similarities among semantic compaction, language learning, and literacy learning and use *Thus, semantic compaction, language, and literacy all share the characteristic of being generative in nature. Others argue that the question is not a fair one because no symbol or encoding system itself promotes (or impedes ) language development–it all depends on how it is taught and used!*

13. Manual Signing Linguistic in nature Individuals with a range of disabilities are often able to acquire extensive manual sign vocabularies in the course of intervention Manual sign learning often stalls at the one-word stage of development, especially when individuals with cognitive disabilities use it Nonetheless, despite some clear theoretical advantages in favor of manual signing as a technique for language learning, the research suggests that there may be no real advantage to using this symbol system rather than others for AAC users who can hear.

14. Instructional Strategies and Language Learning By instruction, we mean methods for organizing and teaching the use of symbols, in this case, to encourage language development Not one best way to do this Little research exists in this area overall Find ways to create links between whichever system a person uses for face-to-face communication and whichever system he or she uses for language and literacy instruction, so that he or she is not faced with the daunting task of learning completely separate systems for each of these domains

15. Organizational Strategies • Have the potential to encourage language learning • Two main categories: • Grid displays, in which the elements depicted are the event, persons, objects, • Related actions that are inherent components of the scene

16. Organizational Strategies: • Activity Grid Displays • Semantic-Syntactic Display • Taxonomic Grid Displays • Visual Scene Displays • Other Categorical Arrangements

17. Activity Grid Displays • One of the most popular grid display strategy involving the organization of vocabulary according to even schemes, routines, or activities • Many AAC users begin using pictorial or other graphic symbol displays that are organized for different environments or activities which can function as overlays on electronic devices or as stand-alone, low-tech communication aids • Participation is enhanced when multiple activity displays are available • Activity displays can also be designed for use by individuals across the age range in community, school, and vocational settings • Advantage: facilitators can construct new displays relatively quickly using only the vocabulary items appropriate to the activity or event • Activity-based displays are preferable to semantic-syntactic displays because they latter adds to the cognitive demands of the task for individuals who might not think in semantic categories • Promote the use of multiword linguistic structures and build a strong receptive language base

18. Semantic-Syntactic Display • Encourages the AAC user to learn language by mapping the symbols according to spoken word order and/or usage (i.e. organizing symbols from left to right into categories such as who, doing, modifiers, what, where, when and so forth with frequently used phrases and letters clustered along the top or bottom of the display) • Taxonomic Grid Displays • Grouping symbols according to superordinate semantic categories such as people, places, feelings, food, drinks and action words • Visual Scene Displays • Visual scene displays are similar to activity displays in that they contain vocabulary words associated with specific activities or routines • The words in a scene display are organized schematically rather than semantically • Most appropriate for use with speech-generating devices (SGDs) with dynamic screen displays • Other Categorical Arrangements • Some individuals may have skills that facilitate the use of unique categorical arrangements.

19. Message Units: From Sentences to Morphemes Message units can range in length from 1 symbol=1 paragraph to 1 symbol=1 morpheme marker, in between these two extremes are symbols for sentences (e.g., a single symbol that means leave me alone), phrases (e.g., I want or I don’t want), and single words

20. Longer message units speed up the communication process, which is usually slow and cumbersome. Longer message units require fewer cognitive/linguistic resources and may be good for individuals who fatigue easily, are minimally motivated to communicate, and/or are just learning to use AAC techniques. Finally, longer message units permit the person to produce messages that actually exceed his or her productive language ability. “How does use of different message unit lengths affect both long- and short-term language development?” But… longer message units may also impede communication accuracy. Shorter message units such as words and morpheme markers, allow more flexibility in communication. Having opportunities to manipulate word- and morpheme-length units is also likely to enhance language development. Finally, shorter message units reduces the need for the individual to have to “translate” the language he or she hears (input modality) into the language he or she is able to use (output modality).

21. Teaching Strategies • Structured Approaches • Milieu Teaching • Interactive Model • Aided Language Stimulation and the System for Augmenting Language (SAL)

22. Structured Approaches Characterized by adult- or computer-delivered discrete trials that are usually conducted with one learner at a time Typically, each trial consists of a stimulus (e.g., the facilitator holds up a cookie and asks, “What’s this?”), a prompt (e.g. from an array of two photographs, a cookie and a shoe, the facilitator gestures toward the symbol for cookie), a response by the learner (e.g., he or she points to the cookie photo) and a reinforcer (e.g., the facilitator says “good work!”) Note* the use of a structured teaching approach to teach labeling may have some advantages over other instructional approaches, especially when applied in natural contexts A “two- pronged approach” is recommended for teaching manual signs, with structured discrete trial techniques to teach language forms and incidental instructional paradigms to teach the use of the forms The problem with generalization is one of the major disadvantages of structured approaches to language intervention

23. Milieu Teaching • A naturalistic strategy for teaching functional language skills • Appears to be more effective than structured approaches in promoting early vocabulary learning and abstract symbol learning • Most reports of successful AAC interventions using milieu teaching have been confined to individuals at the early stages of language development who are learning functional, one-word communication skills. Few reports have documented the efficacy of milieu teaching to develop more complex language with AAC techniques.

24. Interactive Model Parent training programs situated within an interactive model of language development that are designed to teach parents to provide rich language input, respond to their child’s communicative attempts, and encourage the use of a variety of language forms and functions Parent training programs: The Hanen Early Language Parent Program and associated offshoots such as More than Words and Allow Me; the Prelinguistic Milieu Teaching At least in the short term, parents trained within the Interactive Model learn to be more in tune with their child’s abilities, more responsive to the child’s focus and communicative attempts, and less controlling of the child’s conversational topics Both short- and long-term treatment effects of standard Interactive Model interventions are usually restricted to increase use of existing competencies and do not include acquisition of new communication and/or language skills Interactive Model programs, which are widely used in North America, can be applied to successfully to at least increase communication opportunities for beginning AAC users.

25. Aided Language Stimulation and the System for Augmenting Language (SAL) Both designed specifically for AAC applications and based on milieu teaching with several additional elements Both are total-immersion approaches to teaching individuals to understand and use graphic symbols with the purpose of providing learners with models for combining symbols in a flexible manner and opportunities to do so Based on the premise that by observing graphic symbols being used extensively by others in natural interactions, “the [learner] can begin to establish a mental template of how symbols can be combined and recombined generatively to mediate communication during the activity”. Both are intended to teach the AAC learner to use language in a very natural way that eliminates the need for more structured training interventions, because they mimic the way natural speakers learn to comprehend language

26. Aided Language Stimulation • A facilitator “highlights symbols on the user’s communication display as he or she interacts and communicates verbally with the user”, similar to the “total communication” approach used to teach manual signs to individuals with hearing or other impairments • Also incorporates a variety of techniques for eliciting communication using symbols and other AAC modes. Nonverbal juncture cues are “nonverbal signals (achieved via facial expression, gesture, body posture) performed by the facilitator that precede the highlighting of a symbol on the communication display.” • The cues serve two functions: • They code the target symbol in nonverbal form • They help the individual to anticipate symbol selection by providing a brief time delay during which the individual might jump ahead of the facilitator and select the symbol spontaneously

27. System for Augmenting Language (SAL) • AKA: Augmented Communication Input • Similar to aided language stimulation, with two notable exceptions: • The use of an electronic voice-output communication device is considered a critical component of the intervention • SAL techniques are much simpler than the elaborate procedures for augmented input and elicitation used in aided language stimulation • Similar to aided language stimulation, with two notable exceptions: • The use of an SGD is a critical component of the intervention • SAL techniques are much simpler than the elaborate procedures for elicitation used in aided language stimulation • Communication displays using graphic symbols with a printed word gloss are constructed for the learner’s SGD, and communication partners learn to activate symbols on the device to augment their speech input in naturally occurring communication interactions. • A 2 year longitudinal study of SAL showed: • Generalized use of their communication devices with both familiar and unfamiliar adults and peers without disabilities in a variety of environments • Students learned to use arbitrary symbols in combination with gestures and vocalizations to request items, assistance, and information; to make comments; and to answer questions, among other functions • Meaningful and functional symbol combinations spontaneously emerged in the repertoires of 10 of the 13 participants

28. CHAPTER 13 - LITERACY DEVELOPMENT OF CHILDREN WHO USE AAC

29. Most individuals consider reading and writing skills to be a valued component for successful participation in society. These skills allow them to use literacy as a tool for communication, critical thinking, and the attainment of social and cultural power.

30. Primary Motor Impairments/Severe Speech and Physical Impairments (SSPIs) Includes individuals with: congenital impairments such as cerebral palsy and arthrogryposis, as well as people with acquired impairments (e.g., spinal cord injuries) The greatest barrier to literacy learning may be reduced opportunities to engage in authentic reading and writing opportunities and erroneous beliefs that individuals with SSPIs are not capable of learning to read and write Lack of knowledge about literacy curricula and supports to literacy learning has been one of the critical challenges in supporting the literacy learning of students who use AAC

31. Handwriting/Fine Motor Impairments Dysgraphia: inhibit the mechanics of producing words on paper This difficulty with handwriting may be related to underlying fine motor control or eye-hand coordination problems, visuospatial impairments, or attention deficits Many students with fine motor impairments also experience learning disabilities, specific language impairments, and/or cognitive impairments

32. Specific Language Impairment • Is considered to be a primary, rather than a secondary, disorder in that it is not the result of mental retardation, autism, or other etiologies • Considerable attention has focused on describing a heterogeneous group of children who have considerable difficulty with spoken receptive and expressive language • Specific language impairment, childhood aphasia, developmental aphasia, dysphasia, and language disability, among others, have been used interchangeably to refer to the problems that children experience

33. Learning Disabilities • A variety of names used, including language-learning disabilities, dyslexia, minimal brain dysfunction, and specific reading disabilities, among others. • The national Joint Committee on Learning Disabilities uses the following definition: • Learning disabilities is a general term that refers to a heterogenous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. • These disorders are intrinsic to the individual, presumed to be due to a central nervous system dysfunction, and may occur across the life span. • Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. • Although learning disabilities may occur concomitantly with other handicapping conditions...or with extrinsic influences...they are not the result of those conditions or influences.

34. Cognitive Impairments People whose intellectual abilities lag behind their same-age peers The severity may vary widely across individuals and is usually established in terms of an individual’s scores on both norm-referenced intelligence tests and adaptive behavior scales When making decisions about literacy instruction, consider not only the impairment itself but any additional learning needs that might be present Many children with cognitive impairments can develop both emergent and conventional literacy skills and should receive access to the same instructional opportunities as typically developing children

35. Visual Impairments The vast majority of these individuals are not totally blind, it is estimated that 80% of all individuals classified as legally blind have residual vision that is sufficient for use as a primary learning channel for reading, writing, and other school activities Assessment involves specialized vision tests that evaluate a number of components including visual acuity, visual field magnitude, oculomotor functioning, light and color sensitivity, and visual stability Approximately 50-60% of school-age individuals with VI have additional impairments, with physical and/or intellectual abilities occurring most often Educational adaptations for this population should consider use of enlarged text, enlarged keyboards, screen magnifiers, speech output text readers, or braille

36. Autism Spectrum Disorders As you know… • As many as 40-60% of children with ASD do not use speech as their primary mode of communication • Some of these individuals have significant strengths in word recognition (e.g., hyperlexia) and relative deficits in comprehension that are evidenced across language and literacy

37. Emergent Literacy and Literacy Development

38. Early Literacy Experiences of Typically Developing Children The home environment is important in laying the foundation for success in literacy Literacy learning is thought by many to begin at birth, as writing, reading, speaking, and listening skills develop simultaneously Across both home and school environments, the literacy experiences of children who use AAC are distinctly different from those of typical children A large part of becoming literate is learning the functions of literacy, simply having exposure to favorite books, children learn a host of literacy concepts - story schema, plot structure, anticipation of events, memories from previous readings, and ways in which story language creates emotions such as surprise and humor

39. Early Literacy Experiences of Children with Severe Communication Impairments and those who use AAC • Substantial differences exist between the experiences of children who do and do not have disabilities in learning to read *One survey found that although parents of preschoolers without disabilities reported that they read to their children daily, parents of children with SSPIs read to their children, on average, two to three times per week* • Factors that influence literacy development in children with severe communication impairments: • Many parents of children who use AAC report that they primarily focus their priorities on communication and meeting the children’s physical needs, in contrast, parents of typically developing children place the highest priorities on communication, making friends, and literary activities • Children who use AAC often have difficulty manipulating and playing with literacy materials (e.g., selecting books, turning pages of books, playing with pencils and crayons) because of their motor impairments • Positioning and seating difficulties, paired with vision impairments, may make it difficult for these children to see the illustrations while their parents and teachers read to them; which, in turn, influences the quality of the interactions during storybook reading activities • Language and cognitive factors affect the development of play skills related to literacy (e.g., pretending to read), and parent modeling of literacy opportunities may be less frequent because the child is less mobile • Children may also be unable to provide their parents with feedback related to their level of understanding as well as their preferences • Classroom literacy learning experiences have also been found to be substantially different for school-age students who use AAC compared with their typically developing peers, instruction differs not only in quantity but also in quality and amount of time spent engaged in literacy tasks.

40. RELATIONSHIP BETWEEN LANGUAGE KNOWLEDGE AND LITERACY LEARNING

41. Early Literacy Support • Three main principles of child learning should guide activities: • activities should be child directed and interactive, with the parent following the child’s lead • parents should consider learning to be a constructive process in which the child participates actively and is supported to map previous knowledge onto new experiences • literacy tasks should be meaningful, goal directed, and embedded in purposeful activities.

42. Reading and Storytelling • Strategies family members, teachers, and others can use to encourage the development of literacy skills: • Read age-appropriate stories aloud frequently and repeatedly, young children enjoy hearing the same story over and over- repetitive reading helps children to see that all stories contain a predictable structure (pattern) • Involvement in story times such as those sponsored by many libraries, as well as by visiting the library with the child to borrow books from an early age • AAC users need integrated communication and literacy activities that allow them to engage in active, meaningful interactions about texts • It is essential that AAC users master considerable language knowledge before entering the elementary grades, the development of conventional literacy skills is inextricably linked to the potential of their language and communication systems

43. Writing and Drawing Children also need opportunities to learn writing, drawing, and other composition skills that involve the use of output tools

44. Augmented Reading and Writing • Emergent literacy computer programs for young children are available to teach language and preliteracy skills to young children that provide AAC users with access to materials that foster critical reading skills, (e.g., grapheme-phoneme awareness). • Emergent reading software offers: • Opportunities to develop skills in visual discrimination, letter naming, letter recognition and recall, sight word recognition, spelling, and phonics (e.g., letter-sound combinations); • Access to basic decoding and writing functions, such as sounding out words inventing word spellings, and engaging in early writing that is legible, (e.g., writing names of family members, writing familiar environmental print such as Stop or Exit) • Access to drawing tools or picture dictionaries to produce story illustrations.

45. SYMBOLIZATION AND LITERACY LEARNING ! # 123 $ & ABCDEFGHIJKLMN

46. Graphic Symbols and Language Development • Most young children with SSPIs who cannot speak are also unable to read and spell in order to prepare their messages • Many of these students must focus on the simultaneous acquisition of three modes of communication-speech, graphic symbols, and orthography • Instructors should consider overlapping features of the three modes and utilize instructional time as a means to foster integration of concepts across modes • Through exposure to print children learn: • that print conveys meaning • that there is directionality to the way we read • a basic understanding of the concepts of words, letters, and sounds • that the words we speak are mapped onto print and there are certain patterns in speech-to-print correspondence • that each letter has a shape and a name • that letters can represent sounds

47. Graphic Symbols Cont. • There are several important skills related to the influence of language abilities on reading comprehension. These critical variable include: • phonological processing skills • word recognition abilities • problem-solving skills • lexical processing abilities • syntactic awareness • semantic knowledge • narrative discourse processing skills • Difficulty with any one of these skills may have an impact on the individual’s ability to comprehend text • Frequent exposure to graphic symbols and orthography may not automatically give students who rely on AAC an “upper hand” in the early stages of literacy

48. The contributions of graphic symbols to literacy learning: When learning AAC symbols, children develop the knowledge that symbols convey meaning, and they may be able to transfer this concept to understand that print also conveys meaning When communication displays support left-to-right progressions, children may also learn the concept of print directionality When symbols are paired with traditional orthography, children who use AAC are exposed to the concept of words When facilitators draw attention to the concept of letters, and communication displays utilize sound symbol mapping rules, knowledge of words, letters, and sounds may be fostered Symbols are presented at the whole-word level, so the ability to recognize words out of context, and to discriminate individual letters through paired associative learning (i.e., letter-phoneme associations and speech-to-print matching) is not facilitated Because symbols are not orthographic in nature, they are unlikely to teach children who use AAC that letters have shapes and names and that letters can represent sounds

49. The relationships between graphic symbols and reading comprehension: • Phonological awareness skills in students who use AAC also play a role in facilitating word recognition and thus support their ability to understand text • For students who use AAC, word knowledge relates directly to the availability of symbols to communicate, the more symbols the student has, the more vocabulary words he or she can manipulate and use • Graphic symbols play a role in supporting syntactic awareness and competence if facilitators or teachers teach the student who uses AAC to integrate symbols into sentence sequences • Pragmatic awareness: ability to recognize relationships between groups of sentences, to create on overall representation of the sentences, and to use prior knowledge to gain the full meaning of a passage. This skill develops through experience with written paragraphs, thus the influence of graphic symbols on comprehension at this level is unclear

50. Graphic Symbols and Reading Acquisition • Print Conveys Meaning • When learning AAC symbols, children develop the knowledge that symbols convey meaning, and they may be able to transfer this concept to understand that print also conveys meaning. • Directionality of Print • When communication displays support left-to-right progressions, children may also learn the concept of print directionality. • Words, Letters, and Sounds • When symbols are paired with traditional orthography, AAC users are exposed to the concept of words. In order to emphasize this concept, as well as to draw attention to the concept of letters, facilitators can teach AAC users to relate the words on their communication displays with written text. • Graphic symbols are unlikely to teach AAC users that letters have shapes and names and that letters can represent sounds because the symbols are not orthographic in nature, graphic symbol use will teach these concepts only if the AAC user communicates with the symbol set in combination with traditional orthography and if the facilitator directs the user’s attention toward the sound system of language.