Alternate Communication Systems: Providing a Voice for Students with Intellectual Disabilities

1. Alternate Communication Systems: Providing a Voice for Students with Intellectual Disabilities Lee Ann Brammer, M.A., CCC-SLP, Speech-Language Impaired, Coordinator, WVDE

2. Financial Disclosure Ms. Brammer is employed by the West Virginia Department of Education. She has no other relevant financial or nonfinancial relationships to disclose.

3. Learner Outcomes • Participants will learn different aspects of communication and cognition • Participants will learn ways to address needs of student with multiple disabilities • Participants will learn ways to evaluate students with intellectual disabilities • Participants will learn about the importance of core vocabulary • Participants will learn about available communication systems for student with autism and receive some hands-on experience

4. IT TAKES A TEAM

5. Population This presentation will focus on the 1% population who will be participating in everything Alternate.

6. Let’s Look at Some AAC Myths

7. Myth Busting Myth Number 1 – AAC hinders or stops further speech development. Research clearly shows that the use of AAC can actually help children develop speech. Consider AAC if: • Inadequate vocabulary • Not understood by all partners • If the child only repeats what he’s heard.

8. Myth Busting – (continued) Myth Number 2 – Children must have a certain set of skills to be able to benefit from AAC. There are no prerequisites to communicate!

9. Myth Busting – (continued) Myth Number 3 – Speech Generating Devices are only for children whose cognition is intact. Advances in technology mean that advanced cognitive skills are not necessarily needed to use high tech systems.

10. Myth Busting – (continued) Myth Number 4 – Children have to be a certain age to benefit from AAC. Research has shown that providing a communication system early is beneficial and will not hinder speech development. AAC has been cited as an evidenced-based strategy for helping speech develop in young children. Waiting too long denies a child the opportunity to learn language.

11. Myth Busting – (continued) Myth Number 5 – There is a representational hierarchy of symbols from objects to words. Research has shown that children can learn any symbol if it’s presented often and consistently. There is no research that shows that children l earn less complicated symbols faster.

12. Early Intervention “Early intervention can help improve learning, communication and social skills, as well as underlying brain development.”

13. Communication Intervention “Augmentative and alternative modes of communication (AAC) have assumed an increasingly important role in meeting the communicative need of individuals with severe disabilities. Despite the potential of AAC to enhance an individual’s communicative effectiveness, practitioners may encounter challenges in implementing AAC interventions with individuals with severe disabilities.” (ASHA Practice Portal on AAC)

14. Communication

15. Communication Children communicate to greet others, request desired objects, request help, comment on objects/actions, refuse, ask questions, direct others, entertain and share events by initiating communication spontaneously. Children with severe intellectual disabilities should have the opportunity and be taught to initiatespontaneous communication, too!

16. How Intellectual Functioning Affects Communication Skills • Language may be slow to develop • Speech may be delayed, or there may be no speech at all • Difficulty understanding and using language (verbal and nonverbal) • Social skills may be poor (relationships with family and friends) • May misinterpret the intentions of others • Has trouble linking actions to consequences • May use simple language with short sentences • Displays some obsessive / compulsive behaviors • Difficulty following rules and routines

17. How Intellectual Functioning Affects Communication Skills (continued) • Will have important relationships with the people in their life • May have little or no speech and will rely on gestures, facial expressions, and body language to communicate needs or feelings • Will require functional communication systems (e.g. low or high tech augmentative communication devices) in order to express their wants and needs • Will need visual prompts such as daily schedules and pictures of routines • Will require extensive support with daily living activities throughout their life

18. Language, Speech and Communication Language – a formal symbol system that has structural qualities, including morphology, semantics and syntax (form, use and content) Morphology – rules for how words are structured in a sentence Semantics – rules for how meaning is created by words and sentences Syntax – rules for the ordering of words in a sentence

19. Verbal Students

20. Functional Language Even though a student is “verbal” with an intellectual disability, it doesn’t mean that they have functional language. Q: “What do you want to drink for lunch?” A: “Drink.” Q: “Do you want chocolate or white milk for lunch? A: “Milk.” What would you do next?

21. Conversation Continued Q: “For lunch, you can have chocolate or white milk to drink. What do you want?” (Presenting choices visually.) A: Reaches out and touches both.

22. Let’s Be Honest … How many of you typically “communicate” with children with intellectual disabilities by asking questions (especially yes/no), giving directives or asking them to name concepts/items? Responding to questions and following directives uses language that is elicited and does not teach the student to initiate spontaneous communication.

23. Do They Have the Language Skills?

24. Anticipating NeedsWithout Requiring/Modeling Communication Examples: • Child is handed a reinforcer a the first signs of a tantrum. • Toys and favorite objects are always readily available. • Child is always immediately assisted with all activities. Why does the child need to communicate? We are also not modeling the skills that they need to communicate when we anticipate the need.

25. Encouraging Communication Through Modeling When providing models to teach language, we need to be aware of the • form, use and content we model (what) • when we model it (when) • facial expressions, tone of voice we use (how) • developmentally important time to teach it (why) (one-word vs. phrase)

26. Routines Are Important in Autism the Classroom Provide opportunities to embedgoals Provide opportunities to embed communicationskills Provide opportunities to model for preschool teacher andstaff

27. Setting Up Opportunities to Communicate • Introduce developmentally appropriate attractive toys or snacks and then put them away or out of reach. • Set up situations where the child has to ask for help or assistance. Opportunities to problem-solve are critical to cognitive development, which affects and shapes speech and language. • Stop actively commenting during play and become quiet. When the child starts talking or imitating what you have said, it indicates he wants more of the experience. Expand on what he is saying. • Let the child lead and you follow. • Imitate back what the child is doing.

28. Ways to Create the Need to Communicate • Tape lids • Secure lids tightly • Put items in a box so the child has to say “open” • Put snack pieces in Ziploc bags • Give them all but “one” of an important item to complete an activity (i.e., scissors during an art activity) • Give them the wrong item for a task, such as a straw instead of a spoon to eat ice cream

29. Ways to Create the Need to Communicate

30. Don’t Be Afraid • to get messy • to stay silent • to entice • to sabotage • to just wait as you try to create opportunities to encourage communication!

31. Factors to Take into Consideration Echolalia Immediate or delayed (what is the student trying to communicate) Visual Supports Objects, photos, or symbols Choices Augmentative Communication Supports Low tech to high tech

32. Nonverbal Students

33. FIVE TIPS WHEN COMMUNICATING WITH NONVERBAL STUDENTS • GET UP, GET DOWN! Try to get to the student’s level and talk to them face to face with eye contact. • KEEP ON TALKING! Sometimes it feels like you’re just talking to yourself, but you don’t know what is getting through. Talk to your student about things happening around them, what you’re doing, and about academics! • CHOICE, CHOICE, CHOICE! Offer choices to students, even if they are unable to reliably respond, get into the habit. From a student’s perspective, it feels more respectful than just doing what you want … and you never know what may illicit a response.

34. FIVE TIPS WHEN COMMUNICATING WITH NONVERBAL STUDENTS (continued) • BUILD VOCABULARY! Start building expressible vocabulary by introducing choice with flashcards or picture icons with at least two or three choices to offer the student an opportunity to expand vocabulary and make choices. • WHAT’S MY MODE? We have to equip students with some mode of communication before they graduate. Be sure a student has one and that everyone is consistently working on make it a viable way to talk.

35. Myth #1 – Having a child use augmentative communication will prevent him or her from developing speech FACT – Research clearly shows that using augmentative communication does not prevent students from becoming verbal. In fact, in many cases it encourages speech development and helps build successful communication skills.

36. Myth #2Use of AAC is a last resort, which means that professionals are giving up on speech. • According to ASHA, AAC is within the scope of practice for SLPs.  Dr. Blackstone indicates in the 2006 article that for adults with acquired conditions such as a stroke or ALS where speech is affected, AAC can be an appropriate form of treatment for communication difficulties that are temporary or long-term. She states that for children “as soon as severe communication problems are identified, the evidence shows that professionals should consider AAC interventions to enhance and support speech and to allow language to develop.” • “A Communication Device will Prevent Speech from Developing” and Other Myths, Jeannie Krull, July 28, 2014, North Dakota Assistive Technology. http://ndipat.org/blog/a-communication-device-will-prevent-speech-from-developing-and-other-myths/

37. Myth #3 – Children who are nonverbal are not communicating FACT – All children are communicating at some level

38. MOVEMENTS AND GESTURES

39. Myth #4 – Children aren’t ready to use AAC FACT There are NO PREREQUISITES TO COMMUNICATE! NONE, ZILCH, NADA!!

40. 20 Ways AAC Can Benefit Nonverbal or Minimally Verbal Individuals with Autism • Feel reassured by having communication system available, reduced anxiety • Since email, texting and chats are so popular, I can communicate with peers • You may realize that they are more academically capable and socially aware than you thought • Can participate more doing class • Can participate in the IEP process • Can practice language skills that are beyond their current expressive language skills – so you can move language skills forward

41. Receptive and Expressive Language Receptive Language – ability to understand information including words, sentences and meaning of what others say or what is read. Expressive Language – ability to put thoughts into words and sentences, in a way that make sense and is grammatically accurate. Impairments in receptive and expressive language impact every aspect of a student’s ability to learn and function in all environments.

42. Behavior and Communication

43. ONE BIG MYTH - #5 We need to wait until the child’s behavior improves before we can start doing AAC or working on communication skills. Fact: Many times the behavior is caused by frustration from not having a way to communicate.

44. Assistive Technology

45. EVALUATION Children should have AT recommended on the basis of a formal evaluation process, especially those needing augmentative communication. It should take the individual needs of the student into consideration. Team process: • Information Gathering – may include new tests • Decision-Making • Trial Use • Recommendation and incorporation into the IEP

46. Assistive Technology Recommendations • Should be based on an evaluation, not the student’s diagnosis or whatever technology is readily available.

47. VISION AND HEARING You MUST know the student’s vision and hearing status before you begin any evaluation! Hearing and Vision Resources: https://wvde.state.wv.us/osp/deafblindresources.html Check out Come Learn with Us on that website!

48. PURPOSE OF THE AAC EVALUATION To get an estimated • Get background information • receptive language age • receptive vocabulary age (if you can’t overall receptive language) • to determine where they are functioning expressively • determine a communication system that meets their needs • access method

49. EVALUATING FOR AAC We need to evaluate receptive and expressive skills • Communication Matrix • TECEL • REEL-3 • PPVT-4 or MAVA • EASIC-3 • MacArthur-Bates • CELF-5 • LinguiSystems Milestone Chart – on your thumb drive

50. COMMUNICATION MATRIX • Expressive language evaluation • Free to set up account • Examines 7 levels of communication • Examines different purposes for communication • Shows a visual of where the student is currently functioning • Shows progress • Can pay to have a report generated • Examination of the Communication Matrix can tell you where they‘re functioning • Can be completed by parents and/or speech-language pathologist • If functioning above 18-month level, then they are likely symbolic and can use understand that a symbol/photo/object stands for something • Can create custom reports - $6.00 each • www.communicationmatrix.org