“Your child is too young for assistive technology” . . . and other myths about communication in early childhood

1. “Your child is too young for assistive technology” . . . and other myths about communication in early childhood Molly Heck, BS-SLPA Deanna Hughes, PhD, CCC-SLP Larissa LaPineFerill, MA, CCC-SLP April 11, 2012 San Diego Infant Development Association

2. Introduction

3. Assistive Technology (AT) vs. Augmentative Alternative Communication (AAC) • Assistive Technology:an umbrella term referring to adaptive and rehabilitative devices for people with disabilities and the process for selecting and implementing • Augmentative Alternative Communication: a subset of assistive technology designed to replace or supplement verbal language

4. Maintaining a Perspective Technology Should Never Replace Play, Engagement & Interaction

5. Stages of Early Communication(Ingersoll & Dvortcsak, 2010)

6. Stages of Early Communication(Ingersoll & Dvortcsak, 2010; Searcy, 2011) • First Words • Two-Word Combos • Early Syntactic-Semantic • Later Syntactic-Semantic • Pre- • intentional • Pre-linguistic • Intentional • Communicative Competence

7. Early Stages of Play(Ingersoll & Dvortcsak, 2010)

8. Functions of Communication • Request objects and items • Continue an action • Stop an action • Request social interaction • Express a feeling • Make a choice • Initiate and terminate an interaction • Request assistance (Gamel-McCormick & Dymond, 1994)

9. Assessment

10. Consider Profile ofIndividual Child • Receptive/Expressive Communication • Cognitive Skills • Motor Skills • Visual Skills • Auditory Skills • Physical Health

11. Ability of typical communication partners Settings where the communication is used Child preferences Family and caregiver preferences Durability and Portability Potential for growth Projected rate of growth Other AAC Considerations

12. Even More Considerations • Amount of training for families and caregivers • Implementation: consistent use across settings • Low-tech vs. high-tech • Permanency of the disability • Age of the user and caregivers • Existence of prior knowledge vs. new learning • Cost effectiveness

13. Selecting a Device

14. The question is not "Can my child use AT?" but "What AT can my child use?" • Given the breadth of assistive technology available,much can be adapted for very young children • Developmental stage of child must be considered before including some features (e.g., symbols versus pictures to represent language) • Children and infants are often already exposed to abstract forms of assistive technology (e.g., prenatal sound machines and cause:effect toys)

15. Children Need to Have Good Motor Skills to Access AT Both a challenge and liberty of AT is that can be continuously adapted to meet the needs of specific individuals, including: • Language skills and needs • Visual/hearing complications • Sensory integration • Portability • Access (can be activated by feet, fingers, whole hand, eye gaze, head, etc.)

16. Rapidly Changing Technology Offers More Options • With increased experience, it becomes easier to creatively adapt AT so that it can be accessed appropriately • Teachers and therapists can use household objects to adapt AT (e.g., utility belt to enable a child to carry an AAC device)

17. Common Myths

18. An iPad Will Help All Children iPadscan offer financially reasonable solutionsto families, but it is important to consider all options • specificskills are necessary to use iPad applications (ability to isolate and activate buttons, scroll, categorize, access "home" and/or "back" button) • although many apps target language and pre-literacy skills but pre-requisite abilities must be considered • adultscan provide live adaptations to enable interaction with a device • example: if child taps his hand on the floor, adultcan push a button to activatepreferred,animated response (on iPad or computer)

19. Verbal ChildrenWill Not Benefit From AT • If a child is not effectively able to use verbal language, another communication modality must be identified • Teaching children with (or without) language delay to augment communication with adapted sign language or AAC, frustration can be decreased,while enabling the development and use of communication • Similar to 'baby sign', AAC may increaseverbalization,and provide a concrete and consistent verbal model

20. Communication Devices and Applications are too Complicated for Most Parents to Edit • While editing applications and AAC devices can be difficult to learn, they tend to be similar and can become familiar overtime • Once the "lingo" and concepts for one device are acquired, it becomes easier to problem solve, program other devices, and communicate to others using them • Most companies offer live tech support that can help with any issues

21. There is no funding for AT With an assessment completed by a Speech Language Pathologist, funding for AT is available through: • Insurance Companies • School Districts • MediCareand MediCal

22. Goals for young children should target successful transition to Kindergarten Focus of ALLtherapy should be: • Engagement and play skills • Interaction with adults and others • Language development within the activity

23. Some children are too "low functioning" for AT Despite language and/or cognitive abilities all children will benefit from activities which are engaging and promote language development

24. An AAC device will stigmatize a child • AAC devices have changed dramatically in recent year • Many AAC devices look just like the iPads and iPhones that all children use

25. AAC will prevent my child from learning and using verbal language • AAC provides a bridge for functional communication by reducingfrustration and sparkinglanguage development • Current research revealsincreased verbal skills in children who are exposed to symbolic language, such as icons, gestures and pictures

26. AAC Do’s and Don’ts

27. Technology Do’s • Have a plan: how and why technology will be used in your intervention • Be able to articulate your rationale with families: why are you getting paid to play with your iPad? • Acknowledge that families may have more technology savvy than you or none at all: collaborate with families • Use technology as a concrete support for parents that may require minimal training: help parents find a way to play successfully with their children

28. Technology Do’s (continued) • Be prepared: be sure that equipment is charged; haveknowledge of applications and programs before introducing them • Incorporate other, more familiar tools: visual timers, alerts, camera, video, and alarms in addition to applications • Understand and appreciate how technology is typically used in the family’s home: (e.g.,distracter;entertainment forthe child; reinforcer) • Know professional standards: American Academy of Pediatricians and ASHA

29. Technology Don’ts • Neveruse technology as a substitute for good therapy: it must enhance interaction, not replace it • Technology must never be used as a time-filler or distracter: use it for functional communication requests and to provide visual representation of language • Block access to self-stimulating activities on the device: e.g., limit scrolling and access to repetitive videos • Maintain control of the device: avoid tug-of-war • Neverassume one technology is right for every child

30. Technology Don’ts (continued) • Never narrow your choices to one specific type of technology • Avoid assumption that technology will hold the child’s interest • Never minimize the importance of face-to-face interaction • Neverexclude use of natural gestures and modified sign • Never forget the power of engagement, and the role it plays in communication and interaction

31. iPad Applications for CommunicationAdvance March 19, 2012 • Proloquo2Go • Touch Chat HD • Tap to Talk • Custom Boards • Grace • Aunt Maggie’s Recipes • ACT Spell • Categories Learning Center • Conversation Builder • Easy Concepts • Fun and Functional • Fun with Directions • Image Spinner • Language Builder • Story Line • RJ Cooper’s Rad Sounds AAC LANGUAGE

32. Communication and Learning • Cookie Doodle • Go Away Big Green Monster • Icebox Doodle • Music Colors • Toca Hair Salon and Toca Tea Party • Sound Touch • The Social Express • Cinderella by Nosy Crow • NoodleWords