Worcester Public Schools Assistive Technology Specialist Catherine Salerno Karen Hernandez Kathleen Marple

Referral Process is made to the ETC  Request to screen made by staff or parent  Written request made to AT Staff  AT Staff arranges for screening  If necessary AT Staff recommends supports  If necessary, AT Staff provides consultation

Who is referred ?  Any child may be referred for an Assistive Technology Screening  Why?  Supports may be needed for communication, curriculum access, demonstrate knowledge computer/environmental access etc.

Service Delivery  Evaluate to determine barriers and supports necessary to overcome barriers  Meet with educational team to determine appropriate course of action  Provide appropriate supports through the WPS  Provide trainings to appropriate team members and WPS students  Provide on-going consultation to team members

What is Assistive Technology?  “Federal Special Education Laws: PL Technology Related Assistance for Individuals with Disabilities Act of 1988 and PL Individuals with Disabilities Education Act (IDEA) of 1991 defines Assistive and Instructional Technology Devices as:

AT Definition: “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” ……

Any services that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device” including but not limited to :  Augmentative and Alternative Communication  Environmental Controls  Adaptive Computer Access  Visual Aids  Assistive Listening  Mobility  Positioning and Seating  (from Toddler Talk at School MJ Co 1999)

What is AAC ?  Augmentative and Alternative Communication (AAC) is the term used to describe methods of communication which can be used to add to the more usual methods of speech and writing when these methods are impaired.  AAC includes unaided systems such as signing and gesture, as well as aided techniques ranging from picture charts to the most sophisticated computer technology currently available. AAC can be a way to help someone understand, as well as a means of expression. (from:isaaconline.com)

What can AAC do? “AAC makes it possible for people who are unable to express themselves through speech or handwriting to communicate through the use of special techniques and devices. Using strategies such as electronic talking devices and computers, boards with pictures, alphabet or words on them, sign language or gestures, people around the world who have difficulty communicating can go to school or work, develop relationships and be active in their communities. There are people all over the world who have an interest in AAC and who are working to promote a greater awareness and understanding of AAC. …..(from isaaonline.com)

Access Supports

Computer Access  Switch Use  Touch Window

Mouse Alternatives  Track Ball Joy Stick Switch Click

Alternative Keyboards  Big Keys Intellikeys

Hand Writing Supports

Low Tech Mechanics of Writing/Drawing  vertical/slanted surfaces – angles the writing surface for easier viewing or reaching; may allow access from varying positions (e.g., sitting, standing, kneeling  non-slip pads - keeps objects from slipping on table/wheelchair, e.g., between slantboard and table; on seat of wheelchair; under clipboard with writing paper  time - allow more time to complete assignments  reduce quantity – require less output  fill-ins – allow student to fill in key words as opposed to writing entire sentence  multiple choice – offer field of potential answers to circle as opposed to writing  tactile materials - provides sensory and kinesthetic feedback

Mid Tech Mechanics of Writing/Drawing  digital voice recorder - record homework assignments,  AlphaSmart – portable battery-powered word processor with option of data transfer to desktop computer; simple, easy-to-use word processor; 4/ lines of text on screen; additional software available for more features  alternative mouse or keyboard - for physical/visual/cognitive issues or young children  switch, trackball, joystick – alternative to keyboard control of computer

High Tech Mechanics of Writing/Drawing  "Easy Access" (Mac) or Accessibility Features (WIN) - Both Mac & PCs have keyboard control panels that are already on the computer or on Utility CDs, which come with the computer. They allow the user to use sequential keystrokes when two keys need to be held down together. They also allow for slowing or stopping the repeat function of keys, using the keyboard to control mouse/cursor movement and other features.  "word prediction software - anticipates the words the student wants by offering a list of words to choose from and limiting key stroke  multimedia software - can be used to create on-screen activities for students,  on-screen keyboard software – input via switch, mouse, joystick, trackball, or Eye Gaze, etc., provides access to a keyboard image on screen and letters are selected one at a time through direct selection or a process of scanning/highlighting the keys for selection,

tactile materials - provides sensory and kinesthetic feedback Writing: Comprehending, Composing, and Organizing

Low Tech Comprehending, Composing, and Organizing  posted information - post written directions for hardware and software use; post homework on the board; post visual reminder of topic; clearly define and post the goal and purpose of the activity; record auditory information in a visual form to remind students and decrease repetition  visual schedule – order of student turn-taking, daily schedule, order of tasks  check lists - “Did I...?” or “To do...” lists which students check as they go  object location markers – associate objects with specific activity choices (i.e. paintbrush for easel, disk for computer); students select activities by their object and when the objects are all selected that area is no longer an available option; teacher shows the object when referring to the activity to enhance understanding

personal recorder – small, hand held, recorder to record homework assignments, things to remember etc. hand-held talking dictionary/speller – e.g., Franklin Homework Wiz & Speaking Homework Wiz, dictionary/thesaurus; spell check; create personal word list; words appear on small screen; target words, definitions, and synonyms can be pronounced aloud in speaking version; offers practice in cursive and print handwriting; arithmetic tutor & calculator Mid- tech/ Comprehending, Composing, and Organizing

High Tech Comprehending, Composing, and Organizing  Power Point slide show (Microsoft Office) - create slide show presentation of information; one slide per word for word identification, review of definitions etc.; set the timing for moving from one slide to another at a pace appropriate for the student and increase the time as s/he improves  Web- based graphic organizers  Graphic organizing software offering a variety of formats for visually representing, organizing, recording and relating ideas and concepts  Story Grammar Marker (Discourse Skills Productions, Inc.) – to preview/review story narrative and support reading of text; this interactive, tactile tool made of yarn, bead, and objects is used to represent narrative structure; students each use smaller versions of the Markers to work along with the teacher; aids in organization/recall; also a terrific tool for problem-solving & solving disputes; different versions for older versus younger students

Visual Supports for Written and Spoken Language Boardmaker SymWriter

Visual Supports for Communication Visual Supports for Communication

Visual Supports for Reading & Comprehension

News 2 You

SymWriter

Google images

Communication – an essential ability in all stages of life, necessary for addressing concerns, meeting goals, and otherwise pursuing success and happiness. Unfortunately, many individuals on the autism spectrum struggle to communicate with others.

WPS Approach to AAC Our team approach to working with AAC is based on a “multimodal” approach to communication—encouraging and enhancing to use a “communication system including any and ALL signs of communicative intent and actual communicative acts. There are MANY possible “tools in the AAC toolbox,” and the specific tool that may be most effective in one situation, may not work at all in another. Strategies also need to be changed, adjusted, nuanced--we have found that FLEXIBILITY and keeping an open mind are absolutely crucial! In addition, utilizing strategies generated from solid research and evidence-based practice (rather than anecdotal guesswork) is paramount. The AT staff works with teachers and support staff to determine appropriate supports, provide said supports and provide on-going training and support to help meet the students changing needs. Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO

Communication and Language Communication and language skills allow a person to…  Initiate, maintain, and terminate conversations  Establish/maintain interpersonal relationships  Share ideas  Express feelings  Give information  Ask questions  Describe events  Solve problems  Direct others  Entertain  Show imagination  Refuse  Learn  Function with greater independence

  What is the hierarchy for teaching words to an AAC user?   The hierarchy for teaching communication with an AAC user is objects, photographs, symbols, and then words.

Tangible Symbol Systems The system uses concrete or “tangible” symbols-- objects or pictures that stand for (or represent) something about which a student needs to communicate. Tangible symbols may be whole objects, parts of objects, associated objects, textures or shapes, line drawings, or photographs. They are “permanent” (they exist in a permanent display and don't have to be recalled from memory), and may be manipulated by both the user and the communication partner. Most importantly, the relationship between a symbol and its referent is obvious to the individual user, since it is based on the user's own experience. Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO

Picture communication Picture communication strategies typically begin with teaching the student to associate a picture (photo, or line drawing) with a specific preferred activity or object. Many different methods have been developed to address all the issues discussed above. Because each individual on the spectrum has unique abilities and challenges, a variety of instructional techniques and therapy options are available. The Picture Exchange Communication System™ allows nonverbal individuals to “talk” with images; virtually simulated environments help reduce stress, facilitating communication; and speech therapy in natural environments brings the therapist to the client in order to remove the confines of the office and provide real-world practicePicture Exchange Communication System™simulated environments

Low Tech Tools & Strategies for Communication expressive communication supports tools that are primarily intended to facilitate the student’s output or expression of wants/needs, information, and social messages; can help students communicate if they have unclear speech, limited speech, word retrieval problems  choice board – provides a display of the options that are available for the student to select  topic boards – vocabulary display of messages that are related to a specific topic  large vocabulary communication book – a book of picture vocabulary organized into different categories (i.e. people, places, actions, food, animals etc.); contains both personal vocabulary and academically related terms;  letter board – portable board with printed alphabet

Mid Tech Tools & Strategies for Communication  digitized voice-output communication aids (VOCA’s) communication devices which use recorded speech paired with symbols to allow students to express themselves verbally; available in a great variety of styles, capabilities, and cost to match with student need single message/target voice output communication aids - capable of one recorded message and/or has one target to select; good for students who have difficulty making an accurate selection from a field or who has physical access issues

High Tech Tools & Strategies for Communication  dynamic display voice-output communication aids – computer based system that changes displays by selecting targets via touch screen, mouse or alternative access techniques

Text-based communication We want to take advantage of the children’s strengths to teach them more challenging communication and language skills. Use of skills that the child already has and enjoys practicing–i.e., decoding and/or encoding words– may facilitate learning of new skills.

Communication Functions  Request reinstatement of a preferred activity/item  Refuse a non-preferred activity/item  Choose between two items (both preferred)  Choose between two items (one preferred and one non-preferred) and more than two items  Comment on the item and/or activity

Level 1— Emerging Communicators These are pre-symbolic communicators who may display reflexive/reactive behavior (laughing, crying) which is interpreted by the observer as communicative, and this level extends on through individuals who exhibit intentional goal-directed behavior (not necessarily directed towards another person), and finally on through those who exhibit intentional communicative behavior (goal directed behavior directed towards another individual) using gesture or natural non-symbolic means. Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO

Level 2— Beginning Symbolic Communicators might be using some symbols: manual sign or sign approximations, vocalizations, stylized gestures (including pointing), and verbalizations or verbal approximations (one through approximately 503). They use the symbols one at a time and have not started combining them together much, if at all. They might use (or have tried) picture or object-based communications strategies, or a single or double-message speech generating device to indicate a simple greeting, the desire for reinstatement of a preferred activity or a choice between two activities Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO

Level 3— Intermediate Symbolic Communicators may be using a number of (about 25 or more) symbols: manual signs or sign approximations, vocalizations, verbalizations (or verbal approximations) one at a time—they may be combining the symbols (which would imply having close to 50 symbols in their repertoire) at least in a rudimentary syntax or word order, e.g., I want.... I like... I don’t like... I go... etc. Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO

When considering a student as a potential candidate for AAC, it is important to be aware of all of the possibilities that exist as far as appropriate technology is concerned— thoroughly understanding, and knowing how to use, all of the “tools in the AAC toolbox.” There are several different AAC classification systems in use at the present time.  Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District,  Boulder, CO

In order to communicate intentionally, two factors are absolutely crucial :  1. that the student has a clear awareness of the relationship between his/her behavior and the behavior of another person (social contingency awareness: “cause and effect” between people)  2. s/he has something specific to communicate about. The magic ingredient here is “communicative intent”—if the student has nothing to express, s/he will not communicate !  Paul Visvader MA CCC-SLP © 2013  Assistive Technology Team, Boulder Valley School District, Boulder, CO

No Tech: These are “unaided” systems an individual uses with no additional tools or technology such as motor behaviors, gestures, vocalizations, verbalizations (or verbal approximations), proxemics (approach, avoidance), eye gaze, and facial expressions. Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO The Continuum

Low Tech –“No Batteries Required". These tools are often paper based, and can be as simple as a pad of paper and a pencil. These are “aided” communication strategies (i.e., requires some type of external assistance for the symbols) which do not run from a power source--such as picture or object communication, PECS (Picture Exchange Communication System), partner assisted auditory scanning, etc.  Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District,  Boulder, CO The Continuum

 Mid Tech There are two basic types of mid-tech tools. One type of tool uses pre-recorded words or phrases, and a button for each. The other type has a keyboard, display, and speaker. Users type words that show up on the display and are spoken aloud by a computer voice.  Voice output communication systems which are typically battery operated and have a static (non-changing) display such as the Big Mac, Rocker Plate Talker, Step by Step, Cheaptalk, Tech Talk, Go Talk, Supertalker, or 7-Level Communication Builder.  Paul Visvader MA CCC-SLP © 2013  Assistive Technology Team, Boulder Valley School District,  Boulder, CO The Continuum

High-tech AAC aids permit the storage and retrieval of electronic messages, with most allowing the user to communicate using speech output. Such devices are known as speech generating devices (SGD) or voice output communication aids (VOCA).A device's speech output may be digitized and/or synthesized: digitized systems play recorded words or phrases and are generally more intelligible while synthesized speech uses text-to-speech software that can be harder to understand but that permits the user to spell words and speak novel messages  Systems typically requiring an electronic power source and having a dynamic  (changing—i.e., computerized LCD screen) display / devices dynamic display voice-output communication aids – computer based system that changes displays by selecting targets via touch screen, mouse or alternative access techniques Paul Visvader MA CCC-SLP © 2013  Assistive Technology Team, Boulder Valley School District,  Boulder, CO The Continuum

 There are many factors that need to be examined when assistive technology devices and services are being considered for a student, including educational goals, personal preferences, social needs, environmental realities, and practical concerns and appropriate technology. Factors

USING iPADS AS AAC DEVICES Physical access can be a significant problem for some students—is s/he able to isolate finger motions? Is s/he able to swipe or pinch? Can s/he see what is on the screen? The situation is improving considerably with newly marketed switch interfaces and apps designed for scanning, but at this point, it is still a significant consideration. Another question would be whether the student understands what a picture represents or whether s/he can comprehend synthesized speech (a computer voice). In addition, iPad apps are nowhere near as complex and “robust” as fully-functional AAC software, so that a student might be poorly served by a relatively simple iPad app when s/he might really need the power and capability of a dedicated device A final disadvantage might actually be one of the already-listed advantages: multi-functionality and versatility. Traditional speech-generating devices have always had the communication software as their main function and purpose …. ? An informal poll we did of about a dozen or so international AAC experts produced answers across the spectrum: a few suggested that the iPad, if used as an AAC device, should be a DEDICATED device—close off all other apps as distractions

USING FACILITATED COMMUNICATION AS AAC Facilitated communication (FC) is a technique in which a “facilitator” (a therapist, teacher, or caregiver) gives a student consistent direct or indirect physical (and other) supports in an attempt to promote communication: pointing to pictures or objects, pointing to printed letters or words, or typing on a computer keyboard. According to personal anecdotal accounts and descriptions, this type of technique may reveal previously undetected literacy and communication skills in students with autism and other severe disabilities. Although publicized FC success stories are both dramatic and impressive, it should be noted that Although publicized FC success stories are both dramatic and impressive, it should be noted that this strategy is considered “controversial” by both the American Psychological Association (APA) and the American Speech-Language-Hearing Association (ASHA) in their 1994 and 1995 Position Statements, respectively. In their view, in many cases it can be unclear who is really doing the communicating and how much help the communicator is really obtaining from the facilitator Paul Visvader MA CCC-SLP © 2013 Assistive Technology Team, Boulder Valley School District, Boulder, CO

Supports for Classroom Management software that supports diverse learners phonetic/phonemic software

Student Self-Management  verbal reminders – periodically restate the topic, focus or goal of activity  timer – visually designate how much time an activity will take, how much time to wait, or how much time is left in an activity; creates an objective means of “when” – it’s non-negotiable  posters – post class rules, jobs, computer use guidelines, schedule, etc.; use words and/or pictures to enhance understanding and quick recognition  social stories - can alleviate anxiety about activities/tasks (write/draw or create on computer a storybook describing the steps of any activity, academic or nonacademic, to allow the student to preview and be prepared for what is to come;

Reading Supports

No Tech Reading and Decoding  strategic reading - teach students to look for particular information, e.g., review title/chapter headings, locate main ideas, etc.  strategic reading - teach students to look for particular information, e.g., review title/chapter headings, locate main ideas, etc.  reduction – reduce the amount of reading required  reduction – reduce the amount of reading required  time - adjust allotted time for assignment  time - adjust allotted time for assignment  physical/verbal - enhance meaning of reading with gestures, exaggerated facial expressions and intonation during group reading  physical/verbal - enhance meaning of reading with gestures, exaggerated facial expressions and intonation during group reading  choral reading – students read together peer tutor - or adult, to support or read to student  choral reading – students read together peer tutor - or adult, to support or read to student  finger tap for syllable counting – kinesthetic and auditory reinforcement  finger tap for syllable counting – kinesthetic and auditory reinforcement  reading preview – focus on vocabulary development, story line, background information, etc.  high interest/low reading level - locate books that are easy to read but interesting to facilitate fluency in reading and motivation

Low Tech Reading and Decoding  word walls - to reinforce frequently used words and topic/story vocabulary; create on blackboard, whiteboard, or cards posted on walls; words may be grouped together by category and color-coded  word rings - another way to reinforce topic/story vocabulary by putting text, drawn/cut-out/scanned pictures/drawings, story characters, Picture Communication symbols, etc. on oaktag cards; then create rings with the cards using binder rings, shower curtain rings, pipe cleaners or yarn  modify worksheets – simplify format; reduce amount of text; reword in simplified language  graphic organizers – to preview/review story narrative, vocabulary, characterization, etc.; e.g., concept maps, Venn Diagrams, story boards, sequence grids, & webs (place topic in center circle, brainstormed related ideas branch out from the topic and can later be grouped into clusters; pictures/symbols can also be used as templates, e.g., spider, tree, flower, etc.)

Mid Tech Reading and Decoding  tape record text – for students to hear/review story content or to read along with text  books on tape – to preview content/sequence of story/text (library, audiotape purchase or rental stores, Learning Ally, BookShare  hand-held talking dictionary/speller – e.g., Franklin Homework Wiz & Speaking Homework Wiz, dictionary/thesaurus; spell check; create personal word list; words appear on small screen; target words, definitions, & synonyms can be pronounced aloud if speaking version; offers practice in cursive and print handwriting; arithmetic tutor & calculator

High Tech Reading and Decoding  PowerPoint slide show - create slides of words for word identification; set the timing at a pace appropriate for the student and increase the time as s/he improves the rate  multimedia software - adapt/modify books by, e.g., using story graphics alone on slides to “tell” the story, putting graphics and text together on slides, rewriting text at lower grade level, adding symbols/rebuses to replace text or to enhance text, WEB BASED text  text-to-speech - for reading text on computer, a.k.a. e-text or electronic text); text reading software will read any text file aloud; freeware/shareware programs are available  software that supports diverse learners phonetic/phonemic software

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