1. Building AT Knowledge: Augmentative Communication in Schools Ben Satterfield GA Tools for Life www.gatfl.org

2. Agenda Definitions and Assumptions Continuum of AAC Solutions Core Vocabulary Access the Tools For Life AppFinder Communication Apps Questions AAC Myths Dispelled Four Competencies for AAC Users

3. A framework for addressing students with communication challenges DEFINITIONS AND ASSUMPTIONS

4. Four Components of AAC Symbols Aids Techniques Strategies. ASHA, (1991)

5. Continuum of Communication Tools Low Tech Mid Tech Single Message Sequenced Messages High Tech Dynamic Display Icon Sequencing

6. Continuum of Communication Tools Dedicated Speech Device Exclusive purpose Integrated (Non-Dedicated) Speech Device on PC Platform Can provide other functions Computer, cell phone, Internet

7. Communication: Two Apects Receptive Communication Receiving the message from communication partner Understanding the message received Expressive Communication Conveying a message to communication partner Many ways: speaking, writing, gesture, signing, symbols/images. Can be enhanced through inflection, body language

8. Receptive Language Hard to assess without expressive component Often taking place at some level. Best practice is to “presume competence” assume some receptive language is there until proven differently Pay attention to expression & body language. Look for evidence of receptivity in: Behavior Gestures & expression

9. Three W’s of Communication Who should speak? When should they speak? Where should they speak?

10. Motivation Bakers Basic Ergonomic Equation: Motivation = Success P+L+C+T Where: P= Physical Load L= Linguistic Load C= Cognitive load T= Time Load King, T. W., (1999).

11. Communication Ability Levels AAC users generally fall into one of three functional skills levels: Emergent Context Dependent Independent Based upon work of Patricia Dowden from Univ. Washington http://depts.washington.edu/augcomm/03_cimodel/commind1_intro.htm

12. The Emergent Communicator The Emergent Communicator: Uses facial expression, body language, gestures, and/or behaviors (either socially appropriate or challenging) to communicate May be starting to use clear and simple symbols (especially in motivating or preferred activities) May show some variability in both understanding and expression from day-to-day or activity- to-activity Relies on communication partner to be a successful communicator

13. The Context- Dependent Communicator The Context-Dependent Communicator: Understands general conversations and directions as well as same age peers Uses symbols and objects spontaneously to communicate basic needs and wants Beginning to combine 2 or more symbols to create longer and/or more complex messages Communicates best in routines regarding familiar topics and, in some cases, with the support of communication partners Developing literacy skills (e.g. letter names and sounds, sight words, spelling of simple words)

14. The Independent Communicator The Independent User: Understands communication the same as same-age peers Combines single words, spelling and phrases together to communicate about a variety of subjects as others would at his/her age Literacy and social skills on par with same-age peers

15. A framework for addressing students with communication challenges CONTINUUM OF AAC SOLUTIONS

16. Low Tech Tools Picture Exchange Communication Boards Adapted Books Social Stories PowerPoint eBooks Picture Word Processing

17. Low Tech Tools Communication Wallet Communication Ring

18. Low Tech Tools Communication Boards

19. Low Tech Tools Communication Books

20. Social Stories/ Social Scripts Useful to support pragmatic communication: Using PowerPoint/ presentation software. Teach appropriate behavior, language choices. Print out books for reading before entering situation. Student may review PowerPoint on PC. What is appropriate to say in specific situations? What is appropriate behavior in specific situations?

21. Eye Gaze Talkers E-tran frame See-through frame with letters or pictures Client uses eye movement to answer questions Comm. partner interprets for client

22. Single Message Devices BigMack  Digitized recording  Easy to change message  Snap Caps: Symbol or picture as label

23. Sequenced Single Messages Step By Step  Digital recording of a series of messages  Easy to create messages  Facilitate interactive exchanges:  Knock Knock Jokes  Lines in a Play

24. Series of Single Messages Talk-Trak Pocket GoTalk  Wearable  Levels/Volume control  Simple to operate  Digitized messages  Strip of four symbols

25. Static Display Devices TechTalk, GoTalk  Durable  relatively inexpensive  Multiple levels  Change level  Change overlay  Digitized messages  Easy to record, change

26. Spelling Flexibility (generative power) Speed High Low High Low Goossens’, C., & Crain, S. (1992). Utilizing switch interfaces with children who are severely physically challenged. Austin, TX: Pro-Ed.

27. PreStored Phrases/Sentences Flexibility (generative power) Speed High Low High Low Goossens’, C., & Crain, S. (1992). Utilizing switch interfaces with children who are severely physically challenged. Austin, TX: Pro-Ed.

28. Words Flexibility (generative power) Speed High Low High Low Goossens’, C., & Crain, S. (1992). Utilizing switch interfaces with children who are severely physically challenged. Austin, TX: Pro-Ed.

29. Type & Talk DYNAwrite, Link Plus, LightWriter  Large, bright display  Word prediction  Stored abbreviations Documents created on the DynaWrite can be backed up to a Windows ® or Macintosh ® computer Onboard Universal Remote Control

30. Dynamic Display Devices Nova Chat 5, 8, 10  Sturdy platform  Chat language systems from Saltillo Corp.  Digitized & synthesized speech  Can adapt to changing physical needs  SymbolStix & PCS symbols  English/Spanish option

31. Dynamic Display Devices Dynavox T-Series Integrated Speech / PC Compass Language System New quick programming features: User Setup Wizard, Quick Page, Modify button Visual Screen Displays

32. Dynamic Display Devices Tobii i-Series  Tobii I-12 and I-15  Integrated Speech / PC  Compass and Tobii Communicator Language Software  Always on  Camera  Social media enabled

33. Dynamic Display Typical pages start out looking like this …

34. Dynamic Display …and end up like this

35. Dynamic Display Organization is Essential Index What’s UpDialog Keyboard Word Bank Common Pages Meal TimeMorning Jokes Stuff I Like Situation Pages

36. Multiple Meaning Icons MinSpeak: Operating System AllowsLarge Lexicon Allows Large Lexicon Small Symbol Set Small Symbol Set Icon Sequencing Icon Sequencing Speed Speed Unity: Language System Contains CORE vocabulary Framework for adding customized FRINGE vocabulary

37. PRC Devices: Icon Sequencing Accent 1200, 1000, 800 Words for Life NOVA Eco 2

38. Icon Sequencing What words do you associate with: = = = =

39. Icon Sequencing Icons in combination, sequence: = = + +

40. Icon Sequencing Icons in combination = = =

41. What’s New? Eye-gaze:

42. A framework for addressing students with communication challenges CORE VOCABULARY

43. Core and Fringe Vocabulary Humpty Dumpty sat on a wall Humpty Dumpty had a great fall all the King’s horses and all the King’s men couldn’t put Humpty together again.

44. Core Vocabulary

45. Fringe Vocabulary Fringe vocabulary in activity row

46. Core Vocabulary Core Vocabulary: Makes up ¾ of what adults and children actually say 78% of the words we use daily are drawn from a core of fewer than 400 words

47. What are core words? High frequency words that can be used across conversations, situations, and environments Pronouns, verbs, adjectives, adverbs, prepositions Connect with other words to make multi- word utterances with increasing detail

48. Core Vocabulary Studies

49. Core Vocabulary Core Vocabulary is consistent across: Clinical populations Activities Places Demographic groups Core Vocabulary Very flexible Statistically dominates daily speech Can speak effectively using just core words

50. Vocabulary & Language Core Vocabulary Addresses: Places Activities Descriptions Relative Absence of Nouns Child Language: Simple Words Complex Combination of Structures Simplicity at one level Lays groundwork for complexity at next level Vocabulary alone does not equate to language

51. Activity Based Learning : Cooking Lesson Traditional selection Bowl spoon Measuring cup Eggs Milk Flour Spatula Maple syrup Electric frying pan Core selection Turn it Put them Is hot Upcold Down more On big Off little Innot Over Bad

52. Methodology Used in General Classroom? Focus Critical concepts Context specific vocabulary Self-made or curriculum-based review/test materials Referential approach to learning One word Response oriented

53. Vocabulary Pressures Situation for AAC users & support team Constantly changing vocabulary Each new unit requires new vocabulary Therapy staff, teachers, aides redesigning vocabulary Fringe vocabulary: lots of new pages Words that are infrequently used

54. Vocabulary Pressures Effects Changes needed throughout the day Lack of support Danger of abandonment

55. Vocabulary Pressures Impact Labor intensive support Time consuming Produces stress Preempts other forms of Therapy

56. Alternative Alternative: Use Core Vocabulary Instead of context specific vocabulary to promote AAC user participation in all learning situations Facilitate Inclusion

57. Referential vs. Descriptive Approach Shift focus from Referential Qs & As To Descriptive Qs & As Select / build Core words Commenting Directing Describing Activity based learning

58. Referential vs. Descriptive Approach Referential: Q: Who wrote Tom Sawyer ? A: Mark Twain. Descriptive: Q: Where did Mark Twain get his ideas for Tom Sawyer ? A: Growing up.

59. Referential vs. Descriptive Approach “Name 3 animals we saw on our walk” becomes “Tell me something about a squirrel.” Answers: “run up trees”, “run fast”, “eat things that fall from trees” Role of SLP: Assist Teacher in phrasing descriptive questions Teach student core words (navigation)

60. Effects of Descriptive Approach Content Teach core words Already in device How to navigate Instead of new pages Allows responses of words which are High frequency Reusable

61. AAC in Classroom Today Current arrangement Are students successful? Hours dedicated to programming context-specific academic vocabulary Will words ever be used again by student? Time devoted to programming detracts from therapy/ instruction

62. AAC in Classroom: Descriptive Approach Descriptive Method: Less intensive for teachers, clinicians & staff (students use personal vocabularies) New pages do not have to be created Satisfies conventional teaching goals: Communicates comprehension Demonstrate understanding

63. AAC in Classroom: Visual Strategies Aided Lang. Stimulation Strategies Modeling Prompting Responses Materials Vocab. display © VanTatenhove, 2009

64. Strategies Modeling Strategies Slowly Extend Pair with Speech

65. Strategies Prompting Strategies Expectant Delay Open Ended prompt Broad Focused Coached prompt Idea Word

66. Strategies Response Strategies Expand Connect Correct

67. A Word About Outcomes How many times do I have to model a word before I begin to see the student use that word by himself/herself?

68. CONSIDERING APPS FOR AAC

69. TFL AppFinder Search by: App Name Categories Book Education Environmental Adaptations Hearing Cognition, Learning, Developmental Navigation Personal Care and Safety Productivity Communication Therapeutic Aids Vision

73. SOME OF OUR FAVORITE APPS FOR AAC!

74. Avaz for Autism (AAC) 24 location max SymbolStix (default) Scrolling possible Side navigation remain constant Intuitive editing and creating Keyboard with picture/word prediction Price now $79.99

75. ProloQuo2Go Speak by tapping buttons with words or phrases Access grammar efficiently with verb and noun inflections Transition to literacy with word prediction in typing view Create and edit buttons with 14,000 symbols or photos Change color, font, and voice of multiple buttons at once Basic Communication vocabulary for beginning communicators Research-based Core Word vocabulary for language development Expand vocabulary by adjusting grid size Price now $219.99

76. TouchChat TouchChat is a full-featured communication solution for individuals who have difficulty using their natural voice. TouchChat is designed for individuals with Autism, Down Syndrome, ALS, apraxia, stroke, or other conditions that affect a person's ability to use natural speech. Five US English and 2 British English synthesized voices Core, context-based and quick-hit vocabulary included. Price now $149.99

77. Tobii SonoFlex Available for the iPhone, iPad, Android, Kindle Fire, PCs and SGDs Combines core, quick- hits & situational vocab. 50 pre-made context packages Intuitive programming Structure w/ flexibility Full App: $99.99 Lite vers.: Free

78. LAMP: Words for Life 24 location max SymbolStix (default) Scrolling possible Side navigation remain constant Intuitive editing and creating Keyboard with picture/word prediction Price now $79.99

79. Tap to Talk For emergent communicators For Android, Kindle & Nook Library of 2K symbols Player: Free (comes w/ sample albums) Designer: $99/yr or $179 lifetime Create/ modify w/ Designer

80. Sounding Board FREE app which allows you to create communication boards on your iPad or iPod touch. Use your own photos, or access the AbleNet symbols. Create your own boards -from single button pages, up to 20 buttons per page. Record your own messages on each button (unlimited recording time). Switch accessible (use with switch interfaces such as Applicator, Blue2, Switchbox and Switch2Scan). Latest version now allows you to import and export communication boards

81. Speak it! Copy emails, documents, web pages, PDF files, and more; paste them into Speak it!, and have the text spoken back to you. Email text to speech files Make announcements over PA system Endless phrases and possible uses $1.99

82. Verbally Premium Text-based communication app available for both iPhone/iPod Touch and iPad. FREE version of this app, available but does not include all voices and features of Verbally Premium. SymbolStix (default) Uses a Word grid of 50 commonly used words as well as a keyboard. Word prediction with integrated learning of words. High-quality text-to-speech voices. Save commonly used sentences/phrases. Share messages via email. Price now $109.99

83. Research: Visual Screen Displays “A visual screen display (VSD) is a picture, photograph, or virtual environment that depicts and represents a situation, place or experience. Individual elements such as people, actions and objects appear within the visual scene.” (Blackstone, 2004) “(VSDs) are meant primarily to address the need of beginning communicators and individuals with significant cognitive and/or linguistic limitations. These groups are unserved or underserved by current AAC technologies. “(Blackstone, 2004)

84. Scene & Heard Scene & Heard supports communication and learning through the use of Visual Scene Displays, and is designed for iPad and iPod touch. SymbolStix (default) Make scenes using your own photos, and also access Widgit symbols. A LITE version is available to try the app out. Record your own voice messages for scenes. Switch Accessible (use with switch interfaces such as Applicator, Switchbox and Switch2Scan). Link hotspots on page to photos and videos. Price now $49.95

85. AutisMate A comprehensive communication and behavior tool, with Visual Scene Displays, choice boards and symbol-based grid AAC set. Other visual tools to support behavior and social skills are also included. It is designed for the iPad. Access to SymbolStix library, and easily add your own photos and videos. Video modeling, visual schedules, visual stories and other behavioral tools are included within the app. Personalization and customization is quick and easy. A LITE version is available to try the app out. Share all content via email from within the app. Price now $79.99

86. Pictello Create "storybooks" Talking photo albums Use images in your device's photo library. Easy-to-use Choose a picture for each page, Type in text, Have that text read by a computerized narrator, or record yourself reading it Photo books can be shared

87. WordToob Video Modeling made simple and fun! WordToob is designed to make learning words and new skills fun and engaging through pre-stored and customized videos. Pre-stored board with the 25 words most 2-year-olds know Pre-stored board with common emotions Pre-stored examples of an alphabet board and adaptive skill board Infinite ability to create your own boards Speech recognition so that the learner can practice saying words

88. Talk with Us! What are Your Favorite Apps?

89. Our Question to You: What have You Learned today?

90. An examination of our assumptions AAC MYTHS DISPELLED From: AAC: A Way of Thinking. Special Education Technology-British Columbia, (April 2003) and The Myth of Augmentative and Alternative Communication (AAC) Pre-Requisite Skills, www.Speak for Yourself.org (July, 2014).

91. Myth #1 AAC is only used by people who cannot communicate verbally.

92. Myth #2 The primary goal of communication is to express wants and needs.

93. Myth #3 Using AAC will delay speech development.

94. Myth #4 We should wait to use AAC until a person is ready for it.

95. Myth #5 We should not overwhelm somebody with access to too many symbols.

96. Myth #6 Somebody who has a Speech Generating Device (SGD) should use it all the time…

97. Myth #7 An SGD should be a goal for all people who are non-verbal…

98. Questions

99. What does it take be come a successful AAC User? FOUR COMPETENCIES FOR AAC USERS

100. Beukelman & Mirenda, (2005). Augmentative & Alternative Comunication Four Areas of Competence for AAC Users 1. Operational Competence 2. Linguistic Competence 3. Strategic Competence 4. Social Competence

101. Skills that an AT user needs in order to operate a particular AT device. May be very simple skills like understanding how to press a single switch or May be complicated skills like typing on a computer keyboard. Also skills needed to use alternative access methods such as infra-red head pointer Operational Competence: Beukelman & Mirenda, (2005). Augmentative & Alternative Comunication

102. Also known as “Functional” competence For AAC users, involves the language skills needed to communicate. describes the reason that AAC was chosen and the functional application of device use. If a team has done a good job of AAC eval Attention given to the use of device for linguistic skills. Teams should know ahead of time the ways that the student will use device Too often, there is an assumption that the new tool will allow a student to do things just because it is provided Linguistic Competence

103. Strategic Competence Involves using the device in real world situations. To use device effectively, student may need to learn such strategic skills as: 1) how to decide when to use the phrases vs word x word speech production 2) when to spell out speech (use spelling page) rather than use symbols 3) when an accommodation such word prediction instead of direct selection was a more effective solution; and 4) how and when to print written assignments with device.

104. Social Competence Ability to initiate, maintain and terminate communication with real people in real life situations. Includes the skills needed to develop social relationships using AAC devices and strategies. A focus on social competence can help teams to identify skills that relate to using the technology around other people. Beukelman & Mirenda, (2005). Augmentative & Alternative Comunication

105. As support teams develop and revisit plans for AAC implementation, the four areas of competence can help to ensure that everyone has the same vision for a student's AAC use. If all four aspects of AT competence are not addressed in a student's program, the program is more likely to encounter implementation difficulties. Four Areas of Competence for AAC Users: Support Team Beukelman & Mirenda, (2005). Augmentative & Alternative Comunication

106. Contact Ben Satterfield, Ed.D. AT Consultant and Research Coordinator Ben@gatfl.org Ben@c4atx.com Disclaimer This presentation is produced by Tools for Life which is a result of the Assistive Technology Act of 1998, as amended in 2004. It is a program of the Georgia Institute of Technology, Enterprise Innovation Institute [EI2], Alternative Media Access Center (AMAC) and is funded by grant #H224C030009 of the Rehabilitation Services Administration (RSA), Department of Education. The contents of this presentation were developed under a grant from the Department of Education. However, those contents do not necessarily represent the policy of the Department of Education, Georgia Tech, EI2 or AMAC and you should not assume endorsement by the Federal government.