Medbridge

Medbridge
Great PD at your fingertips

Sunday, October 6, 2019

But He’ll Just Play With It! How a Communication Device is Not a Toy and How This is Not an Excuse

This blog post is going o begin with one of those, “If I had a nickel for every time I heard….” lines.  Over and over parents and professionals alike express their fears that the child will use the voice output AAC system like a toy; either banging repetitively on a single message or bouncing from page to page hitting random buttons.

It is the excuse heard most often after, “He isn’t smart enough.” (Never, of course put quite so bluntly.)  “He just plays with it,” - or some version of that - is tossed around by people who have clearly not learned how to teach a child to communicate. I say this with no disrespect; just a desire to have people be honest with me and with parents.




Yes, kids will often activate the same button repeatedly.  When a toddler says the same (usually new) words over and over again parents may despair, but none actually puts tape over the child’s mouth.  That is exactly what is being done, however, when the device is taken away from a child because he is “just playing with it.”

Yes, when verbal kids are bored they can talk to themselves under their breath or whisper to their neighbor.  And the teacher will admonish them. The AAC user who cannot adjust his own volume (or doesn’t recognize the need) can’t keep his boredom under wraps quite as easily.

And yes, there are undoubtedly kids who haven’t quite figured out the power of genuine communication yet, and just enjoy making verbal noise.

But teaching the child about the power of communication and how and when to use it; teaching the child how to use his AAC system, teaching the child about his ‘voice’ is our job.  I am a big believer in the notion that if a student doesn’t use his AAC system appropriately for genuine communication then we haven’t been successful in teaching him. We haven’t done our job. And we need to do better.



Step 1. Make sure the device is appropriate for this particular child and make sure it is core word based and robust. A system lacking the vocabulary a child wants to use isn’t going to be valued.

Step 2. Make sure everyone who interacts with the child with any frequency is familiar with the system and able to use it.  It’s hard to provide models when you can’t find the words.

Step 3. Make sure everyone is using Aided Language Stimulation - otherwise referred to as modeling.  Nonverbal children learn language through modeling just like their verbal peers. 

Step 4. Make sure the AAC system is always accessible.  Kate Ahern’s motto: “See me, See my AAC” is paramount.  The system should never be left in another room or on top of the filing cabinet.

Step 5. Make sure the environment and the people in it are all encouraging of genuine communication, are reinforcing the child’s communication attempts, and using appropriate strategies to encourage message production.

Playing with one’s voice should be a joyful thing. Don’t stifle that!  
Keep on talking, and let let your AAC users do likewise.

Looking for some materials to help staff know what to do with their AAC users?  Try these:







Sunday, September 29, 2019

Location! Location! Location! On the Importance of Stability or: The Number 1 Reason Why We Don’t Move System Symbols Around

In an on-line discussion recently a speech-language pathologist was looking for research that specifically discussed why we do NOT move symbols around on a  child’s AAC system. Doing so to “test” children, to make sure they really are discriminating the specific symbols, has nothing to do with communicating; a fact that practitioners of ABA don’t always “get.”

Now, I’ve worked in some very very rigid ABA programs myself, but there are some principles that we followed regardless of such issues.  
  1. Symbols stayed in one place in a communication book (this was in the days before high tech).
  2. Symbols were used for communicating, not testing.  Studies I conducted in one setting actually showed that teaching isolated discriminations may have resulted in the students knowing which symbol meant which word, but that definitely did not lead to using the symbols to communicate once they were placed in the communication book.  Modified incidental teaching in context did that.
  3. Symbols were always available.  Students had their communication books with them at all times. Symbols were accessible for communicating at all times.  That’s the whole purpose, isn’t it?  You wouldn’t take your mouth off and leave it behind, would you?  

(Yes, that sounds silly, but really it’s the whole point.  Most of us have no idea what it’s like not to be able to speak when you have something to say.  I have often challenged administrators to spend a day with duct tape across their mouths and no pencils in their hands.)


PRC systems, which utilize core words and consistent motor patterns to access words says this:
          “ In typical speech, our attention is directed to the conversation, not to articulating/saying the words. In order for an AAC user to develop this same “speaking” automaticity, he can’t be consciously thinking about interpreting or locating icons.
For automaticity to develop, each word needs to be accessed by a unique motor plan that once learned, never changes. Two words cannot share the same motor plan.”

One analogy that works for some people is to liken the AAC system display to a typewrite/computer keyboard.  As I recall from my 3 weeks in a high school typing class touch typing relies heavily on the motor patterns of hitting specific keys in specific locations.  What typist would keep working if you were constantly moving they keys around?  I can barely find the letters as it is!


LAMP training tells us: 

“Speaking is a motor plan, as are tying shoes and typing. Once the plan is learned it becomes automatic.
     o We don’t have to think about how to make a word with our articulators
     o We communicate well because we have automaticity
     o LAMP helps develop automaticity in a way that other approaches do not.
     o If a motor movement changes each time we say a word, we do not develop automaticity. Consistency of that motor pattern is key for teaching language.
     o A word can be produced in 1-3 keystrokes along a unique and consistent motor pathway. The AAC user can devote more cognitive energy to interacting vs. navigating through category pages.”

In summary, [AAC users need a] “Unique and Consistent Motor Plan: stable word location leads to effortless communication due to low cognitive load”

On the Assistiveware blog is this: “Augmentative and Alternative Communication (AAC) is blocked when users are required to prove themselves as ready and worthy before they can get AAC. Instead we should be presuming competence and not requiring any prerequisite skills before they can be eligible for a full balanced AAC system.”


Our job is to make communicating as easy and possible.  Let’s not use unnecessary demands to make it more difficult.
Keep on talking!




Sunday, September 22, 2019

Moving Stories Along

I’m talking some more today about narrative skills in students, including those who do not speak. I can’t stress enough the importance of developing narrative skills in children.
Narratives are important because they allow us to move away from the “here and now,” and to focus less on our personal experiences, while allowing students to talk about what is not immediate, but rather the decontextualized language of the classroom.


Narrative skills begin to develop in young children and are mediated by parental support.  These early interactions build the foundation upon which children build their narrative and academic skills (Boudreau 2008).  The narrative skills of preschoolers are predictive of academic success in school, as well as social success.  As students with narrative language deficits continue having difficulties in academic and social success, we are reminded of the importance of intervention at the narrative levels.

Shared Reading :

These early interactions [between parent and child] build the foundation upon which children build their narrative and academic skills (Boudreau 2008).  The narrative skills of preschoolers are predictive of academic success in school, as well as social success.  As students with narrative language deficits continue having difficulties in academic and social success, we are reminded of the importance of intervention at the narrative levels

One of the most ubiquitous and powerful discourse forms in human communication is narrative.”  (Bruner 1990).  Narrative is crucial in human interactions, yet often receives the least attention.  Bruner went on to name the 4 areas of grammar critical to narrative production:


  1. A means for emphasizing actions towards obtaining a goal,
  2. A sequential order should be established and maintained; so that events are stated in a linear way
  3. Sensitivity to what forms and patterns of language are acceptable
  4. Containing a narrator’s perspective or ‘voice.’

     

Narrative has been found (Nelson et al 1989) to capture not only the events of daily interactions, but to encourage interpretation, imagination, and use of self-talk to solve problems. 

One factor that is shown to have an influence on students’ skills in narrative discourse is early interactions around books and experiences.  The interactions with parents or other adults that provide scaffolding of story telling/ experience retelling, that co-construct narratives with children and gradually decrease that support, are critical.  By providing opportunities to interact with partners who provide quality exchanges students develop the narrative skills that they need.

There are 3 basic types of narrative scripts: personal experiences, scripts, and fictional stories (Hudson & Shapiro, 1991). Personal narratives are the easiest place to begin in intervention with children.  And they are the most often used types of narrative.

 “By focusing on narratives in our language intervention, we can explore processing limitations, create opportunities for using decontextualized language, facilitate social relationships, provide practice in constructive listening, improve reading comprehension, and identify language learning strengths and weaknesses.” (Johnston 2008)


For AAC users, focusing on the use of core words and important fringe, and moving from single symbols to sequences of symbols for generating novel utterances (SNUG), we need to keep our AAC users moving on the "oral" - literate continuum.  This means teaching AAC users to construct messages and sequence ideas in order to engage in meaningful conversations.





Boudreau, D. (2008) Forword. Topics in Language Disorders, 28 (2), 91-92

Catts,H et al (1999). Language basis of reading and reading disabilities: Evidence from a longitudinal investigation. Scientific Studies of Reading, 3(4), 331-361.

Gillam, R, & Pearson, N. (2003)The Test of Narrative Language. Austin, Tx: Pro-Ed.

Johnston, J. (1982). Narratives: A new look at communication problems in older language-disordered children. Language, Speech, and Hearing Services in the Schools, 13, 144-155.


Johnston, J. (2008). Narratives: Twenty-five years later. Topics in Language Disorders, 28 (2), 93-98

Sunday, September 15, 2019

Can You Tell Me About It? More Evidence for Narratives

I have frequently performed assessments on kids who seem to do ok on standardized tests, which mostly assess at the word or sentence levels.  But when asked to formulate entire paragraphs; to tell about an experience or re-tell a story or make up a store, their difficulties really stand out.

This problem is exacerbated in AAC users, whose language skills are often impaired or delayed, often from a lack of appropriate instruction.

This inability to organize language into meaningful narratives impacts children in social and academic contexts alike.  Narratives are at the heart of our conversations, our classroom performance, and our ability to tell others about…. well, anything.



There have been numerous studies of children’s abilities to construct narratives, and researchers like Carol Westby, Nickola Wolf Nelson, Ron and Sandra Gillam, and Maryellen Rooney Moreau, among others, have given us a wealth of information about how children develop this skill and the steps they need to take.

Narrative discourse is defined as, “at least two utterances produced in a temporal order about an event or experience (Hughes, et al, 1997).  Students with language disorders tend to miss the ability to integrate background knowledge with pragmatics - or social language - to formulate an organized recounting. 
Moreau has defined narrative as a story that involves telling or re-telling events and experiences (Lafontaine & Moreau 2014).
And Jerome Bruner (1990) called narrative skills “One of the most ubiquitous and powerful discourse forms in human communication…”  He went on to name the 4 areas of grammar critical to narrative production:

  1. A means for emphasizing actions towards obtaining a goal,
  2. A sequential order should be established and maintained; so that events are stated in a linear way
  3. Sensitivity to what forms and patterns of language are acceptable
  4. Containing a narrator’s perspective or ‘voice.’

One study (D. Boudreau, 2008) looked at narrative skills in academic settings and cited studies showing that 

  • students whose narrative skills are greater than their syntax skills performed better than those who had age-appropriate syntactic skills but poorer narrative abilities or tasks for story comprehension and re-telling,
  • the single best predictor of students’ future need for remediation or special education or retention was their earlier performance on tasks of narrative abilities,
  • that narrative abilities in Kindergarten predict students’ vocabulary and reading comprehension skills in 7th grade  
  • that there is a correlation between students’ narrative skills using wordless picture books and their Math skills in school,
  • and more evidence for the role of narrative discourse skills.

The bottom line, says Boudreau, is that discourse abilities are crucial in academic success, and, in order to make students with this profile successful, we need to provide remediation in both comprehension and production of narratives.

If you want to learn more about narrative skills assessment and development, Gillam and Gillam have written some terrific articles and presentations. You can grab some amazing CEUs through MedBridge’s courses on narratives by Sandra Gillam here.


As well as this great course offering from Sean Sweeney:                                         Tell me a story: Targeting narrative skills through the alignment of methodology and technology


And if you’re looking for some resources to help you work with narrative skills, try these I’ve created:
    


Boudreau, D. (2008) Forword. Topics in Language Disorders, 28 (2), 91-92

Catts,H et al (1999). Language basis of reading and reading disabilities: Evidence from a longitudinal investigation. Scientific Studies of Reading, 3(4), 331-361.

Gillam, R, & Pearson, N. (2003)The Test of Narrative Language. Austin, Tx: Pro-Ed.

Johnston, J. (1982). Narratives: A new look at communication problems in older language-disordered children. Language, Speech, and Hearing Services in the Schools, 13, 144-155.


Johnston, J. (2008). Narratives: Twenty-five years later. Topics in Language Disorders, 28 (2), 93-98




Sunday, September 8, 2019

What a Difference a Morpheme Makes

You know what a morpheme is, don’t you?  It is defined as the smallest unit of speech that carries meaning.  According to dictionary.com, it is “any of the minimal grammatical units of a language, each constituting a word or meaningful part of a word, that cannot be divided into smaller independent grammatical parts, as the, write, or the -ed of waited.”

So when I say I want to talk about facilitating communication today, don’t mistake my message for ‘facilitated communication.’  There is a very big difference between those two, determined by the ending morphemes.



Facilitated communication is supported typing, using hand-over-hand to help the nonspeaking individual type their message.  This technique has been discredited many times over in the literature and is not at all what I’m referring to.

Facilitating communication, on the other hand, is what we do daily with our AAC users to help them acquire language and communication skills.  In order to facilitate communication, we:

  1.    Provide access to the aac system - it needs to be available all of the time. This is how this child “talks” and (s)he needs to know that communication is valued enough to be there whenever it is needed 
  2.    Provide AAC models - use aided language stimulation as much as possible. When asking questions during an activity, highlight key words by using the aac system
  3.    Provide opportunities for the child to take a turn - i.e. by pausing after each turn you take. Don’t be the only one “talking”
  4.    Pause/expectant delay - give the child time to process, time to formulate a response. Looking expectant while pausing lets the child know you expect a response
  5.    Ask open-ended questions - and wait for the answer before you provide it; if necessary, you can answer the question then provide a prompt for the child to imitate the answer. Asking Wh-questions instead of yes/no questions allows the child to learn higher-level responses.
  6.    Prompt those responses - providing verbal prompts lets the child know what they are supposed to do.

 Begin with routine activities. Many routine activities have a set beginning - middle - end that are predictable, use words that are predictable. This makes it easier for the child.
Other activities are a little less predictable but can easily provide communication opportunities.

Start using ALgS (Aided Language Stimulation) with one activity. When you’re comfortable, add another activity/time.  Keep adding activities throughout the day until the strategies are used all of the time.  This helps keep the overwhelmed feeling down. Just take one step at a time.  Soon, you’ll be off and running.

In case you don't already have a copy, grab my free Being a Good Partner to an AAC User handout here.

In the meantime, keep on talking!





Sunday, August 18, 2019

Why Bother with Stories?

One factor that is shown to have influence on students’ skills in narrative discourse is early interactions around books and experiences.  The interactions with parents or other adults that provide scaffolding of story telling / experience retelling, that co-construct narratives with children and gradually decrease that support, are critical.  By providing opportunities to interact with partners who provide quality exchanges students develop the narrative skills that they need.


If you read this blog regularly, you know that shared reading is another favorite topic of mine
These early interactions [between parent and child] build the foundation upon which children build their narrative and academic skills (Boudreau 2008).  The narrative skills of preschoolers are predictive of academic success in school, as well as social success.  As students with narrative language deficits continue having difficulties in academic and social success, we are reminded of the importance of intervention at the narrative levels.


I’ll circle around and talk some more about narrative skills and shared reading opportunities in subsequent posts.  In the meantime, if you’re interested in increasing the narrative skills of students, take a look at this resource I have on increasing narrative skills. As well as this one for increasing narrative skills in AAC users.




And, for a superb discussion of narrative skills, check out Sandra Gillam’s CEU courses at Medbridge. I've heard Sandra and her husband speak on the topic and they are superb.  Medbridge charges just one annual fee for as many courses as you have time for!











Sunday, August 11, 2019

Your Next Great Read is Here!

I recently responded to a request for interesting and educational picture books for children.  The article was published recently, and I think it's worth taking a look at.



Mine were not the only recommendations, of course, and some of the books listed I hadn't heard of.
So, in the interest of good read-aloud time, here is a link to the article and the list.
Each book has a brief description.  

Can you tell which books I recommended? 
 Aunt Isabel Tells a Good One was one
The Snowy Day was another

and Tommy at the Grocery Store (one of my own kids' favorites! and perfect for an SLP).  



The article itself contains links to the books, as well as my affiliate links here.

I love each of these for different reasons.

Aunt Isabel tells her niece and nephew a wonderful story while in the process teaching them how a story is created. I've taught many children about story elements with this one.

The Snowy Day is a classic. It's deceptively simple and good for talking about sequences in a story.  Not only is there the overall sequence of events in the whole story, but you can break the boy's day into 2 distinct parts: in the snow and in the house.  I used to work this book into my seasons theme in therapy.

And Tommy.... I can't say enough about this book that will tickle your funny bone.  Tommy's mother accidentally leaves him at the grocery store.  A procession of other customers move him about the store, each explaining why he belongs in a different department; "He has ears" so he must belong with the corn.  "He has legs" so he should go with the tables and chairs.
Poor Tommy finally is rescued by his mother.  Wonderful for part and whole discussions.

Enjoy!
And if you're looking for some guidance during your read aloud time to get the best language impact, take a look at my shared reading strategies and templates resource.

Keep on reading, and.... keep on talking (about books).