Autism: Moving Beyond Choice-Making with AAC

AAC, the iPad and Autism:
Moving beyond choice-making
Gwendolyn Meier, MA, CCC-SLP, MT-BC
Speech Language Pathologist, Music Therapist
Villa Esperanza Services
Pasadena, CA

Terry Kappe, MS, CCC-SLP
Speech and Language Therapy Services
CSHA District 7
Temple City, CA

Disclosure
• Nothing to sell, nothing to buy
• Thank you to the students and their
parents for video permissions
• No video recording of this session
permitted
• FYI - there is no Wifi in this room

AAC, the iPad and Autism - Moving Beyond Choice-making. CSHA 2013

Why are we here?
• We all have iPads
• To talk about moving beyond
choice-making and
requesting with diﬃcult-to-
motivate, nonverbal students


Why are we here?
• Because we can pave the way for
“Requesters” to learn additional
functions of communication using
AAC with the essential teaching
strategies of modeling and
demonstration

Why are we here?
• Because we want you to
consider that even “symbol-
blind” individuals can be
taught to use visually-based
communication


From an AT Specialist: A tale of AAC Failure
• Parent bought an iPad
• AT Specialist provided an iPad
But, “It’s not working”
“He’s not using it”
• The iPad is not the best communication tool
for every student
• That being said, exposure to visually
supported communication may lay the
foundation for future skills


From an AT Specialist:
A tale of AAC Failure
Which means...
• SLPs are the most qualified amongst the
team to provide skilled AAC intervention
and implementation support.


Nonverbal, Diﬃcult-to-Motivate
“Lower Functioning” Students

• These kids are on regular school sites
• ...on your caseload
• ...their communication needs are complex


So, how do we
go from this...

...to this?

Diﬃcult-to-Motivate Students
Much of the info on teaching AAC focuses on
teaching non-oral individuals with
INTACT SOCIAL SYSTEMS

• More info needed on how exactly to teach
AAC to learners with social deficits
• Children with autism often have to be
taught to take pleasure in social
engagement


“iPad”
Tonight’s terminology:

• In today’s presentation: Info. applies to
any Speech Generating Device
• iPad, Android, Vantage, Maestro
Tech32, GoTalk
• We’ll use the term “iPad”

Autism: Communication Options Using the iPad
March 1, 2013

An AAC system should...
• Increase participation: classroom, work,
community, home
• Address goals: IEP, work, personal
• Support eﬃcient and interactive communication
• Provide the user with meaningful language
• Support language and literacy learning
• Be age-respectful
• Provide a positive support to behavior


Getting Communication Going

In autism we know we can teach:

Cause-and-Eﬀect Requesting

Cause-and-Eﬀect Rejecting


START with One-word/One-button Requesting
for items, actions or recurrence (“more”)

• Builds “buy-in”

• Adds pay-oﬀ to the eﬀort of
communicating


START with One-word/One-button Requesting
for items, actions or recurrence

• BUT DON’T STOP HERE!

• It’s very easy to get stuck on requesting
...but additional functions ARE possible!


Communicative Functions
*Sometimes Present* In Nonverbal Autism
• Attention Directing
• Requesting
• Rejecting*
• Greeting*
• Self-Expression and Self-Assertion
• Naming
• Commenting
• Giving Information / Requesting Information


Early Pragmatic Communicative Functions
• Requesting
• Rejecting
• Greeting
• Naming
• Commenting


WHY communicate?

In typical development,
does not need teaching

Early Pragmatic Communicative Functions
The s
• torie
sI
Requesting
• Rejecting hear
• Greeting ...
• Naming
• Commenting


• It is rare for diﬃcult-to-
motivate students to naturally
move out of the requesting
function

• Modeling and
Augmented Input are KEY to
the process of expanding
communicative functions


Model and Expand Language
• Oral language development


Model and Expand Language
• Non-oral language development

Sign language Speech Generating Device

Pi
ct
Sp

ur
ee

es
ch

Pictures

Augmented Input
Partner Augmented Input
Point to pictures while you are
Speech
p talking.*
• Use parallel talk, self-talk, break down,
build up.
Pictures • Produce a variety of communicative
Pictures
functions such as questions, comments,
greetings, requests, etc.
• Use a large percentage of available
vocabulary
• Use a large percentage of vocabulary
as they appear in your speech
Build language skills by • 80:20 ratio of statements to
questions/commands
demonstrating use of AAC!
• Strive to provide Partner Augmented
Input at least 80% of ongoing daily
p g g y
WEB ADDRESS IN YOUR HANDOUT
Copyright notification: User may not copy or distribute these materials
except for use with the students, patients, clients, or other individuals who
receive instruction, therapy, supervision, assessment, care or other services
activities
directly from the User. Otherwise, these materialsAutism - Moving Beyond Choice-making. CSHA 2013
AAC, the iPad and may not be copied without • Use scripts to develop ideas
the 1
written consent of DynaVox Mayer-Johnson.
* See references for sources

In ASD, modeling is essential to:

First) Demonstrate the use and power of
additional functions of communication:
attention directing, commenting, sharing
opinions, greeting
Then) We can worry about teaching the
vocabulary/symbol location for these
functions - after they know WHY


Augmented Input
VIDEO
• Gissette - (16 years old) - JB Music video
✴ Sharing Opinion - Modeling


Sounding Board
Attention Directing, Comments, Sharing Opinions

Augmented Input in ASD
VIDEO
• Ryan (20 years) - Bracket Assembly
✴ Requests for items - Mastered
✴ Attention Directing - Teaching


Sounding Board
Attention Directing, Greeting, Requests


Augmented Input
Tonight’s terminology:

• “Augmented Input” • “Aided language
stimulation” (ALgS)
• “Modeling”

• “Demonstration”
• “Aided language
support”
• “Aided language input”
• “Simultaneous
Communication”


Augmented Input
VIDEO
• Milo (4 years old)
✴ Naming, Describing- Teaching

Pogg - $0.99


Augmented Input at
Early Language Stages
• Requires pre-planning
• Occupies valuable ‘real estate’ on the
visual display

• Takes dedicated modeller(s)

• Like oral language development - aided
language development also TAKES TIME


One-Hit at a Time
• Requests
Do
• Sharing Opinions n’t
for
get th
• Commenting ese
!
• Greeting


One-Hit at a Time
Inexpensive Apps

• Answers:YesNo ($1.99)
• Sounding Board (FREE)
• Picture Card Maker (FREE, $5.99)

• Digitized (recorded) voice
• Icons: Take a pic, online pic, Photos

One-hit: Moving Beyond Choice-Making

Attention Directing
• Delivering a message
✴ Delivering/picking up items
✴ Social scripts
• Making announcements
✴ Before transitions, “It’s time for...”


AnswersYes/No (Requests)
DARD
STAN

CUS
TOM
I ZED


AnswersYes/No (Deliveries)


AnswersYes/No (Deliveries)

2-part
scripts


Pic Card Maker
Attention Directing - Delivering Messages


Pic Card Maker
Attention Directing - Delivering Messages

3-button script;
one-hit per turn


Pic Card Maker
Script

March 1, 2013


VIDEO
Nicolas (6 years) - Delivering flyers
✴ Attention Directing - Teaching


Pic Card Maker
Attention Directing - Making Announcements

One-hit:
“It’s time for...”



Attention Directing

✴“Look!”

✴Naming
• Item or action label
✴Descriptive word
• Broken, dirty, ...


Attention Directing
✴“Look!” - Versatile
- Best use of real estate
✴ Naming
• Item or action label
✴Descriptive word
• Broken, dirty, ...


Comments & Sharing Opinions
• Expressing taste
• Cool, oh man, good, bad,
gross...
• Giving Compliments


Sounding Board app
One-hit: Mixed Function Board
Comments, Sharing Opinions


Sounding Board app
Attention Directing

N
a
m
i
n
g


Sounding Board app

Directing Action


AnswersYes/No (Compliments)


Sounding Board app
Just Comments

CLUB


TouchChatHD ($149.99)

March 1, 2013


• Versatile Requests for actions
• Sharing Opinions
• Commenting
• Greeting


Sounding Board

Core Vocabulary Board:

Sym bol
wed ns
B orro x ico
Sti


Sounding Board

Core Vocabulary Board:
Request Action


One-hit: Request Action
VIDEO
• Milo - Firefighters Book
- Augmented Input, Core Words board

Question:
What will be Milo’s ﬁrst core word?


Greetings

✴Hey / Good Morning / Hi
✴Bye / See you later / Have a good weekend
- One of the easier ones to teach
- Create motivating equation for any of
these additional functions of comm.


One-hit: Mixed Functions
Book Reading - Requests,
Comments, Directions


One-hit: Mixed Functions
Butterfly Coﬀee filter craft -
Requests, Comments, Sharing
Opinions


Attention Directing
Sharing Opinions
Comments
Greeting

Teach it! Model and demonstrate
Reinforce it! Provide motivation to perform


Early Language Stages
1. One word at a time
2. Two- and three-word phrases
3. Building phrases and early sentences
4. Learning grammar and sentence structure
5. Sentences with more grammatical
endings


2- and 3-hit Goals
Choice-Making and Beyond
• Elaborated requests: “I want” + item, “More”
+ item/activity, “I want” + “to go” + place
• Attention Directing: “Look” + item/location,
“It’s time for” + activity
• Directing other’s actions, core vocab: Open
it, give me, my turn, put in, you go
• Greet using names

2- and 3-hit Goals
Choice-Making and Beyond
Elaborated requests Will
requ
links ire s
Attention Directing ome
betw navig
Directing other’s actions een ation
boar /
Greet using names
ds

• Comments/Sharing Opinions often still one-hit
Rather than expecting a sequence of hits
Lots of modeling/augmented input & reinforcement

Apps for 2- and 3-hit
2- and 3-Button Phrases
• Sounding Board (FREE)

• Picture Card Maker (FREE; $5.99)

• Full-featured Communication Apps
($149+)

Sounding Board - Requests


2- and 3-hits
Elaborated Requests
VIDEO
• Gissette (16 years)
1. Elaborated (3-hit) request - Almost
mastered

Intuitive navigation
allows for complete sentences

2-hit request embedded in a Multi-Function
board
At Work Break Choices


Picture Card Maker

Sentence Strip -
2, 3, or 4 symbol
Elaborated request


2- and 3-hits
Descriptive Request
VIDEOS
• Gissette (16 years) - Watch video clip
1. Directing Actions & Attention
(really, a descriptive request) -
Emerging

2- and 3-hits
Moving Beyond Choice-Making
• We know we can teach: Elaborated requests:
“I want” + item, “More” + item/activity, “I
want” + “to go” + place
• Directing attention: “Look” + item/
location, “It’s time for...”
• Directing other’s actions, core vocab: Open
it, give me, my turn, put in, you go
• Greet using names
March 1, 2013

Sounding Board
Core Vocabulary


TouchChatHD ($149.99)


2- and 3-hits
Core Vocab, Directing Actions & Attention

VIDEO
• Gissette (16 years old)
Comments, Directing actions, using core
vocab
- Put on (nail polish)


Teaching the Power of Core Vocab
• Single button - or - a sequence
• Same page - or - navigating between
board/pages


• Gissette’s Symbol Recognition
• How is she going to learn to use
“Put” + “on” to request?


Symbol Recognition
• When we’re teaching communication, we
should not be testing symbol recognition
• When we create multiple pages for
communication, we need to keep same
messages in same locations
• By shifting locations of pictures we are actually
testing symbol comprehension


TM
PECS - Symbol Recognition

• TM
PECS Phase 3:
Discrimination Training
- Aims to teach symbol
discrimination skills given a
limited field of choices


Picture Communication Books
Rely on symbol understanding


Motor Plan VS. Icon Recognition
• We have found that consistent placement
of icons may be more important than
symbol recognition
• Learners don't need to be able to
recognize/"point to"/"give" a symbol that
is named before they can use that symbol
to get something done in the world.


Motor Plan VS. Icon Recognition
• We have found that consistent placement of
icons may be more important than symbol
recognition
• Learners don't need to be able to
recognize/"point to"/"give" a symbol that is
named before they can use that symbol to
get something done in the world.

THIS IS COUNTER-INTUITIVE...

Location, Location, Location!
When teaching AAC: Teach location
Why??

• Stable key location enables the development
of motor automaticity
• Motivating outcomes/consequences of the act
strengthen motor plans
• Consistent motor plans reduce the cognitive
requirement of symbol recognition


Motor Planning
EVERY learned physical activity
depends on motor planning
• Walking, talking, driving, climbing/
descending stairs, eating dressing, typing
reading, Smartphone or computer access


When Motor Plans Must Change
• Think about how diﬃcult it is when you’re
faced with typing into an ABC keyboard
rather than a QWERTY?
• Turning on and tuning the radio in a rental
car vs. your own...


We can take advantage of motor
planning when:
• Each word has its own motor pattern due
to consistent icon location
• Motor patterns don’t change
• Patterns build upon themselves as
language grows - preserve relative location


Motor patterns don’t change


As language system grows...


Motor Plans are extremely important
when...
• Teaching the use of core vocabulary and
use of more abstract vocab/symbols
• When using multiple pages of vocabulary
• When symbol recognition is weak


PIC Core Vocab hidden buttons


Using Motor Planning to Our
Advantage...
• Our lower-functioning students can
generate multi-word phrases...
• ...across multiple pages
• ...using core vocabulary
We’re ready for Language Stage 3


Multi-Word Language Stages
1. One word at a time 3+ words
2. Two- and three-word phrases
in length
3. Building sequenced phrases and early sentences -
meaningful order, word endings (-ing, -s)
4. Learning grammar and sentence structure -
question words, negative statements, irreg. past tense
5. Sentences with more grammatical endings -
possessives, 3rd person present, reg. past tense


Stage 3+ Goals
Beyond 3-word phrases...
• Visual sentence strip or message window
• Useful for the learner
• Useful for the
communication partner


Language Stage 3+ Goals
Meaningful word order
Adding more verbs and adjectives to requests
Describing phrases (Object+Action+Location)
Including word endings (-ing, -s)
• Navigation between multiple pages (Core vocab,
actions, descriptors, multiple categories, etc.)
• Extensive icon library is a plus for abstract vocab
• Larger vocab: Synthesized (text-to-speech) voice


SGDs Apps

Full-Featured
Communication
- Expanded, Word-based Vocabulary
- Variety of Phrase Types
- Multi-Word Language Construction
- Intuitive Navigation
- Grammatical Endings

Apps for Stages 3+
ProLoQuo2Go TouchChat HD

• $189.99 • $149.99

• The first, not necessarily the • Highly customize-able
best
• Unique features: Button
Actions more varied, Copy
and move pages between
users, iShare mobile upload/
download

• Language Stages 4, 5 -
WordPower version $299.99

Other apps: Words For -Life, Sonoﬂex, GoTalk Now, Talk Tablet
AAC, the iPad and Autism Moving Beyond Choice-making. CSHA 2013

TouchChat Family of Apps
• Full featured communication
application for the iPad
• Not interchangeable between
iPad and iPod versions
• 3 kinds to buy - Lite (no voice),
HD, WordPower
• Does not Scan

Today’s presentation:
Students used customized
TouchChat HD
vocabularies

TouchChat Starter Vocabularies

• Diﬀerent users: Diﬀerent needs
• Main key to success of a communication app -
VOCABULARY
• Vocabularies set -this app apart
AAC, the iPad and Autism Moving Beyond Choice-making. CSHA 2013

VocabPC • How it’s ...Organized
...Accessed
...Programmed
in sentences
and words
• Pre-programmed
navigation is often intuitive
MultiChat 15


TouchChatHD WordPower Vocabularies
WordPower 24
• Vocabularies evolving
for 10-15 years
• WordPower by Nancy
Inman, SLP
- Makes words available
through the process of
WordPower 80 creating sentences

• WP also available on
other platforms


TouchChatHD
Various
Button
Actions


TouchChat HD


TouchChat:
Visual Scene Display


TouchChatHD - Invisible buttons


Two-Page Navigation (Play Video Button Action)

Download
YouTube
videos:
Dvdvideoso2.com


4-button Sequenced Video Request, Multi-Chat 15


Word%Power%30%Sequencing%


One$Year$
Free$
Subscrip0on$


Let’s Wrap Up
We have talked about:
• Paving the way for lower functioning students to move
beyond choice-making and requesting with the essential
teaching strategies of modeling and demonstration
• Using motor planning so that even “symbol-blind”
individuals can use a variety of vocabulary in visually-
based, multi-page communication systems
• Our favorite, very robust communication app that out of
the box makes it easy to teach additional functions, to
use motor planning to our advantage and to generate
multi-word utterances - TouchChat HD


• Monthly email blast - write to join
socalaacnetwork@gmail.com
• Blog - www.scaacn.blogspot.com
Updated weekly with AAC-related news, materials,
trainings, jobs
• Facebook - SoCal Aac Scaac-n
• Twitter - @SCAACN


• FREE Quarterly “support group” meetings,
Pasadena, CA
Next meeting: Tuesday, 4/23/13
6:30-8:30 p.m.
Topic: TBD


Thank you!

Gwendolyn Meier
Villa Esperanza Services
gmeier@villaesperanzaservices.org

Terry Kappe
Speech and Language Therapy Services
terrykappe@gmail.com

Autism: Moving Beyond Choice-Making with AAC

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