Evaluate your child’s communication needs to make the best tech decisions among ever-increasing choices…
Last year in Autism File, I discussed the growing popularity and use of touch screen tablet devices in special education classrooms. (See “iPad Therefore I Am” p.28-31 Autism File issue #45.) The intent was to encourage autism parents to explore these new tools for their wide range of applications and lower cost over traditional devices and software (such as tower PCs, laptops or expensive and proprietary AAC devices).
This time around, I want to discuss Augmentative and Alternative Communication (AAC) specifically. With the advent of inexpensive hardware and applications, the options for educators and parents to choose from have greatly multiplied. However, with these new options and their accessibility, comes a greater potential for caregivers to rush into an AAC solution before properly evaluating or assessing the individual child’s communication needs. This risks the possibility of an inappropriate solution that could cause abandonment of the chosen device, or the desire to use AAC entirely.
In the interest of helping parents find effective solutions for their child’s communication needs, I’ve spoken with two experts in the field of assistive technology and AAC. Dr. Samuel Sennott is a PhD, whose specialty is in AAC, cocreated the popular iOS app “ProLoQuo2Go,” which has become ubiquitous in special education classrooms and homes everywhere. Secondly, I interviewed Debby McBride MS, CCC-SLP, a veteran speech language pathologist who does clinical outpatient evaluations for Boulder Community Hospital. Additionally, Ms. McBride runs her own AAC resources company, “AAC TechConnect,” which services SLPs (speech language pathologists) and those who do AAC evaluations and provides information to parents and caregivers.
I was particularly interested in getting input from Dr. Sennott and Ms. McBride regarding the questions:
- Who does the assessing?
- What is an AAC evaluation and in what areas is a child assessed?
- How are solutions chosen?
- What can parents do as participants?
We’ll discuss these answers and follow up with some resources parents can use for their children who require AAC.
Who does the assessing?
According to Dr. Sennott, it’s typically a Speech Language Pathologist. SLPs assess, diagnose, and treat disorders related to speech, language, cognitive communication, voice, swallowing and fluency. A certified SLP has at least a Master’s degree (an MA or MS) if not a Clinical Doctorate degree (SLP-D).
If a child is evaluated/assessed by his or her educational team at school, that team will include an SLP but “…also a special education teacher or some sort of occupational therapist or physical therapist may be part of that assessment as well,” Dr. Sennott remarked. “I feel strongly about special educators taking responsibility for their place in the AAC field. They’re making sure things are working across the child’s whole educational program,” he added.
Debby McBride, as an SLP working with the Boulder Community Hospital in Colorado wrote a paper for The American Speech-Language Hearing Association (ASHA) in their publication Perspectives on Augmentative and Alternative Communication entitled “AAC Evaluations and New Mobile Technologies: Asking and Answering the Right Questions.” In this paper, McBride quotes a variety of sources and outlines the basics of evaluating a child’s communication needs and how solutions are chosen, by matching the features and functionality of an AAC device or app to their specific requirements.
Asking and Answering the Right Questions
McBride’s company, AAC TechConnect, developed a framework for evaluations called “Asking and Answering the Right Questions.” In her paper, McBride describes the process as identifying and asking key questions that support an evidence-based evaluation process. Questions that this framework considers are:
- What does the communicator NEED, WANT or DESIRE to communicate? How is that expressed?
- Where, when and with whom will the individual communicate?
- What are the communicator’s current skills and abilities?
- What is the communicator’s language/linguistic ability? (e.g. vocabulary, symbols, language representation, organization, etc.)
- What are the device functions and features required?
- How does one make appropriate decisions for the optimum communication device?
- If a device has already been provided, is the communicator currently using the AAC device?
To determine what the child wants or needs to communicate, the SLP relies on case histories, direct observations, previously reported information and other related sources, according to McBride. The SLP uses one of a few available assessment tools to determine a child’s current communications skills.
What is an AAC Evaluation?
To learn the “where, when and with whom” the child will communicate, the SLP takes an inventory of the individual’s current communication contexts, taking into account her current interest and desire to use communication skills in everyday routines. Toward this end, both Dr. Sennott and Ms. McBride have mentioned the use of the “SETT Framework” (Student Environment Tasks & Tools) which can help make “…appropriate assistive technology decisions through focusing on the student and the environment, including communication partners, tasks and tools.” To determine a child’s current skills and abilities, Dr. Sennott explains, “You’re going to look at a whole range of things, from motor abilities, to cognitive and linguistic abilities, literacy abilities and sensory and perceptual abilities. You might have to assess motor skills such as determining how easily someone can touch a touch screen or access a switch system. For cognitive and linguistic functioning, you might look at how people organize vocabulary, how they look at linguistic symbols and then determine what symbol set would be appropriate for them.” He further suggests literacy, comprehension, and writing skills assessments. “For sensory and perceptual assessments, this is everything from vision and hearing to ability to perceive symbols. It’s a range of things we’re going to assess as far as usage, and looking at Dr. Janice Light’s AAC communicative competence, linguistic, operational, social and strategic skills are all taken into account.” Once the type of AAC system and software features are paired to the child’s abilities, the SLP must also factor in the device’s functions and features. These considerations (which she quotes from another paper by Lloyd, Fuller, & Arvidson, 1997, and I paraphrase here) include input methods (touch, eye gaze/movement, use of mouse, keyboards or switches), selection techniques (direct selection or scanning/scrolling), encoding, output capabilities (synthesized or digitized speech, visual display, printed), as well as portability, size, weight, and other physical aspects of the hardware.
So how do we choose the right AAC?
Everything discussed thus far leads up to the idea of “Feature Matching” the type of AAC system and all its “features” to the child’s skills and abilities, as determined by evaluation. It requires a thorough knowledge of AAC theory and practice, as well as an awareness of all the available systems and applications currently on the market. A parent or caregiver should seek the help of their child’s educational team and arrange for a Speech Language Pathologist to begin an evaluation, prior to jumping into a purchase. As you may be aware, some AAC solutions cost multiple thousands of dollars, representing a significant commitment. While less expensive options exist on open platforms like the iPad and Android tablet devices in the form of “apps,” and can make experimentation with different solutions more affordable, appropriate choices and support must be given or we run the risk of failing to engage the child to use AAC.
One of the most important aspects of implementing technology in the life of an individual with autism is the participation of parents and caregivers. “My goal is to help parents get educated on the types of choices available for devices and apps,” said Ms. McBride, noting that parents can access free information in both of these areas on her website (See Find Out More.) One file I found particularly helpful on her website is entitled “Apps Summary: Spring 2013”. The file provides a nice listing of AAC apps in categories including robust apps, starter apps, and spelling/text-to-speech apps, all listed with current pricing. The .pdf file also gives links to other pages within the AACTechConnect website to help parents make comparisons based on features.
Ms. McBride also recommends that parents explore the continuum of communication functions. “People tend to get focused on wants and needs, but there is so much more that can be communicated beyond that for many individuals. When people focus on wants and needs, they can also be making comments such as, ‘Oh, I like that,’ or ‘I don’t like that, it’s yucky.’ However, they can also communicate what they’ve been doing that day or what they did over the weekend.” McBride encourages parents to work closely with their clinician, and be very clear about what they want their child to be able to communicate. “Aim high! Parents are good at that. We should all be striving to maximize the spectrum of communication.”
McBride, Debby (2011) “AAC Evaluations and New Mobile Technologies: Asking and Answering the Right Questions” published in Perspectives on Augmentative and Alternative Communication, Vol. 20, No. 1, pages 9-16 Retrieved from: http://div12perspectives.asha.org/content/20/1/9.abstract
Find Out More> The American Speech Language Hearing Association
This website is for SLP’s and professionals in the field, but is rich with information that some parents and caregivers may find helpful as they wish to educate themselves.
Top 7 AAC Considerations
Across the range of AAC systems, Debby McBride outlines seven considerations relative to the individual skills being assessed:
- Symbolic Representations (single-meaning pictures, multi-meaning pictures, words, spelling)
- Amount and type of vocabulary (nouns, verbs, adjective, pronouns, verb tenses)
- System use (number of messages, number of pages, adjective, pronouns, verb tenses)
- Organization of vocabulary (situational, categories, use of core words, phrase-based, visual scenes)
- Message formulation (single-key messages, phrases, semantic compaction, simple sentences, complex sentences, grammatical/morphological use)
- Navigation (ability to remember location of vocabulary, number of pages)
- Access (use of device functions, such as clear, on/off, speak, ability to use programming features)
These seven considerations basically encompass all known types of AAC. An SLP will choose the type based on the child’s abilities. Can he understand generic symbolic representations? Can he understand parts of speech? Can he remember the location of words and pictures well enough to navigate the software? And what type of messages can the individual handle? Are they limited to selecting a pre-set phrase, or can they build messages? What method of message building is easiest for them? And finally, where she describes “access,” can the child understand the basic functions of the software features? All of these questions must be addressed before matching the right technology with the individual.