on the web:by Nancy J. Hogan, Assistive Technology Specialist
The CCATT Center
Northampton, MA
Recently Chauncy asked me to write an article for the ConnSENSE Bulletin. I always like to start a project by figuring out what I am feeling passionate about. At this point of my life it is an easy task to decide which issue is most important to me. For the past year and a half I have been spending a lot of time researching Developmental Verbal Dyspraxia in the birth to three population. I have been focused on interventions that can be done in the home. Our home.
I began working with children who had difficulties with communication back in the eighties. While I was a classroom teacher, I began going to assistive technology workshops, and later to classes at UCONN. I asked to work with the students who needed technology.
Meanwhile, back at the ranch, my family began to grow. My firstborn was a precocious talker. The second child took his time learning to speak. Jamie, my wonderful puzzle, is approaching three all too quickly. This is the story about how he is learning to communicate...
on the web:By his second birthday we really were not hearing any words. He dropped most of his signs. He would no longer gesture to music or books. He would not look at me if I tried to show him a sign. About this time I remembered an article I had read in "Discover" magazine. Apparently, parrots can learn to repeat a word through direct teaching. But if you want the parrot to understand that the word "key" is associated with the object, that it is better to teach someone else the word "key" and to show its function while the parrot is watching. I began to teach my four year old signs in front of Jamie. Sam loved learning signs. He became Jamie's best teacher. Jamie had great imaginative play skills, adored his brothers, and was a remarkably good communicator in his own little way.
I
began to experiment with using topic boards. I wanted to make sure that Jamie
immediately understood the power of pictures. I got a bag of M&M's. I dumped
them into a bowl and cut out the label to make it a symbol. I told my middle
child that if he wanted an M&M he could hand me the symbol. The nine year
old wanted to try. By this time Jamie couldn't wait to try. I then pulled out
a bag of Skittles. Let the two oldest make choices, then Jamie begged for a
turn. In half an hour Jamie learned to initiate and to discriminate with picture
symbols - well worth the dollar investment. I left the nine year old in charge
of giving out the candy so Jamie would begin to generalize across people.
At this point, I turned to the internet. I emailed presenters I had met at
CTG (Closing the Gap). I 
did
research. We tried Early Intervention briefly. Caroline Musselwhite and Linda
Burkhart were kind enough to mail me advice and encouragement. They both confirmed
that yes, it was time to begin using symbols. They suggested starting with books
and music.
Now, at this point in time Jamie found music and books aversive. So, I generalized their advice to mean, start with something that is important to your child. Like many of us, Jamie was motivated by food. I discovered that computer and craft stores sell sheets of flexible magnets that feed through ink jet printers. I put a small communication board on the refrigerator. I cut apart some supplemental pictures of favored snack foods. I was not surprised that Jamie started using these pictures effectively almost immediately. I was surprised that he would return them to their places - these pictures were important to him.
I wanted to expand his communication beyond wants and needs. Since Jamie loved watching any living creature, I gave in and said we could get a hamster. Then I went to the craft store next door and got some window clings that can feed through a printer. While Jamie and I sat and watched the hamster, I used the resulting transparent board while talking about the hamster. Verbs were now also important.
 |
Static clings work great on windows - and rodent cages. |
We discovered that Jamie had a good sense of design. When I tried using a Carol
Goossens's board with him 
while
playing with Duplos, he was not very interested. On a whim, I downloaded some
graphics of Duplo blocks and pasted them below the board. Somehow this helped
him to link the use of the board to the activity more. It was also a great supplemental
strip, allowing us to talk about the colors and shapes of the blocks.
Jamie was more willing to use boards when they became part of the activity. So, I put the doctor boards on mini clipboards. I made him a "Press Pass" and attached it to his play camera. Using fabric transfers, the cooking board was ironed onto a potholder... While I often modified the presentation of the board, I always used boards from Goossens' and Crain's book of communication displays (available from http://www.mayer-johnson.com). When I needed a board for a topic not covered in the the overlay book, I looked for one with a similar theme and substituted the particular vocabulary that I needed. This helped me to "borrow" their consistency of symbol placement. The first AT workshop I ever went to was by Carol Goossens and she's been my hero ever since. I just wish that I could work with Carol's materials without Carly Simon's song running through my head - unfortunately, I even hum off key:
And nobody does it better
Though sometimes I wish someone could
Nobody does it quite the way you do
Why'd you have to be so goodARTIST: Carly Simon
TITLE: Nobody Does it Better
I discovered that the web is a great place to get graphics. When I wanted pictures of specific toys, I could go to a toy web site and download graphics that were already small file sizes - that meant that they could fit easily into Boardmaker without choking it. Pictures of older toys could be found on sites like E-Bay (if the images are large, you need to bring them into a decent photo editing program and reduce the size. About 100 - 125 pixels seemed to work well for image size on my Mac . When using a PC, reduce the colors to 256.)
Jamie
loves the Rescue Hero toys (Fisher Price). I made him a set of 4 tabbed pages
and spiral bound them. The tabs are for who does he need, what is the problem,
where is the problem, and what rescue vehicle is needed.
This was his first experience with dynamic display - his brothers or I would show him how to flip the pages to get more vocabulary.
Another great source for symbols is: http://www.trainland.tripod.com/pecs.htm
I began using some ideas that Dale Gardner-Fox, my colleague and friend, had shared with me. When we have to make a quick choice, I ask Jamie, "Which do you want [extend one hand] chicken or [extend the other hand] spaghetti." Jamie will touch the hand that matches his choice. We call this method "Talk to the Hands". His brothers are pros at asking questions and interpreting answers, which is so helpful in the car!
The other simple intervention is: we store a Magnadoodle next to the TV. Now we can draw the symbols along with Steve (Blue's Clues) and Dora (Dora the Explorer - both on Nick Jr.)
Around this time I came across www.Apraxia-Kids.org website and list serve. I appreciated the information on this site and the chance to "chat" with other parents and professionals. When Jamie got mad at me and managed to stick out his tongue intentionally and in context , it was nice to have people who could share my excitement.
Total communication was obviously the way to go for us. Once Jamie learned
to label something in one
mode, the pressure was off - he would soon start labeling it in other modes,
also. As he began learning more words, this became even more important, because
his words often sound alike. One site that I have found very helpful was:
http://aac.unl.edu/ASHA1999/Hustad_ASHA99.htm
This site has a presentation, Enhancing intelligibility through application
of AAC strategies, Katherine C. Hustad & David R. Beukelman, University
of Nebraska, Lincoln. Basically, I found that going to www.google.com and typing
Beukelman was a great way to get information.
I got a digital camera for my birthday last year. Whenever we have a special outing, I take pictures. When we get home we make scrapbook pages with my kids dictating the text. These journals let Jamie take place in reliving and retelling family stories. We also make up simple stories around some of these activities in IntelliPics. Writing with Symbols 2000 has been helpful for writing up quick stories about events that were important to him, like finding a bug in the grass. If Jamie decides that he NEEDS something he saw advertised on TV, he can deal with waiting for grocery day to buy the treat as long as he has his note on the fridge to remind Dad.
Jamie likes recording his voice on the computer. He is more willing to practice making a sound if he knows we are about to record. Also, when we open these activities, he is immediately sitting on our laps and repeating the sounds. When I saw Noisy Stories by Joan and Jessica Rivard advertised through www.mayer-johnson.com, I suspected it would be helpful. This collection of stories with repetitive lines targets a sign and a phoneme in isolation and in combination. The themes are very child friendly. Jamie is willing to read and reread these stories. Most of the stories we use "as is", but there are a couple I modified to match our family or Jamie's interests more closely.
From time to time I borrow a device from work. I was impressed with the Communication Builder from Enabling Devices. He used it to learn some of his new boards very effectively. This device is lightweight and he could carry it easily. Jamie loved it when I brought home the Dynavox (Sentient Systems). When I brought it back to work he had a tantrum, then he threw all of his low tech boards in the trash. This is a kid who knows quality products!
Wanting to make do with what I had, I brought my old Mac into the family room. I set up a series of Speaking Dynamically Pro boards with a TouchWindow (Edmark). Jamie would open boards to activate the picture of himself tantruming and saying "I'm mad, mad, mad" (in his brother's voice) instead of throwing himself on the ground. It worked well for two weeks, then the video card died.
Right now, we are still using low tech solutions. Jamie knows the screens on
Boardmaker. If he sees that I 
have
it open, he will bring me items and tell me to put them on the computer (ie
make a board). My next purchase will be a Flip and Talk by Nancy Inman (available
through www.mayerjohnson. com). This low tech solution uses a
core and fringe word concept. His speech is blossoming now, but if we do decide to get him a device, that is the category I am interested in for him. Jamie now has a small photo album with Tweety Bird on the cover. Some of his favorite boards are in it, along with boards for gymnastics class, and boards so he can answer the "and what's your favorite _____ (color, toy, animal...)" questions that people love to ask. He never uses this book at home, but looks for it before leaving the house.
Jamie is still on a waiting list for services at a clinic that is experienced with kids with DVD. By using Touch Cues, Jamie has acquired some consonants. His language is growing quickly, though the expressive/receptive gap is still larger than I would like. Caroline Musselwhite encouraged me to look into PROMPT therapy. One of her friends is having great luck with this method. Unfortunately, there are no PROMPT therapists in my area, but fortunately the Collaborative has a responsive professional development office. There is a workshop scheduled for September, 2001... In the meantime, if you want me, I'm probably on the web, researching DVD.