FOR GENERAL EDUCATION TEACHERS
References for General Education Teachers
Chapter five of the text identifies general strategies for engaging students with severe disabilities in conversations by supporting both their receptive and expressive communication skills. Initial steps focus on understanding the role of the communication partner, using natural contexts, creating the need to communicate, and motivating the student to communicate. Suggestions for shaping a student’s specific communicative behaviors as they are needed within a general education classroom activities are also described. Examples highlight ways for teachers to address communication skills during general education activities with students of different ages (Chen & Downing, 2006).
Responsive Communication Partner
A responsive communication partner is required to interpret and identify the student’s communication behaviors, and create and identify opportunities for them to communicate, and facilitate the student’s interactions. Parker, Grimmett, and Summers (2008), identified the essential role of a responsive communication partner in Evidence-Based Communication Practices for Children with Visual Impairments and Additional Disabilities: An Examination of Single-Subject Design Studies. These authors examine practices for building effective communication strategies for children with visual impairments, including those with additional disabilities, that have been tested by single-subject design methodology. The authors found 30 studies that met the search criteria and grouped intervention strategies to align any evidence of the replication of successful outcomes. Supporting meaningful communication by individuals with multiple sensory, cognitive, and physical impairments has been a central concern for special education and rehabilitation professionals for many years. Of the children and young adults in special education programs, children who are visually impaired and have additional disabilities may experience the greatest risk factors for developing ineffective communication skills (Bruce, 2002). The low-incidence population of children with visual impairments is highly heterogeneous (Ferrell, 2000). For example, of the 202 infants and toddlers with visual impairments in Ferrell, Shaw, and Dietz's (1998) study, 60% were identified as having additional disabilities; of this subset of children, approximately 90 different coexisting impairments were documented (Ferrell, 2000).
Children with Visual Impairments
Children with visual impairments often lack access to powerful visual cues in the environment, such as facial expressions and gestures, that support the initial development of communication skills (Fraiberg, 1977). If their visual impairment is combined with other disabilities, such as hearing loss, cognitive delay, or physical disabilities, their lack of access to environmental cues is compounded and leads to a greater risk of their delayed development of communication (Rowland & Stremel-Campbell, 1987). With diminished access to observing and imitating communication behaviors and patterns, many children with visual impairments and additional disabilities become passive in their environments, increasing their risk for "learned helplessness," a condition that can occur when an individual perceives no relationship between his or her behavior and its impact on the environment (Seligman, 1975). Because children who are visually impaired and have additional disabilities have extra barriers to environmental cues that support communication, they can develop limited communicative repertoires or highly idiosyncratic ways of communicating that may be unrecognizable to communication partners (Siegel-Causey & Downing, 1987). Studies that have measured communication exchanges between such children and their partners have reported that even individuals with intimate knowledge of the children may not have recognized, supported, or responded to the children's communication attempts or behaviors, thereby decreasing the opportunities for building the children's communication skills (Rowland, 1990; Vervloed, van Dijk, Knoors, & van Dijk, 2006).
Expressive Forms of Communication
Researchers have reported that educators and families who support the communicative functioning of children with visual impairments and additional disabilities need not only to recognize and respond to nontraditional expressive forms of communication (such as movements, facial expressions, and other behaviors), but to support the development of reliable, functional communication systems for the children (Brace, 2005). Without a reliable means of sending and receiving messages, even in a rudimentary form, children with multiple disabilities are at risk not only for not developing their academic potential, but for experiencing abuse and neglect (Knutson & Sullivan, 1993).
Explicit Instruction in Communication
In recognition of the need for explicit instruction in communication for children with visual impairments and additional disabilities, leaders in the field of visual impairment specifically called for communication interventions in the National Agenda for the Education of Children and Youths with Visual Impairments, Including Those with Multiple Disabilities (Huebner, Merk-Adam, Stryker, & Wolffe, 2004). For the low-incidence field of visual impairment, current national policies, such as the No Child Left Behind Act, emphasize that teachers' practices must be validated through the use of scientific measurement. These educational policies present specific challenges in determining which types of instruction in communication will satisfy the federally mandated standards for "evidence-based" practice.
To respond to this complex challenge of creating educational practices that are "scientifically based," the Division for Research of the Council for Exceptional Children (CEC) identified four types of research methods in special education: (1) experimental group, (2) correlational, (3) single subject, and (4) qualitative designs (Odom et al., 2005). Researchers in low-incidence fields, such as visual impairment, may find the single-subject design method the most feasible experimental design to create a body of scientifically based evidence because of the heterogeneity, geographic spread, and diversity of educational contexts of the population
(Homer, Carr, Halle, Odom, & Wolery, 2005). This body of research could then be instrumental in devising the specific teaching strategies that will result in the most efficacious outcomes for students who are visually impaired and have additional disabilities.
Ultimately, the need for educators and parents to have access to information about highly effective, scientifically proved methodologies for teaching, supporting, and fostering the communication skills of children with visual impairments and other disabilities is not only compelling, but highly practical. This need provided the context for this study's approach to examining the body of literature.
In undertaking this research, we devised three research questions:
1. What studies used single-subject research in the area of practices in instruction in communication for children and young adults with visual impairments, including those who are deaf-blind (aged 6-22) from 1965 to 2006?
2. What types of communication practices and interventions were found to be effective with children and young adults with visual impairments, including those who are deaf-blind?
3. Are there any patterns of replication among the identified studies?
The following search terms were used to isolate the interventions that were used: communication (including all devices and systems), tactile symbols, tactile prompts, calendar boxes, calendar systems, activity schedules, manual sign language, Tadoma methods, palm signing, American Sign Language, choice making, and gestures. In addition, the following search terms were used to parse out the focus population for the study: visually impaired, blind, blindness, partially sighted, deafblind, deaf-blind, vision disorders, eye disorders, and eye diseases. Articles that included one or more of the search terms were then examined for additional inclusionary criteria: The participants had to be aged 6 to 22, the studies had to have been published in English in peer-reviewed journals, and single-subject design methodology had to have been used.
We engaged in a search process using the following online databases: PsycINFO, Academic Search Premier, ERIC, PubMED, and EBSCO host. We also engaged in specific journal searches from a list of journals in special education or gifted education, which was compiled by CEC and is listed on the ERIC web site (http://ericed.org/fact/journals.html). This list was divided into thirds, and each author was responsible for searching these journals using the specific search terms. We also consulted librarians at DBLINK, a national information cleatinghouse that is a component of the National Consortium on Deafblindness. DB-LINK houses over 8,000 forms of literature pertaining to deaf-blindness, although much of this information is not peer reviewed in a formal sense (Parker et al., 2008).
ANALYSIS AND CODING OF ARTICLES
As studies were identified, the first and third author used an article-analysis form that was based on the indicators of quality that are recommended for single-subject design studies developed by CEC (Homer et al., 2005). Additional questions were added to the rating form to determine if a formal preference screening was conducted as part of the intervention and if the researcher specifically noted intervention adaptations to accommodate the children's visual impairments. The second author independently checked 30% of the sample ratings of studies and calculated interrater reliability to be at 94%.
We found 30 studies that met the criteria for inclusion. Several distinct types of interventions emerged on the basis of a thorough description of the independent variables that were used to improve children's communication skills. These interventions were grouped thematically into five categories: microswitch interventions (n = 17), multi-component partner training (n = 6), dual communication boards (n = 4), interventions using object symbols (n = 2), and adult-directed prompting (n = 1).
Amy T. Parker, M.S.S.W., doctoral candidate in special education, Department of Educational Psychology and Leadership, College of Education, Texas Tech University, P.O. Box 41071, Lubbock, TX, 79409-1071, and a fellow of the National Center for Leadership in Visual Impairment.
Erie S. Grimmett, M.Ed., doctoral candidate in special education, Department of Educational Psychology and Leadership, College of Education, Texas Tech University, and a fellow of the National Center for Leadership in Visual Impairment.
Sharon Summers, M.Ed., doctoral candidate in special education, Department of Educational Psychology and Leadership, College of Education, Texas Tech University, and a fellow of the National Center for Leadership in Visual Impairment.
Enabling Communication in Children with Autism
When creating communication-rich environments children with communication difficulties require very frequent opportunities to practice their communication skills (Rowland 1990; Sigafoos et al. 1994a; Wall and Dattilio 1995). Approaches we found to be effective in ensuring that children have access to many and varied communication opportunities throughout the day, in the whole range of school contexts (Carol Potter, Chris Whittaker, 2001).
Key Research Findings:
1. Those children who were provided with the most opportunities to communicate spontaneously communicated most.
2. Opportunities to communicate were created by adults more frequently in some situations and classrooms than in others.
3. Most communication opportunities offered in classroom-based situations were for children to make requests for an object – either an activity or an item of food.
4. Proximal Communication sessions provided particularly high rates of opportunities for communication.
5. Few opportunities for children to communicate directly with each other were engineered.
Chapter six of the text discusses the two types of augmentative and alternative communication (AAC) techniques unaided and aided can be used to supplement (i.e., augment) or replace speech. Gestures, facial expressions, vocalizations, and manual signing are the most commonly used unaided AAC techniques. Most individuals acquire unaided techniques on their own and need little or no practice in order to use them. The exception is manual signing, which was among the first formal AAC techniques taught to individuals with severe disabilities in the United States (Matas, Mathy-Laikko, Beukelman, & Legresley, 1985) and other English-speaking countries (Lacono & Parsons, 1986; Kiernan, Reid, & Jones, 1982). Manual signs used with individuals who are not deaf are usually taught in combination with speech, an approach referred to as total or simultaneous communication (Mirenda & Erickson, 2000).
Aided AAC involves using one or more types of graphic symbols (e.g., photographs, line drawings, letters, printed words) that are arranged on some type of display (e.g., communication board, computer screen, mobile touchscreen device). Aided AAC can be used to represent communicative messages at the single- or multiple-word level (e.g., EAT, WANT, COOKIE, LEAVE ME ALONE). The person who communities with symbols can 1) offer them to a communicative partner in exchange for a desired item or activity (e.g., the Picture Exchange Communication System, [PECS]) (Frost & Bondy, 2002); 2) point to them on a communication book or board, using a finger, light pointer, or eye gaze; or 3) activate them to produce digitized or synthetic voice output on a touchscreen device or speech-generating device (SGD). Several authors have examined the aided AAC research for people with developmental disabilities from a number of perspectives. Overall, these reviews provide strong support for the use of aided AAC in general (Schlosser & Sigafoos, 2006) as well as for individual forms of aided AAC, including PECS (Hart & Banda, 2009), SGDs (Rispoli, Franco, van der Meer, Lang, & Camargo, 2010), and touchscreen devices such as iPads (Kagohara et al., 2013). Similarly, several reviews endorsed various types of aided AAC (including SGDs and iPads) for individuals with autism spectrum disorder in particular (Ganz et al., 2012; Schlosser, Sigafoos, & Koul, 2009; van der Meer & Rispoli, 2010).
AAC Strategies for Individuals with Moderate to Severe Disabilities
Johnston, S. S., Reichle, C., Feeley, K. M., SE Jones, E. A. (2012). AAC Strategies for Individuals with Moderate to Severe Disabilities. Baltimore: Paul H. Brookes Publishing Co. Reviewed by Jeong-IL Cho, Indiana University-Purdue University Fort Wayne.
The academic and social success of individuals with moderate to severe disabilities is related to their access to effective methods of communication. The use of various forms of augmentative and alternative communication (AAC) has been shown to be an effective and efficient communication method for many individuals with severe disabilities in communicating with their family members, friends, and others. Recently proposed revisions of Council for Exceptional Children (CEC) Initial and Advanced Role Content Standards for the Preparation of Special Educator extend the emphasis on special educators' familiarity of AAC systems and assistive technologies to support and enhance communication of individuals with disabilities. An advanced methods book on AAC strategies is therefore timely in providing comprehensive and resourceful information on how various AAC strategies can be effectively designed and instructed to individuals with moderate to severe disabilities. This book mainly emphasizes effective procedures in establishing functional communication for individuals with "intellectual delays," "physical disabilities," and "Autism."
AAC Strategies for Individuals with Moderate to Severe Disabilities is edited by Susan S. Johnston and Joe Reichle, faculty members at the University of Utah and the University of Minnesota respectively and experts in AAC, Kathleen M. Feeley, faculty member specializing developmental disabilities at Long Island University, and Emily A. Jones, faculty member having clinical and educational expertise in applied behavior analysis (ABA) at Queens College, City University of New York. The authors and contributors of the book are qualified to offer special educators and speech-language pathologists an advanced a book that provides an overview of AAC and instructional methods addressing individuals with moderate to severe disabilities. The purpose of this book is to provide a methods book that bridges the gap between research and practice on AAC for individuals with moderate to severe disabilities. The authors have achieved this purpose by presenting empirically validated implementation procedural steps that are effective in establishing a beginning functional communicative repertoire for individuals with moderate to severe disabilities and by offering a comprehensive review of basic principles of ABA employed in this book.
The book gives plenty of information on AAC and implementation strategies and maximized the space (386 pages) using two columns in all pages with an exception of the first page of each chapter that presents a chapter overview, objectives, and key terms. The book is divided into two parts: Part 1. Establishing the Framework for Intervention, and Part 2. Establishing Functional Communication. The parts are subdivided into 13 chapters: seven chapters for Part 1 (204 pages) and six for Part 2 (166 pages). Each chapter provides "helpful hints" on terms and practical suggestions, notes directing readers to relevant chapters within the book, a "What Does the Research Say" section (boxed), and illustrative materials. Most chapters also include detailed example research, "Case Example," addressing designs and findings of relevant research. An accompanying CD-ROM provides various monitoring forms both in blank and filled-in versions for each applicable chapter.
The first two chapters provide general information. Chapter 1, Teaching Pragmatic Skills to Individuals with Severe Disabilities, provides descriptions of typical pathways of communication development and functions of intentional communication, and differentiates communication functions from communicative intents (e.g., behavior regulation, joint attention, social interaction). Chapter 2, Building Blocks of a Beginning Communication System, addresses different communicative modes, especially graphic and gestural modes. This chapter highlights the effectiveness of the mixed mode of communication.
Chapter 3 explains features of AAC systems (e.g., output, symbol displays, and selection techniques), especially "aided" AAC system. This chapter provides descriptions and procedural steps on selection techniques, exclusively on a scanning technique for items menued for an AAC user. Chapter 4 relates specifically to indirect selection for individuals with severe physical disabilities. Patricia Dowden and Albert Cook effectively used case examples of "Genna" and "Victor" with moderate to severe disabilities throughout the chapter to assist readers' understanding of ways to build on current communicative competence and to enhance communicative independence. Earlier in the chapter, the authors stress the importance that interventionists need to first examine individual's communication capabilities in all possible modes (e.g., speech, facial expressions, body language, gestures, sign language, visual, graphic) and then identify areas that require technological assistance, rather than jumping right into assessing and selecting technology devices.
Chapter 5, Instructional Strategies, addresses procedural steps that are implemented to build communication skills. Principles of ABA are addressed in this chapter with step-by-step procedures. Most principles and strategies of ABA are explained in multiple ways to enhance readers' understanding. The authors discuss the importance of intervention intensity when building communication skills (Chapter 6). The chapter adopts Steven F. Warren's descriptions of intervention intensity that emphasizes the importance of measuring intervention intensity by considering the number of teaching opportunities, how those opportunities are presented, the frequency with which intervention sessions are implemented, and the time period over which intervention is implemented.
This last chapter of Part 1 (Chapter 7) is an extension of Chapter 6 addressing measurement systems to monitor learners' performance. Monitoring strategies and guidelines are explained with sample monitoring forms and graphic displays illustrating data presented in a sample form in the same chapter. The authors provided guidelines to choose an appropriate measurement system (e.g., frequency, duration, latency, topography, magnitude). In this era of accountability, this chapter is critical in a methods book. Throughout Part 2 of this book, performance monitoring is continuously an integral part.
Part 2 presents procedural steps, strategies, and considerations in establishing functional communication for individuals with moderate to severe disabilities. All basic principles introduced in Part 1 are applied in chapters in Part 2 with illustrative examples. Since Part 1 equips readers well with basic concepts and ABA principles in a comprehensive manner, readers will have an understanding of teaching procedures explained in Part 2. Chapter 8 focuses instructional strategies on simple and conditional discrimination to match graphic symbols to objects and events and ends the chapter with concerns that should be considered in teaching the initial discriminations required to use graphic symbols.
The next three chapters 9, 10, and 11 focuses on building functional communication to gain access to desired objects and activities, escape and avoid objects and activities, and lastly obtain and maintain communicative interactions. These chapters provide example intervention planning forms for case examples. Chapter 9 is on teaching requests for objects/activities, continued engagement, and assistance. Chapter 10 describes teaching strategies on rejecting and request for alternative, break, and assistance. By utilizing example words or sentences one would use and a script between an interventionist and a learner, Chapter 11 not only mentions how to obtain and maintain social interactions, but also how to repair and terminate interactions.
The last two chapters describe how AAC can be used for spoken language comprehension (Chapter 12) and to enhance communication of verbal mode users (Chapter 13). Since these chapters have a different focus (listening and comprehension) compared to previous chapters (expressive language focus), these chapters start with basic information and then provide instructional strategies. Chapter 12 describes two AAC usages that interventionists can implement to improve listening comprehension of individuals with moderate to severe disabilities: augmenting input (also known as aided language stimulation that employs graphics, speech outputs, and total communication) and visual supports (e.g., visual schedules, to-do and reminder lists, and visual stories). Chapter 13 focuses on strategies to enhance verbal communication for individuals relying on speech as a primary communication mode. Intelligibility and comprehensibility are two important concepts in this chapter with an emphasis on how AAC can enhance them.
Unlike many published assistive technology (AT) related books that only touch the surface of various AT and AAC categories, this book is highly intense, practical in an advanced and innovative manner, and truly designed for the step-by-step implementation of empirically-proven strategies in classrooms, clinics, and homes. In the preface, the authors make clear that the book not only embraces behavioral strategies, but also covers a wide range of interventional strategies. It seems to be apparent that readers who are knowledgeable about principles of ABA can achieve a maximum utilization of this method book. However, those with less training on ABA may find this book challenging. For the maximum use of this book by teachers, intervention specialist, and graduate students in a method course, it is recommended that the current table of contents, that only lists chapter titles and their authors, needs to be enhanced in future editions. A detailed table of contents including subheadings would be a helpful resource for readers to easily obtain the direction of this book in terms of a framework and principles in which this book is based. In addition, the detailed table of contents assists readers to have effective and efficient access of desired topics among a wealth of information this book offers. In closing, I have no hesitation to mention that the book is an important addition to the existing body of knowledge on how to apply ABA principles and other strategies to AAC strategies in establishing functional communication for individuals with moderate to severe disabilities (Johnston, S. S., Reichle, C., Feeley, K. M., SE Jones, E. A., February 2014).
AAC Success Stories: Making the Rules of Commitment Work
Hill, Katya, & Romich, Barry, The Exceptional Parent
Children who have severe speech communication disorders can significantly benefit from using augmentative and alternative communication (AAC) systems. However, the issues surrounding the selection and application of AAC systems can be complex. This three-part series is intended as a resource for parents. Empowering parents to contribute in a substantial way will assure that their children receive the AAC system and services that will maximize their potential for personal achievement. This installment uses real and hypothetical stories to illustrate how using the AAC "Rules of Commitment for Professionals" (suggested guidelines to help parents and professional stay focused on the goal) can lead to success in choosing and using augmentative communication.
The educational and legal processes associated with their child receiving a free and appropriate public education (FAPE) have often intimidated parents. The recommendation and purchase of assistive technology has too frequently become a due process issue based on misinterpretation of the word "appropriate." Parents knowledgeable about the provisions of the Individuals with Disabilities Education Act (IDEA) could turn the following hypothetical incident into a success story:
A speech-language pathologist respected in the field of AAC is providing expert testimony in a due process hearing regarding assistive technology and the goals and objectives on a child's Individual Education Plan (IEP). The expert states that the goal of AAC is to provide the system and services that result in the highest level of personal achievement for a child who could benefit from the use of an AAC system. The hearing officer interrupts the witness to state that the school is not responsible for providing for what is best, but only has to provide what is considered appropriate.
Clearly, this hearing officer misunderstands the definition and intent of the law in considering the goal of AAC as going beyond the IDEA mandate. Best professional practices in service delivery are appropriate for any student on an IEP. The word appropriate is not to be tied to any expense or funding associated with developing and implementing the IEP.
This scenario addresses the first two Rules of Commitment for Professionals (see Table 1): 1) be committed to the most effective communication for the individual being served, and 2) be committed to following your professional code of ethics. The ASHA Code of Ethics states that Speech Language Pathologists (SLPs) "shall honor their responsibility to hold paramount the welfare of persons they serve professionally." No conflict or contradiction exists between the goal of AAC, the ASHA Code of Ethics, Commitment Rules 1 and 2, and IDEA. For professionals providing assistive technology supports and services, "best" equals appropriate. Parents have a legitimate reason to inquire about a school district's interpretation of appropriate if the recommendation and provision of AAC systems and services will not result in their child being able to work toward achieving the goal of AAC.
COMMITMENT RULES OF AAC SERVICE DELIVERY FOR PROFESSIONALS
1. Be committed to the most effective communication for the individual being served.
2. Be committed to following your professional code of ethics.
3. Be committed to involving the consumer and family in the service delivery process.
4. Be committed to achieving the maximum outcomes for the individual.
5. Be committed to advocating for language.
6. Understand the merits of ALL language representation methods.
7. Support the language representation method(s) for core and extended vocabulary access that best serves the interest of the individual.
8. Advocate for the AAC system that supports the chosen language representation method(s).
9. Be committed to using language activity monitoring to support clinical intervention.
10. If unable to adhere to any rule, be truthful in this to the individual, family, and advocates.
The most successful teams involve all the stakeholders (see glossary) contributing to the decisions that will result in achieving the goal of AAC. Rules 2 and 3 speak to the importance of involving families in the decision-making process. Although your child's IEP was developed by a team, have efforts been made that contribute to effective and successful team building? Successful AAC team building involves a consumer-centered service delivery model with the child who uses augmentative communication and his or her family as the focal point.
Our success story involves a "field trip" arranged by the SLP for school-aged children who rely on AAC and their families to visit the manufacturer of their AAC devices: During the two-day visit, the children and family members toured the facilities and saw how their equipment was manufactured, met with technical support staff, received training, and enjoyed casual conversations with educational staff during breaks. Friendships were formed along with several positive team outcomes: the children's motivation to use their AAC systems was improved by the `star-treatment' they received; the parents and siblings learned more about the systems, thus increasing their comfort level and ability to support use of the equipment. Upon returning home, family members became more involved in the day-to-day implementation of the AAC systems. This increased involvement and in-turn energized the professional members of the child's team.
Not everyone has the opportunity to organize similar field trips, but many activities or events can be planned around families being equal and respected members of school teams. If school professionals are not taking the initiative to foster family involvement, empowered parents might consider how their efforts in team building can lead toward achieving better outcomes. These are just a few real-life examples of what teams are doing around the country:
* Ice Cream Socials
* AAC Camps
* Parent/Sibling Device Training Seminars
* Playground Picnics
* Parent Volunteer Days
* "Make-and-Take" AAC Parties (activities where team members can create materials to support use of the AAC system)
ADVOCATING FOR LANGUAGE
Commitment Rules 5-7 address the language issues associated with the selection and implementation of the AAC system. The Communication Bill of Rights was developed through the National Joint Committee for Communication Needs of Persons with Severe Disabilities (Table 2). It begins with the following sentence, "All persons, regardless of the extent or severity of their disabilities, have a basic right to affect, through communication, the conditions of their own existence." Without adequate language, a person who relies on AAC systems will not become a competent communicator. The team must understand the issues of core and extended vocabulary and language representation methods (see glossary for definitions). Only then will an individual who uses AAC be guaranteed the basic communication rights that recognize and acknowledge the inherent dignity as a person.
THE COMMUNICATION BILL OF RIGHTS
All persons, regardless of the extent or severity of their disabilities, have a basic right to affect, through communication, the conditions of their own existence. Beyond this general right a number of specific communication rights should be ensured in all daily interactions and interventions involving persons who have severe disabilities. These basic communication rights are as follows:
1. The right to request desired objects, actions, events and persons, and to express personal preferences, or feelings.
2. The right to be offered choices and alternatives.
3. The right to reject or refuse undesired objects, events, or actions, including the right to decline or request all proffered choices.
4. The right to request, and be given, attention from and interaction with another person.
5. The right to request feedback or information about a state, an object, a person, or an event of interest.
6. The right to active treatment and intervention efforts to enable people with severe disabilities to communicate messages in whatever modes and as effectively and efficiently as their specific abilities will allow.
7. The right to have communicative acts acknowledged and responded to even when the intent of these acts cannot be fulfilled by the responder.
8. The right to have access at all times to any needed augmentative and alternative communication devices and other assistive devices, and to have those devices in good working order.
9. The right to environmental contexts, interactions, and opportunities that expect and encourage persons with disabilities to participate as full communicative partners with other people, including peers.
10. The right to be informed about people, things, and events in one's immediate environment.
11. The right to be communicated with in a manner that recognizes and acknowledges the inherent dignity of the person being addressed, including the right to be part of communication exchanges about individuals that are conducted in his or her presence.
12. The right to be communicated with in ways that are meaningful, understandable, and culturally and linguistically appropriate.
Source: The National Joint Committee for the Communication Needs of Persons with Severe Disabilities. (1992). Guidelines for Meeting the Communication Needs of Persons with Severe Disabilities. 34 (Suppl. 7), 1-8 [C] American Speech-Language--Hearing Assoc. Reprinted with permission.
The following success story illustrates the importance of the Rules of Commitment where language is concerned.
At AAC camp, Dana was Michael's direct service provider (DSP). (DSPs or professional team members from school accompanied the campers to work with them at camp and also to assure carryover to the home, school, and other environments at the end of the camp experience). Michael, age 10, used an eight-location digitized speech output AAC device. His registration form indicated that he was not motivated to use his device. Dana had quickly realized that although Michael had several (many) overlays in his carrying case, none of the overlays allowed him to say anything related to the communication occurring at camp.
The language representation method used to construct his overlays was based on single-meaning pictures using pre-stored sentences to express messages. His messages were either expressions of basic needs and wants (which he could indicate using other modes of communication, such as gestures) or related to his school curriculum. Dana spent each evening constructing an overlay for the next day's activities. Michael was soon saying the camp cheers and slogans. Next she constructed an overlay that consisted of core vocabulary allowing Michael to generate his own novel messages. Michael soon became a camp star and his smile beamed from ear-to-ear. Dana left camp inspired for the new school year and encouraged to advance Michael to a 32-location overlay with a more powerful language representation method.
Rule 8 implies that teams are frequently required to advocate for the funding of the AAC system that supports the chosen language representation method(s). In the past, parents resorted to bake sales, car washes, and raffles to raise money to purchase technology for children. The law now guarantees the right to assistive technology, and funds for equipment purchases are available through Medicaid and Medicare. Unfortunately, not everyone is aware of their state's provisions and procedures for securing funding for AAC systems and supports. Not everyone is empowered or has the available tools to pursue funding and the appeal process if their initial equipment request is denied. AAC manufacturers' representatives and office staff, and other AAC professionals should be good resources to guide families through the funding process.
The following success story (though over 10 years old) illustrates the importance of advocating for the AAC system that supports the chosen language representation method(s):
Tony was a high school student who had been in an accident with a recreational vehicle sustaining major head injury. He had been assessed and recommended a high-technology dedicated AAC device using semantic compaction as the language representation method. The physician reviewing Tony's documentation which supported the necessity for an AAC system denied the request on the grounds that Tony could use a head pointer instead of the device.
In the time between the denial and the day of Tony's appeal hearing, the SLP had made arrangements with the manufacturer for an extended loan of the AAC device. The regional consultant for the manufacturer had visited Tony at school and home to offer strategies for improving Tony's learning ability to this language representation method. The SLP had educated himself on the device by taking an Internet-based distance learning course that was offered by the device manufacturer. By now, Tony was using his AAC system to not only communicate his basic needs and wants, but to express his opinion and feelings.
Tony's parents and SLP were asked to testify regarding the necessity for the AAC system and the reasons why a head pointer would not be appropriate. Finally, the SLP requested that Tony answer the questions himself Although his grammar was not always correct or his sentences complete, using his AAC system he very eloquently expressed why he needed it. Tony won his appeal!
Although performance monitoring is not a new concept, automated language activity monitoring (LAM) for AAC performance is a new procedure. LAM tools will facilitate the collection and analysis of language samples for children using AAC devices. Detailed documentation to measure IEP goals and objectives will be possible and accountability of educational services will achieve a new standard.
The following success stow illustrates how one parent used performance monitoring and observation to improve the level of service her child was receiving:
Jamie was again attending a week-long summer AAC camp. He looked forward to seeing his old friends and making new acquaintances. This year, one of the SLPs at camp was collecting and analyzing language samples. In reviewing the language transcripts, Jamie could see how many different words he was using, how long his responses were in the conversation, and how fast he was talking. More important for Jamie was that the information showed how he was using the language representation methods available in his device. Jamie was using Minspeak to access core vocabulary but using spelling and word prediction for less-frequently used vocabulary. Jamie's use of word prediction contradicted reports that he was not spelling and reading. A listing of the words he was using during conversation supported his knowledge of Minspeak. Jamie's mother was able to take a printed report of this information to a team meeting to support recommendations making changes to Jamie's IEP before the start of the new school year.
Very few people involved with AAC have had role models to help support their decisions or provide them with the opportunity to see the possibilities AAC has to offer. Team members need to be committed, motivated, and willing to work toward the goal of AAC. New AAC users need opportunities to witness the accomplishments of those who have used augmentative communication successfully or others who can serve as a mentor. It can frequently be a turning point for someone who feels uncomfortable with learning new technologies and strategies.
The Pittsburgh Employment Conference for Augmented Communicators (PEC) is the largest gathering of people who use augmentative communication in the world. PEC is held the first weekend in August and is organized by SHOUT (Sharing Helps Others Utilize Technology), a non-profit organization. It usually attracts nearly 100 augmentative communication users along with over 200 other participants who attend the conference. PEC is committed to an equal interaction and participation among people who rely on augmentative communication and those who do not communication. However, more significant is the spontaneous mentoring that occurs between individuals during sessions and into the evening.
PEC creates unique opportunities for AAC users and non-users alike to share success stories about assessment, intervention, and funding. It is an opportunity for AAC users to exchange information related to their customized use of their technology.
The Augmentative Communication On-Line User Group (ACOLUG) is a list serve established to address the interests of people who rely on AAC. Consumers, family members, and professionals participate in various levels of activity and involvement on ACOLUG. Various users of augmentative communication have made significant contributions to the exchange of ideas and information, and leadership qualities have emerged through the process. ACOLUG bridges the gap providing encouragement, support, and inspiration.
With the proper supports and information at their command, parents can become stronger advocates for their child with a communication disorder. The examples discussed here can serve as a framework parents may use to get the best services for their child, and thus enable them to have their say.
Part 3 of this series will appear in the next issue of EXCEPTIONAL PARENT. It will cover the areas of assessment and intervention and will provide resources (Hill, K., & Romich, B., November, 1999).
Katya Hill, MA, CCC-SLP, is an Assistant Professor at the Edinboro University of Pennsylvania, Assistive Technology Center. You can contact her at: Edinboro University of PA, Dept. of Speech and Communication Studies Assistive Technology Center, Edinboro, PA 16444; telephone: (814) 732-2431; fax: (814) 732-2184; e-mail: KHill@edinboro.edu.
Barry Romich, PE, is President of the Prentke Romich Company. You can contact him at: Prentke Romich Company, 1022 Heyl Rd., Wooster, OH 44691-9786; telephone: (800) or (330) 262-1984, ext. 211; fax: (330) 263-4829; e-mail: firstname.lastname@example.org; Web site: http://www.prentrom.com. The authors welcome questions and comments.
AAC Device Funding
American Speech, Language, Hearing Association 10801 Rockville Pike, Rockville, MD 20852 Telephone; (301) 897-5700
Chen, D., & Downing, J.E. (2006). Tactile learning strategies: Interacting with children who have visual impairments and multiple disabilities [DVD]. New York: AFB Press.
c/o SHOUT P.O. Box 9666, Pittsburgh, PA 15226 Tel and Fax: (800) 668-4202 and (412) 885-0943 e-mail: SHOUT@sgi.net
Rowland, C. (Ed.). (2009). Assessing communication and learning in young children who are deafblind or who have multiple disabilities. Design to Learn, Oregon Health Sciences University.
Rowland, C., Friend-Oken, M, & Steiner, S.A.M. (2009). Communication supports inventory- children and youth (CSI-CY). Design to Learn, Oregon Health Sciences University.
Communicating My Writing with Others | Literacy Strategies for Students with Cognitive Disabilities
Downing, J.E., Hanreddy, A, & Peckham-Hardin, K.D. (2015). Teaching Communication Skills (3rd ed.). Baltimore, Maryland: Paul H. Brookes Publishing Co.
Hill, K., R., Barry. (November 1999). AAC Success Stories: Making the Rules of Commitment Work. The Exceptional Parent, 60, Volume: 29. Issue: 11.
Johnston, S. S., Reichle, C., Feeley, K. M., SE Jones, E. A. (February 2014). AAC Strategies for Individuals with Moderate to Severe Disabilities. Education & Treatment of Children, 168, Volume: 37. Issue: 1.
Parker, A.T., Grimmett, E., & Summers, S. (September 2008). Evidence-Based Communication Practices for Children with Visual Impairments and Additional Disabilities: An Examination of Single-Subject Design Studies. Journal of Visual Impairment & Blindness, 102, 540-549.
Potter, C., Whittaker, C. (2001). Enabling communication in children with autism. Philadelphia: Jessica Kingsley, 199-207.
Delven H. Mearis