PowerPoint Presentation

LITTLEs CAN have a VOICE Too!Michelle Moorehead, MA, SLPAmanda Ream, MA, CCC-SLP

March 22, 2013MSHA Annual Conference 2013Provide background information about ourselves and current working location and AAC experience.1 March 25, 2011Dear Parent,

Your CHILD is learning to use a communication device (Augmentative Alternative Communication-AAC) & we would like to have your input!

If we had a summer AAC camp, would your child attend? _____ YES ______NOIf the camp is held on July 20-August 11 would your child be able to attend? _____ YES ______ NOIf your child could attend, would you or another caregiver be able to attend some of the sessions with your child? _____ YES _____NOIf your child attends an AAC summer camp, will someone be able to transport? _____YES _____NOThe purpose of this camp would be to teach new skills, practice new vocabulary, interact with other AAC users, and educate family/caregivers about the importance of AAC use in all environments.

Thank you for your input!!Please return by April 15, 2011 MORE TO COME..

It started with a survey..MSHA Annual Conference 2013Sent out the survey to see who would be interested. The survey went to all preschool classroom and SLPs working with preschoolers. We had ____ returned and ended up with _3___ in our first summer group. From our peers we also heard that there was a question/concerns about students trialing devices and the needs for some organization in this process.2NEED basedDetermine age level of group4 students registered-3 attended + peer mentor

Goals:

Students will be responsible for carrying devices They will use voice to interact with building staffVocabulary based on theme-PiratesParent Education

Year 1MSHA Annual Conference 2013Student 3Students:

Brayden is a 4 year old with a special education eligibility of Physically Impaired. He has been receiving special education services since he was an infant. Exploration of AAC began for Brayden as a toddler.

Kendra is a 3 year old and has received special education services since infancy. She has a special education eligibility of Early Childhood Developmental Delay supported by a medical diagnosis of Downs Syndrome.

Jacob is 3 year old that has received special education services since infancy. He is a child with a medical diagnosis of Downs Syndrome and has significant motor planning issues.MSHA Annual Conference 2013 Mentoring ProgramCaitlinCurrent AAC userUsing the VantageGoing into 3rd. GradeLooking for leadership opportunities for herAlecCurrent AAC userGoing from the Dynavox to ECHO w/eye scanUses eye gaze to access deviceGreat role model!!MSHA Annual Conference 2013AR will talk about Caitlin and past; Brief comments about Alec-age, device @ camp, moving to Boston, switching device-ECO-passing5 ArRgh!!ALL Aboard Ship Porter Education CenterSailing on Thursdays, 9:0011:30 a.m. Room 320July 21July 28 August 4 August 11+ PARENTS EDUCATIONAL TIME August 18 + PARENTS COME & SEE!!

MSHA Annual Conference 2013We went with a pirate theme, because SLPs love themes. We also included 2 weeks for the parents to come in for some educational time and also to spend time with their young AAC user. We had 100% participation with parent involvement the first year. The parents can often be last to see the students success because often there is a disconnect between school and home. Part of the goal of our summer program is to give the students experience with devices and help parents understand the function for their lives.6 Schedule

9:00: Arrival9-9:15: Openings/Greetings9:15-9:30: Calendar time9:30-9:50: Story time9:50-10: Bathroom9:50-10:20: Scavenger Hunt10:20-10:30: Bathroom10:30-10:45: Snack 10:30-11: Craft11-11:20: Games(11-11:10 Optional Bathroom break)11:20-11:30: Treasure Box, Rhyme, Closing

Parents are invited the last 2 weeks Last Day: Caitlin orders lunch. MSHA Annual Conference 2013AR will add comments about Caitlin-gift/lunch; Scavenger hunt-staff in the building-positive feedback from thisVocab based-challenge of making certain everything put on devices-all vocab lots of work7

Our FocusMSHA Annual Conference 2013These were our goals. Nothing was provided to student or parents to take home other than crafts we completed.8

A learning opportunity.MSHA Annual Conference 2013Our world changed when we went to Pittsburgh to an AAC Language Seminar Series called Best Practice for integrating AAC into classrooms.9Amandas AHA moments!!!Changing focus fromcurriculum vocabulary to core

Motor planning

AAC teaming

Language Stealers YouTube

MSHA Annual Conference 2013Changing my focus in the school system to more language based than strictly to participate or answer wh questions.10 http://www.youtube.com/watch?v=iOVm8q0mCYA Language Stealers YouTubeMSHA Annual Conference 2013Link the video and show here.11AHAAAA MOMENT -MichelleAll the children that I work with begin with language such as: me, mine, I want, up, down, in, out, all done, .

With all of my years of experience, why am I thinking that children that need a voice output device should learn the name of items to interact ..

MSHA Annual Conference 2013Stage I -- Semantic Roles and Syntactic RelationshipsMLU 1.75Earliest 18 months; latest 27 monthsSee mommy.See daddy.Find it.Hide it.Fix it.Mine.All gone.Up here/Over there.Stage II -- Grammatical Morphemes and the Modulation of MeaningMLU 2.25Earliest 21 months; latest 30 monthsThat's daddy's nose.Stage III -- Modalities of the Simple Sentence (Yes/no questions, WH questions, negatives, &imperatives)MLU 2.75Earliest 23 months; latest 37 monthsWho is this?What is this?I can't swim.Stage IV -- Imbedding of One Sentence within AnotherMLU 3.50Earliest 26 months, latest 44 monthsNow, where's a pencil I can use?That's a box that they put it in.Stage V -- Coordination of Simple Sentences and Propositional RelationsMLU 4.00Earliest 27 months, latest 48 monthsYou snap and he comes.I did this and I did that.We went up to Foxboro and there were slides.Browns Five StagesMSHA Annual Conference 201313The Balandin sample is the largest sampling of natural conversation ever done. It contains a sample of more than a quarter million words in length. The speech was harvested by body-mounted recording devices worn during break times at McDonalds restaurants in New South Wales, Australia.Toddler Vocabulary Arranged by FrequencyWords PercentageI9.5No8.5Yes/yea7.6my5.8the5.2want5.0is 4.9 it4.9that4.9 a4.6go4.4mine3.8you3.2 what3.1on2.8in2.7here2.7more 2.6out2.4off2.3some2.3help2.1all done/finished1.096.3%Banajee et al.26 core words shown at left comprise 96.3 percent of the total words used by toddlers in this study

Are any of these words picture producers?

Which of these words commonly seen on language boards?MSHA Annual Conference 201314Children use simple, common words in their utterances. Unfortunately, language models in AAC for early communicators typically ignore the vocabulary children actually use. In preference for a motivational vocabulary based on adult models of childrens behavior. The word ice cream may represent a very motivating idea but the language a child uses in relationship to this motivating noun is probably closer to want some or mine.Note that the possessives my and mine are earlier and more frequent than the teachers favorite me. Note how frequently the subject pronoun I is used.Two additional studies, one by Howes and one by Jones find core vocabulary plays the same role with pre-school children and with adults.15aaboutafteragainallalmostalreadyalsoanandanotherantanyarearen'taroundasatawaybabybackbadballbathroombebeanbecausebeforebeingbetbetterbigbirdbirdsbite

Christine A. Marvin, David R. Beukelman, Denise BilyeuAAC, Vol. 10, Dec., 1994blackbluebothboxboybugsbutbuybybyecallcamecancan'tcandycarcatchcausechaircomecomescookiecorncouldcouldn'tcupcutdaydiddidn'tdifferentdo doesdoctordoesn'tdogdoingdon'tdonedoordowndrinkduckeateatingelseeveneverybodyeverythingfacefallfindfingerfirefirstfivefixedflyfootfor fromfoundgetgetsgettinggirlgirlsgivegogoes

goinggonnagoodgreatgreenguyshadhairhandhandshashavehaven'the he's herheadhearhellohelpherehere's hihighhillhimhis holdhomehorsehothousehowhuhhumI I'llI'mifininsideisisn'titit's juicejumpjumpedjumpingjust kindknow lastleavesletlet'sliftlikelittlelonglooklookinglot lunchmademakemanmanymaymaybememeanmessymiddleminemommommymoremostmovemuchmustmymyselfNamenamenamedneednevernewnextnicenonotofoffohotherokoldononeonlyopenor

ouroursoutoverpaintpeople pet namepickpieceplaypleasepushputreadyreallyredrememberriderightroomrunsaidsamesawsayseesheshe's showshutsidesitsostill

some somebodysomeonesomethingsometimessomewherestopstuffswingtapetellthanthatthat'sthetheirthemthentherethere'sthesetheythey'llthey'rethingthingsthisthosethreethrewthroughtimetotodaytogether

tootoptoystreestrytryingturnturtlestwoumupususeusedverywaitwantwanted waswasn'twatchwaterwaywewe'll

we'rewellwentwerewhatwhat'swhenwherewhere's whichwhilewhowhole whywithwon'twould yayesyetyouyou'llyou'reyouryoursIn the Course of Development the Banajee Core Vocabulary is Nested Within the Marvin Sampling

MSHA Annual Conference 201315At this point you may want to hand out a printed version of the Marvin vocabulary. The Toddler high frequency words from the Banajee sample are included in the Marvin sampling Focus Core VocabularyLiteracyParent participation Year 2MSHA Annual Conference 2013We felt like we did right in our first campwe repeated Parent Participation!!16 AAC for summer ESY services Daily Schedule Year 2

8:30-8:35/10:30-10:35Book/puzzle time

8:35-8:40/10:35-10:40Introductions/hello song

8:40-9:00/10:40-11:00Book time

9:00-9:20/11:00-11:20 Request time

9:20-9:25/11:20-11:25Bathroom/wash hands

9:25-9:55/11:25-11:55Snack

9:55-10:00/11:55-12:00Good bye songMSHA Annual Conference 2013Our daily schedule, we were very pleased with how we laid out our day. We knew this year we had a great plan. We had our list of words that they were all going to use fluently to request and comment, we had great snacks. Everything was going to be perfect. Our first group was delightful, there were a few tears, but everyone conformed to what we wanted them to do. The second group arrived and the 5 minutes we spent trying to corral them to the puzzle area felt like an eternity. WOW, they were not in a ready state to learn and use AAC. SO, we immediately through out the schedule and headed to the sensory room. Our second group had many sensory and environmental needs that we had to help with before they were ready to communicate. We just changed our requesting items to the swing, zoom ride, trampoline, and ball. Once our sensory time was up they were ready for our book time. It was not perfect. We still had a couple who did not want anything to do with structured learning. 17Date:Core VocabularyActivitiesSnackJuly 12I, want, it, that, yes, noBook/request itemsPretzels and dips (cheese, mustard, ranch & salsa)August 16I, want, it, that, yes, no, more, all done, help, on, off, in, out, color words, my, mine, you, stop, goBook/request itemsQuestion and answer time with Gabe.Ice cream baggies: ice, vanilla, salt, milkMSHA Annual Conference 2013By the end of the summer, wanted kids to have exposure to over 25 words and phrases. Each week we built on the vocabulary from the previous week, we added the words to their books and to the cooking/snack activities.

18 I Want..Books for Summer Camp # 2I Like.MSHA Annual Conference 2013Each student was given a book to take home and practice so we could review at the next class.19

I want popcorn. Do you want it?

I want it!I dont want it.MSHA Annual Conference 2013The feedback from the parents was mixed. One parents said they liked the practice books, because it helped them learn were the items were located. While another parent felt it was hard because of the amount of buttons on the device. On some of the devices we hid the icons to reduce the distraction and just focus on the core vocabulary for the week. We never want to limit the childs ability to speak because it is out of our comfort zone or we are apprehensive. 20

I want asparagus. Do you want it?

I want it!I dont want it.MSHA Annual Conference 2013We added dont want into our books, because it came up during our snack time. We had 2 students that like to protect with noise and behaviors, but since we introduced dont want, the expectation was for them to tell us to stop or that they dont want it.21

I like m & ms.

I like it!I dont like it!MSHA Annual Conference 2013

I like red m & ms.

MSHA Annual Conference 2013More pictures with requesting colors and how many.23 Student: BraydenDevice used this summer:VantageFall teacher:XXXXSessions attended:4 out of 5Strengths: This is Braydens second year in our summer AAC camp. Brayden is very bright but often does not work up to potential. He is very happy and enjoys his social role with others. Brayden has some word approximations and an excellent use of his gestures to interact.Weaknesses: Brayden needed max cues to use device. He often refused to use device and would turn it off/move it away. It appears that Brayden does not see the need for communication, other than what he currently uses. This is a difficult place for Brayden and his family, a transition with no true decisions or commitment. **This weakness can be turned into a strength as a commitment to consistency (home & school) of a strategy is determined and used-Brayden knows that all the adults are not on the same page and he is playing the game.Recommendations:Brayden has been using the LISD Vantage for over a year. Teacher, therapist, and family need to make a decision to trial other devices or move forward to purchase a device for Brayden. Summer Progress and SuggestionsUpdateEarly Childhood Special Education ProgramCurrently using iPad with Touch Chat appBackground -BraydenBrayden is 5 yo with a special education eligibility of Physically Impaired. He has been receivingspecial education services since he was an infant. Exploration of AAC began for Brayden as a toddler,but caregivers have waivered in their focus-voice output support or Brayden voice. *Year 2 of camp attendance.MSHA Annual Conference 2013 Summer Progress and SuggestionsCurrent AAC useEarly Childhood Special Education Classroom Currently using iPad with Proloquo only at schoolBackground-Kendra Kendra is 4yo and has received special education services since infancy. She has a special education eligibility of Early Childhood Developmental Delay supported by a medical diagnosis of Downs Syndrome. Kendra has some pop out language, but communication support began early with sign language, pictures, and voice output devices. *Year 2 of camp attendance.Student: Kendra Device used this summer:SpringboardFall teacher:XXXXSessions attended:4 out of 5Strengths: This is Kendras second year in our camp. She was very eager to learn and participate in activities during summer group. Kendra needs cues and models to use the Springboard. Mom has now seen Kendra using the device and sees the need. Weaknesses:Kendra needs continues support in the area of independence with using the Springboard.She is distracted, but understands the benefit of communication this year! Kendra is a swiper due to her use of an Ipad. When using a device, she will need a keyguard to support direct selection. High expectations are key for Kendra because she CAN do it!Recommendations:We recommend continued trial of the Springboard.MSHA Annual Conference 2013 Summer Progress and Suggestions UpdateEarly Childhood Moderately Cognitively Impaired Classroom Currently using Go Talk-(& has communication book available), according to classroom teacher Background- JesseJesse is 5 yo with a special education eligibility of Early Childhood Developmental Delay. He has been receiving special education services as a toddler and was non verbal. Jesse has been involved in using PECS, sign, Go Talk, & apraxia programs. Minimal progress was noted. *Year 1 of camp attended.Student: JesseDevice used this summer:SpringboardFall teacher:XXXXXSessions attended:5 out of 5Strengths:Jesse enjoys interacting with people. He can vocalize/verbalize, but is stuck in the I want stage. It is exciting that he is able to verbalize, but due to his Weaknesses:Jesse needs handover hand assistance to use device. He was not able to locate pictures independently even with model.Jesses focus interferes with his independence-as well as follow through of activities at home. **a device was sent home with home practice.Recommendations:We recommend continued trial of the Springboard.MSHA Annual Conference 2013 Summer Progress and SuggestionsUpdateEarly Childhood Moderately Cognitively Impaired Classroom Currently using communication notebook Background-Daniel Daniel is 6yo and has received special education services since age 24 months. He was originally givenThe eligibility of Early Childhood Developmental Delay, but that was changed to Autism SpectrumDisorder @ age 40 months. Daniel has been exposed to visuals paired with many low tech voice outputBeginning as a toddler. He is driven to be independent & use his behavior to get his needs met.Daniels motivation is extremely selective. He is one of 6 other children in his family, with one sisterWho is also ASD.*Year 1 of camp attendance.Student: Daniel Device used this summer:Springboard/VantageFall teacher:XXXXXSessions attended:5 out of 5Strengths:Daniel benefits from a model. After a few trials he is able to be independent. He prefers the freedom to do things independently, but will not try new things if he is not guided.Weaknesses:Daniel has many protesting behaviors. He needs many prompts and cues to use communication device.Daniel resists new learning, but when he GETS something he likes-he is VERY capable!! Daniel will benefit from strong adult persistence, consistency, and the understanding that he can do it!Recommendations:We recommend continued trial of the Vantage.MSHA Annual Conference 2013 Summer Progress and SuggestionsUpdateEarly Childhood Special Education Classroom Currently using iPad with Proloquo only at schoolBackground-Rebekah Rebekah is 4 yo and has received special education services since 20 months of age. Her initialEligibility was Early Childhood Developmental Delay until 2/2012 when the MET changed it to AutismSpectrum Disorder. Rebekah is one of 6 children. She has a twin sister with significant languagedelays, a brother w/ASD, and mom is a person with a hearing impairment. *Year 1 of camp attendance.Student: Rebekah Device used this summer:SpringboardFall Pre-school teacher:XXXXSessions attended:5 out of 5Strengths:Rebekah benefits from sensory activities (swinging, squishies, and joint compressions) before group work. She is able to match colors and numbers with the device. Rebekah is able to use two to three word utterances with prompts and some hand over hand guidance. She enjoys using the device once she sees the intent/purpose it serves. Weaknesses:Rebekah has many protesting behaviors. She needs structures activities to use communication device. Rebekah will resist the use of something new, until she sees a purpose. She is very capable and persistence & consistence of adults will support her learning.Recommendations: We recommend continued trial of the Springboard/Vantage. **a device was sent home with practice homework, so the family was also exposed to an AAC device.MSHA Annual Conference 2013 Summer Progress and SuggestionsUpdate Early Childhood Special Education Classroom Currently using Go Talk at calendar time; Springboard Lite; some low tech; and trialing other devices from MiTs.Parents have AAC evaluation scheduled at U of MBackground-Katelyn Katelyn is 4 yo. She has a medical diagnosis of Retts and has received special education services since a toddler as a child with the eligibility of Otherwise Health Impaired. Katelyn has been exposed to alternative communication strategies since a toddler including pictures, switches, Go-Talk 9, & Springboard. *Year 1 of camp attendance.Student: Katelyn Device used this summer:VantageFall teacher:XXXXXSessions attended:5 out of 5Strengths: Kate is able to match objects to device. She benefits from limited vocabulary/highlight key words for her to access. Weaknesses:Needs a way to access device from walker; distractable-hand over hand assist with waiting for focus (put m&m over color to get Kate to look at color icon); device needs keyguard for direct access; used thumb on left hand for accessRecommendations:Recommend continued use of AAC devices and parent trainings.MSHA Annual Conference 2013 Summer Progress and SuggestionsCurrent AAC useEarly Childhood Special Education Classroom Currently using low tech pictures and sentence strips; at home also using sentence strips and picturesTrial DynavoxBackground-Max Max just turned 4 and has received special education services since age 2 . He is eligible for services As a child with an Early Childhood Developmental Delay. Max is a twin and at this time, his sister is notEligible for service. He is developing expressive language of an echolalic nature. Max has beenExposed to visual supports for language comprehension and other expressive opportunities since toddlerservices. Use of AAC may facilitate the organization of Maxs ideas into words.*Year 1 of camp attendance. Student: Max Device used this summer:VanguardFall teacher:XXXXSessions attended:4 out of 5Strengths: Max is a very bright young man. He was able to change settings on device (always have a copy of your customization & lock the tool box). Maxs speech output increased during summer therapy with the use of the Vanguard device. He imitates phrases, sentences, questions, jokes, etc. Max is using more un-prompted communication The device has been assisting with sentence structure and grammar.Weaknesses: **not really weakness-Maxs desire to learn and explore the information in the device is hard to keep up with!! Structured learning opportunities will assist with his ability to learn and address goals.Recommendations:Recommend continued use of AAC devices to facilitate expressive language development, grammar, and comprehension.MSHA Annual Conference 2013 Whats NEXT??

Meeting with SupervisorsMeeting with other SLPsBridging gaps in supportContinues professional development around AAC devices & usersProviding additional resources for parentsContinuing to advocate for preschoolersMSHA Annual Conference 2013References & ResourcesAAC Language Lab http://www.aaclanguagelab.com/resources

Balandin, S., Iacono, T. (1999). Adult Vocabulary Usage, English, Australia, AAC, Vol. 14.Banajee, M., Dicarlo, C., & Stricklin, S. B. (2003). CoreVocabulary Determination for toddlers, AAC, 19, 67-73.Beukelman, D., Jones, R., & Rowan, M. (1989). Frequency of wordusage by nondisabled peers in integrated preschool classrooms.Augmentative and Alternative Communication, 5, 243-248.

Brown, R. (1973). A First Language: The early stages.Hill, K. (2001). The Development of a Model for Automated Performance Measurements, Doctoral Dissertation, Speech-Language Pathology, University of Pittsburgh.

Marvin, C., Beukelman, D. & Bilyeu, D., (1994). Vocabulary-use patterns in pre-school children: Effects of context and time sampling.

Stuart, S. and Beukelman, D. (1997). Most Frequently Occurring Words of Older Adults, AAC, Vol. 13.

Prentke Romich Companyhttp://prentrom.com