What is an Augmentative and Alternative Communication Evaluation?

By: Laura Van Zandt, MS, OTR/L

Did you know October was National Augmentative and Alternative Communication (AAC) month? AAC is a specialized area of clinical services. Here at Easterseals DuPage & Fox Valley, we are very lucky to have several therapists who specialize in helping individuals find their voice through AAC. We have both Occupational Therapists (OT)  and Speech-Language Pathologists (SLPs) involved in a multidisciplinary team evaluation to determine the best strategies and/or communication systems to help a child learn to communicate.

As an OT, I first became interested in AAC when I was working with a little boy with autism who received a high tech speech output device. It was amazing to see how having his new voice provided so many new opportunities for him. It helped with his overall regulation as he now had a system to share his wants, desires, and needs.

assist-with-communicationAAC looks different from person to person and varies from low tech options, light/mid tech and high tech systems. If you think your child might benefit from AAC, our team evaluative approach may be helpful. Below is more information on what each team member does to best help your child.

  1. Many parents often have questions about whether or not a device will hinder their children’s ability to speak. This is absolutely not the case. Research demonstrates that AAC does not keep children from learning to speak.  In fact, users will make gains in language AND speech because AAC helps a child connect with others, produce successful communication, and provides consistent speech models. The child I described above, went on to learn a ton of new words after he got his device! When we begin to use AAC with toddlers, it doesn’t mean we believe they are never going to talk; instead, it often means, we believe they need a way to have a meaningful connection to others through a common language which helps serve as a bridge to spoken language.
  2.  Do try and introduce forms of AAC early. Using AAC can be very helpful for a toddler who is beginning to make gestures, eye contact or sounds to communicate messages, but isn’t yet using spoken language. Often these toddlers are frustrated they can’t communicate certain thoughts and messages. Once they start to see and learn the power of communication through signs, pictures, or more formal AAC apps/devices, they begin to feel a little less frustrated.

blog_visual3. Model, model, model. When using any type of AAC, we can never model enough. This means that everyone in a child’s life should use AAC too! As with all language learning, AAC is learned because those around the child speak the same language. If you think about it, early communication development (between birth – 12 months) is only modeling – caregivers communicating without any expectation while being connected with their baby using a common language. I love it when my clients bring their devices to therapy. If your child is already receiving therapy services, ask the therapist to use your child’s communication system during sessions to connect and engage with your child. When using AAC, continue to use verbal speech to model and help children understand the pictorial representation of language and develop the words.

Neela2

4. When you schedule an evaluation, you will see both an occupational therapist and a speech therapist trained in AAC. Both therapists are knowledgeable in a variety of access methods such as hand access, switch scanning, and eye gaze technology. The occupational therapist will specifically look at:

  • the child’s overall posture and strength to allow for upper extremity (or any other extremity) use while accessing the communication system
  • determine optimal positioning of both the child and the device to ensure the most efficient method of access
  • the child’s vision, auditory, and sensory processing needs
  • the child’s visual and/or auditory scanning ability
  • the child’s visual/auditory tolerance
  • any adaptations to engage different sensory systems, as well as monitor for sensory overload and/or assist in sensory regulation for device access.

The speech therapist is extremely knowledgeable in the vast array of AAC communication systems and AAC strategies available. They will help determine the communication system and language page best suited to bridge the gap between the child’s receptive and expressive communication skills. The evaluations are done in a play based manner to help the child feel comfortable. And play is how children learn!

DSC_1Here at Easterseals we offer a team approach for evaluating children for AAC needs. For children that could additionally benefit from AAC, we will see them for co-treats to help expand their language within play based therapy sessions.

When the child’s specific goal is to assist in overall regulation and play to support device access, then a co-treat can be extremely valuable between Occupational Therapy and Speech Therapy. OTs are trained in setting up sensory rich environments to support regulation and drive play. These activities can be very motivating for your child’s communication. There are endless opportunities to model language depending on your child’s unique development.

To learn more about Assistive Technology at Easterseals DuPage & Fox Valley, click here. 

 

Additional resources: www.speechscience.org

Occupational Therapist Recommended iPad Apps

By: Laura Bueche, MOT OTR/L

No one can deny the powers of the iPad. The back lit animations, sound effects and interactive games make apps a great tool for kids to learn. Kids and adults are drawn to the technology?

The American Academy of Pediatrics (AAP) recommends limiting the amount of screen time a child has to “high-quality content.” They recommend children and teens should engage with entertainment media for no more than one or two hours per day and that television and other entertainment media should be avoided for infants and children under age 2.

But what games or content are high-quality? As a pediatric occupational therapist, I use iPad apps during therapy as a therapeutic tool to help kid’s develop skills.  Below are my favorite quality iPad apps.

Fine Motor Skills

Dexteria

 

Dexteria By: Binary Labs, Inc.
Price: $3.99

Dexteria turns your iOS device into a therapeutic tool that improves fine motor skills and handwriting readiness in children and adults.

dexteria jr

Dexteria Jr. By: BinaryLabs, Inc.
Price: $2.99

Set of hand and finger exercises to develop fine motor skills and handwriting readiness. The activities are specially designed for kids age 2-6.

dottodot

Dot to Dot Numbers and Letters Lite By: Apps in My Pocket Ltd By Apps in My Pocket Ltd
Price: Free

Trace through dot-to-dot puzzles for visual motor skills and visual tracking.

bugsandbuttons

Bugs and Buttons By: Little Bit Studio, LLC.
Price: $2.99

18 mini-games and activities that make learning fun. Count colorful buttons, recycle with marching ants or dainty ladybugs, recognize letters, solve bug mazes, and more!

 

Letter and Number Formation

letter&number2 letter&number

Letter School By: Letterschool Enabling Learning B.V.
Price: $4.99

Play to learn how to write all letters of the alphabet: abc – xyz and the numbers 1-10 with LetterSchool.

letterworkbook

Letter Workbook Home Edition By: BigCleaverLearning
Price: Free

Letter Workbook is an interactive educational app which teaches toddlers and children how to form and write letters. Through the simple, interactive guide children will learn how to write their ABC, improve vocabulary and have fun along the way!

myfirst number trace

My First Number Trace By: Neutre
Price: $1.99

Easy tracing for little fingers. Trace letters 1-10.

iwritewords

iWriteWords By: gdiplus
Price: $2.99

iWriteWords teaches your child handwriting while playing a fun and entertaining game.

 

Visual Perception

littlethings

Little Things By: KLICKTOCK
Price: $2.99

An innovative seek and find game. Search colorful collages built from thousands of little things. Randomized searches ensure a different game each time you play.

rushhour

Rush Hour Free By: Thinkfun Inc.
Price: Free

The original sliding block Traffic Jam puzzle, works on visual perception, problem solving, and attention.

 

visual attention
Visual Attention Therapy By: Tactus Therapy Solutions Ltd. Price: $9.99

Visual Attention Therapy helps brain injury and stroke survivors, as well as struggling students, to improve scanning abilities. It also helps rehab professionals to assess for neglect and provide more efficient and effective therapy for attention deficits.


Cause and Effect Apps

peekaboo

Peekaboo Forrest, Barn, or Fridge By: Night & Day Studios, Inc.
Price: $1.99

If you see something moving, tap on it to find out who it is!

ilovefireworks

Ilovefireworks lite By: Fireworks Games

Price: Free

Create beautiful fireworks display by easy tap operation! Touch on the screen, you immediately see breath taking fireworks in 3D graphics and real sounds.

touchofmusic

Touch of Music By: gamegou

Price: Free

Enjoy the freedom to play songs at your own beat while never missing a note.

 

Self Care Skills 

idohygiene

IdoHygiene By: C.E.T – THE CENTER FOR EDUCATIONAL TECHNOLOGY
Price: Free

Learn the most common personal hygiene daily activities (teeth brushing, shampooing , hand washing, toilet training, taking a shower , public bathroom, etc.)

t-rex

T-Rex Toothbrush Timer By: PCAppDev Limited
Price: $0.99

Encourage your kids to brush their own teeth properly by following Dino brush his teeth!!

To learn more about Occupational Therapy at Easter Seals DuPage & Fox Valley visit eastersealsdfvr.org.

Myths and Realities of Augmentative Communication

By:  Amanda Nagle, MA, CCC-SLP/L

Frank in therapy
Two-year-old Frank vocalizes the word “duck” while playing with a computer laptop and recorder. Frank attends weekly speech pathology sessions at Easter Seals DuPage & Fox Valley to help with issues that stemmed from food allergies and delayed truck core strength. After a year of therapy, Frank is now quite a talkative young boy!
Photo by: Nancy Kerner

Parents understandably worry when they hear the words “speech generating device”, “AAC” and  “augmentative communication”. Concerns are voiced such as:

  • The Speech Language Pathologist (SLP) doesn’t think she will talk and is giving up on her speech
  • My son talks, why is the SLP recommending a speech generating device? My son doesn’t fit this profile!
  • Won’t that device stop her talking and make her too lazy to talk?

That is just not the case. The American Speech Language Hearing Association (ASHA) defines augmentative and alternative communication (AAC) as “all forms of communication (other than oral speech) that are used to express thoughts, needs, wants and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.”

There are many myths around the use of augmentative and alternative communication (AAC) in individuals of all ages but these myths are particularly prevalent with our young children. Below are the most common concerns (myths) that I continue to hear from families and professionals, especially those working with young children.  I want to dispel the myths with the realities surrounding the concerns.

MYTH:  The AAC system will become a crutch for my child.  Parents are frequently concerned that their child will use the device instead of learning to communicate verbally.

REALITY:  Many children’s verbalizations increase when they begin using a voice output AAC device.  Research and clinical practice continue to indicate that AAC does not interfere with verbal speech and actually encourages spoken language.   We frequently see increased imitation and spontaneous verbalizations when children use augmentative communication systems.  Children will communicate with the easiest and most flexible means available to them.  It is easier to use verbal speech when possible than it is to create a message on a communication device.

MYTH:  The term ‘augmentative communication’ refers only to devices with voice output.

REALITY:  There are many different types of augmentative communication with and without voice output.  Some types include using objects, photographs, picture symbols such as Boardmaker or SymbolStix, gestures and manual signs.  Other types are low tech battery operated single message voice output devices with as few as one message.  Mid tech devices are available with multiple message selections.  High tech devices are also available with robust language organization that can be modified for various stages in a child’s receptive and expressive language development. Boardmaker Software

Tablet systems such as iPads have a variety of communication apps from single messages to full robust language organizations.  Frequently, children’s full communication systems include a combination of no tech, low-tech and high-tech AAC, in addition to their unaided communication including verbalizations.

MYTH:  Individuals must progress through a specific hierarchy of skills before they are ready to use augmentative communication or before moving to the ‘next level’ of augmentative communication.

REALITY:  There are no prerequisites for communication.  A child does not need to understand cause-effect before he/she can use AAC.  A child may actually learn cause-effect skills through the use of augmentative communication while she is learning new forms of communication.  A child does not need to know that a picture represents an object.  When a picture is attached to a voice output device or to a low tech surface, the child will begin to associate meaning between the picture and the object she receives when she selects the symbol.

For example, if you attach a picture symbol of ‘bubbles’ to a single message device, your child touches the picture and hears the message ‘bubbles’, then you blow bubbles for her, in time she will begin to associate the picture of bubbles with the actual bubbles.

MYTH:  AAC is a last resort and we are giving up on my child’s speech.

REALITY:  A child’s use of AAC can enhance speech, language and communication development while reducing frustration at the same time. Ideally, augmentative communication strategies should be introduced and implemented prior to communication failure in order to prevent communication failure.  When AAC is introduced early, before increased frustration and communication failure occur, a child may naturally incorporate the system into their typical communication repertoire.  Receptive and expressive language skills can be modeled using an AAC system.  It is never too early to begin to incorporate AAC strategies into a child’s communication development.  When introduced early, AAC can provide a strong foundation for a child’s receptive and expressive speech and language development.

MYTH:  My child speaks and AAC is only for people who are completely nonverbal.

REALITY:  AAC systems and strategies may be used as primary communication systems or as supplemental/augmentative systems for individuals.  Many children are verbal and have trouble being understood by unfamiliar listeners or become frustrated when a familiar listener doesn’t understand a spoken message when the context is not known.

The following are some, but not all of the additional ways that AAC can be used with children who are verbal but may be difficult to understand:

  • repair communication breakdowns
  • set topics
  • word retrieval
  • receptive language development
  • expressive language development
  • expansion

It is important to remember that individuals with complex communication needs should have the opportunity to use augmentative communication strategies if they are not able to say what they want or need, share an idea or story, offer their thoughts, ask questions, tell you that they are afraid and what they are afraid of, and tell you if they are in pain.  Augmentative communication can provide a means for them to share these types of messages to more people in more places more often.It is never too early to introduce AAC into communication intervention.  There are no prerequisites for communication.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

My Favorite Speech and Language Apps: Part 2

By: Jennifer Tripoli M.S., CCC-SLP

Photo by: John Smith
Photo by: John Smith

As promised, here is the next installment of my favorite speech and language apps! My February blog post listed a few of my go to speech and language apps that I use during many of my therapy sessions. Here’s a few more great apps that I hope you will LOVE too!

  1. Panda Games by Dr. Panda ltd.

Price: Apps range from free to $3.99

I recently came across Dr. Panda games app and I fell in love with the adorable characters and interface! Being the therapist I am, I tried to think about how I could use these apps in my therapy sessions. Let me tell you, it was EASY! The company’s mission is to “help kids understand life and the world around them”. There are a slew of Dr. Panda apps, with one being better than the next! Each app has a different theme with countless speech, language and play benefits.dr.panda

Panda’s SuperMarket is my favorite of the Dr. Panda’s apps!

With this app you can work on pretend play scheme for a grocery store, introduce grocery store vocabulary (e.g. shopping cart, checkout, cashier, produce section, etc.), sequencing (First get a cart, then go shopping, checkout, and put groceries in car), following a shopping list, math/numbers during checkout, and categorizing (fruit, veggies, dairy products, bakery, etc.).

  1. Conversation Builder by Mobile Education Store

Price: $19.99 for iPad

This is an app geared towards elementary aged children who need help with conversational skills! This app is essentially a conversation simulator that works on children’s conversational reciprocity with multiple exchanges (back and forth practice).

  1. Bag Game by all4mychild whatsinthebag

Price: $0.99

  • You hide a photo in the bag and your game partner has to try to guess the object you hid by asking questions about it in a process of elimination type way.
  • This app is a spin-off of the game “20 questions”. I use this app to address a variety of different language skills

I have also used this without using questions, but having the child (the object hider) use different language concepts to describe what is in the bag! (the child needs to be careful not to say what the item is in the description!) I will go back and forth with the child where they are describer and I am the guesser and I am the describer and they are the guesser. Not only does this work on descriptor skills when they are describing the items, but also word finding skills when they are the guesser!

You can also go a step further and make it like the game “Taboo” where you give the kids words they cannot use in their description (this is very tough).

whatsinthebag2

  • At the end of it, all the kids LOVE opening the bag and seeing what is inside!
  • It’s a great game for using descriptor words, working on word finding skills, asking questions, and answering yes/no questions as well!

If you are interested in learning about other apps and app resources, please see my February blog post here!

For other speech and language ideas, please visit the Easter Seals DuPage & Fox Valley speech and language department’s pinterest page here!

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

My Favorite Speech & Language Apps: Part 1

By: Jennifer Tripoli M.S., CCC-SLP

“Can we play on your iPad?” is often the first question I get when a child enters my therapy room!  These kids, often referred to as the “digital generation”, are drawn to anything with a screen.  Though electronic overuse can be an issue with kids today, I am forever grateful for Steve Jobs and the people at Apple for opening up another world of speech therapy (a very BIG one!). Since the iPad’s release in 2010, the app world has exploded, especially in regards to educational apps for children. There are hundreds of blogs and websites dedicated to app use in speech therapy. This blog post will not be a comprehensive list of all the apps that can be used to promote speech/language development. There are thousands of apps, so I will touch on a few of my favorites at the moment and provide resources for exploring others.

A few of my favorite apps for development of speech/language/cognitive skills:

1. Anything Toca Boca!
This is my favorite app company for little ones. They have interactive apps that I use to target early language skills and pretend play. Try these apps to target pretend play schemes in a different way!

Visit their website for many more great apps.

2. Popplet by Notion
Price: $9.99
Not sure about it?  Try the lite version here for free!

Popplet is a visual learning app that can be used to target higher level language (word relationships, categories, compare/contrast, story retelling) and executive functioning skills (organizational skills, planning, generating ideas)

Here’s a pic of my client’s “popplet”. This visual representation assisted her in retelling 5 things she did over winter break

popplet

3. Toontastic by Launchpad Toys
Price: $9.99 for the app, other scenes/characters available for an additional cost

  • An award winning app that makes your child’s cartoons come to life!
  • Great for speech language skills: story retelling, sequencing, using complete sentences, working on pronouns, understanding emotions and much much more!
  • Kids follow the story arc to structure their story (setup, conflict, challenge, climax, resolution), choose a setting, pick the characters, animate, and set it to music!
  • Can save these videos or share them!
  • Also, check out Toontastic Jr. which is recommended for kids 3 years and older

4. Peekaboo Barn by Night and Day studios
Price: $1.99
Peekaboo Barn
Not sure about purchasing the full app? Download the lite version here for free!

  • Interactive app aimed at toddlers
  • Typical farm animals (cow, pig, horse, chicken, etc.) are hiding in the barn! Touch the barn and surprise! Out pops an animal
  • I have used this in therapy to work on cause/effect, use of exclamations (ooh! Wow! Whoa!), and use of words “open”, “out”, “knock knock” to name a few
  • This app is recommended for “toddlers”, but please keep in mind the recommendations of the American Academy of Pediatrics on screen time for children under the age of 2 years old.

How do I incorporate the iPad into my treatment sessions? Moderation is key! Lately, I feel as if iPads and other electronic devices are getting a bad rap in regards to overuse. Just like anything else, we need to set limits for our kids. Many kids would play on the iPad the whole session if I allowed this (I don’t!). I try to alternate activities between electronic and non-electronic throughout the session. When alternating activities, it keeps the child more engaged within therapy activities. Using iPad apps in therapy offers a wide variety of ways to target specific skills and assists with generalization of skills. It gives me another platform to practice certain speech/language/cognitive skills.

Here are some great websites that review/suggest speech and language related apps:

Bridging Apps
Moms with Apps
Therapy App 411
Technology in (SPL) Education
te@chthought
Speech Language Neighborhood
Apps for Children with Special Needs

Want to learn about how to use your iPad’s video camera for changing your child’s behaviors? Click here!

Do you need more play ideas for your child that aren’t electronic? Check out my last blog here that gives toy ideas by age! Click here!

 STAY TUNED FOR PART 2!

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

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