Compartmentalizing Communication Doesn’t Work

I’m often stuck in the middle.

Whether you’re a parent or a professional who cares deeply about a child who uses AAC as a voice, does any of this sound familiar?

I work with parents who complain that the school isn’t doing enough to support their child’s communication growth.  Parents cite bars that are set too low, limited opportunities to practice conversation skills and inadequate time spent on aided language input (or modeling) using the device throughout the school day.  There, the emphasis might be on programming an answer box used to assess the child’s grasp of academic content, rather than mastery of language that permits communication across settings and conversational partners. Teachers are overwhelmed trying to address the needs of too many students and there is limited time to practice “talking” in the classroom.

On the flip side, I also work with school personnel who complain there is little or no carryover at home.  Speech generating devices are returned to school the next day untouched and uncharged. And exhausted parents complain they are just too tired at the end of the day to work on communication after juggling homework time, dinner and personal care tasks — or managing challenging behaviors that place a strain on everyone at home.

Communication cannot be compartmentalized.

It simply doesn’t work for schools to treat an AAC device only as a tool for assessing what a student grasps of the curriculum.  Aided language input must happen across pragmatic functions beyond answering questions and requesting preferred items and activities.  Children need to learn to greet, request information, reject, protest, complain, ask questions, inform and comment.  We know there is so much pressure placed on teachers to provide instruction directly related to the curriculum and to verify understanding.  However, aided language input CAN be provided within the context of that instruction using the student’s own vocabulary.  Time to practice “talking” must be carved in throughout the school day.

Simple examples include:

  • Expect a greeting when entering the room
  • Assign students to take turns making announcements
  • Ask for opinions on everything from lesson activities and reading assignments to the lunch menu and happenings in the news
  • Initiate brief conversation time (think “speed dating”) each morning on various topics (favorite movie, biggest fear, weekend plans, etc.)
  • Send students on errands throughout the school building that require meaningful interaction with various school personnel (provide staff training!)
  • Post a daily question for students to think about while settling in at the start of the school day, allowing time for the AAC communicator to formulate a response
  • Set up barriers that promote asking for help (“forget” to open that milk container or pass out crayons needed for that art project)
  • Using randomized turns (like popsicle sticks with student names pulled from a cup), preselect students who will respond to questions (Tommy, your question will be _____. Let me know when you’re ready to answer.)
  • Formulate curriculum-related questions so they can be answered using core vocabulary on the device while providing a word bank for fringe academic vocabulary (terms like metamorphosis, cumulonimbus and electoral college don’t need to be on a communication device)
  • Model, model, model

It simply doesn’t work when parents say to school teams that they don’t need AAC at home because they know what their child wants, needs or feels. I’m not a mind reader and neither are you, as Dana Neider wrote so vehemently in her blog (http://niederfamily.blogspot.com/2013/07/i-am-not-mind-reader-and-neither-are-you.html). Yes, it takes time to model language on an AAC device.  Yes, it takes time to listen when the words come together slowly.  Yes, it takes time to educate family members, friends and neighbors on active listening strategies.  Yes, it takes time to ask your child to elaborate on what’s said to elicit more language. Yes, it’s faster to present a choice of two (Do you want burgers or pizza for dinner?) than asking an open ended question (What do you want for dinner?). When children are very young, I think it’s especially tough for parents to imagine their AAC communicator on their own–engaged in adventures apart from them–especially when that child is dependent on family for all personal and medical care.

Learning to ask for help, to communicate with confidence and to direct one’s own care is empowering even for individuals who rely on others to have their needs met. I ask parents to imagine sending their child to a camp (like Camp ALEC / http://www.campalec.com).  Would that child be able to tell his counselor that he detests broccoli or has a gluten intolerance?  What if that child is hospitalized and parents had to step away to get some rest.  Would that he be able to tell a nurse he needs more pain medication or is afraid?

Here I am in the middle, which is exactly where I am meant to be — I think — in this crazy world of mine.  Why?  Because I’m standing beside that child who is struggling to communicate EVERYWHERE to EVERYONE about EVERYTHING. When a child is not expected to use AAC throughout the day, every day, I believe we are unintentionally sending a message that we don’t always value that voice. In effect, we are silencing that child in one context or another.

When children are encouraged to communicate in every setting, they gain confidence in making themselves heard. When children watch us communicate using their devices, they not only learn language. They see us embrace their words. When children are encouraged to practice communication with new listeners in new environments, THEY become the teachers and begin to change the world.  It’s all part of the journey that is AAC.

Let’s change the world.

Every AAC journey has its ups and downs. Mateo is no exception.  Initially, he was most comfortable communicating with our immediate family at home while school reported that he was less than eager — sticking with single words and short phrases whenever possible.  As his confidence grew, so did his utterances and his personality, most notably his sense of humor, began to shine.  For quite a while, Mateo was very reluctant to use his Dynavox in the community, refusing to order his meal at restaurants or to ask someone for assistance.  Gradually, he became more and more courageous.  That’s a tough thing to do when you’re the only kid in town who uses AAC as his voice.  Nowadays, he strikes up conversations with people he meets everywhere and he’s singing the National Anthem any chance he gets. He’s still learning how to use that voice of his — aren’t we all?

https://www.youtube.com/watch?v=UFsaMS0mklc

AAC Awareness Month and Talking to Strangers

Fall is my favorite time of the year.  October is special to all of us because it is AAC Awareness Month and we love to tell people how proud we are of Mateo. Today, his speech-generating device enables him to say exactly what he wants to say to anyone in any environment.  But he’s had to work very hard to be a competent communicator.

When Mateo obtained his first device at the age of 4, we were sure he was the only one who spoke like he did.  Mateo felt alone.  We felt alone.  But over the years, largely because Mateo attended Camp Chatterbox for AAC users, we found a family.  We grew to know and love children and young adults who communicate like Mateo.  Mateo was introduced to mentors who helped him become more confident with his voice.  I wish every child had a mentor.  As a SLP, I encourage my families to network and to reach out to other families traveling this AAC journey.  It’s easy to feel isolated when your voice is so different.

Now 17 years old, Mateo is a confident communicator.  Because he’s able to say anything that’s on his mind, he’s also able to be more independent and on his own in the community.   He’s outgoing and extremely curious. He has no issues striking up conversations with strangers.  My husband and I are both introverts by nature.  Mateo reminds me of my father and big brothers — always anxious to meet someone new, make a friend and tell a story.  As a small child, we certainly cautioned him about talking to strangers, especially when he was still struggling to communicate.  Now, we encourage him to make connections on his own.  It’s still a little scary for me, but I’m so very proud to watch him do this over and over again.  Sometimes, he initiates the conversations and, on other occasions, strangers approach him because they’re curious about how he’s talking or because they have a family member or friend who uses a similar voice.

At Disneyworld, Mateo approached a teen who was waiting in line with his family directly behind us.  A Cavs fan, Mateo couldn’t help but comment on the teen’s Golden State Warriors shirt given his beloved Cavs had just won the championship in a tough matchup against Golden State in the finals.  I watched as the young man responded to Mateo’s initiation of the conversation.  For a brief moment, he seemed surprised and maybe even a little bit uncomfortable.  He recovered quickly and responded with enthusiasm, respect and genuine interest. They had a great conversation about their teams!

In a hospital waiting room, Mateo asked a family sitting beside him where they were from.  He told them about his home town and, before he left, he wished them a healthy day.

But it’s not just Mateo kicking off conversations.  Often, strangers observe us talking in a restaurant or a store and approach HIM.  This weekend, an elderly man walked up to him and introduced himself. This stranger explained that a parishioner at his church recently obtained a similar AAC device and how it’s been life changing.  They ended up discussing their rival high school football teams.  On many occasions, Mateo is approached by strangers who tell him, “My son uses a thing like that!” or “My cousin talks with a computer too.” I think that people are drawn to Mateo because they want to know they’re not alone. 

There IS more awareness of AAC.  Mateo is working to win over new listeners and make people comfortable with his voice every day. I asked him recently what makes a good listener.  Here are some of the things he said:

  • Wait while I create my message
  • Look at me while I’m talking
  • Remember that I’m doing the talking, not my computer
  • If you don’t understand what I’m saying, don’t pretend that you do (I can tell when you fake it)
  • Ask me questions and I’ll tell you more
  • Just LISTEN!

Mateo recently told us he wants to talk to children about his voice.  He’s working to flush out what he wants his message to be and we’ll try to help him achieve this dream.  It’s who we are.  We are an AAC family.

Fringe Makes Me Cringe

Happy Better Speech and Hearing Month. It’s finally May and I’ve been reflecting on what this career has meant to me personally. To those SLPs who have worked with Mateo and helped him accomplish amazing things, I thank you.  To those SLPs who encouraged me to embrace this incredible career and continue to inspire me every day, I thank you.  And to those families who allow me to work with their children, I thank you. I am deeply touched that you trust me and let me be a part of their story.

So, I took a journey into the past again recently–when Mateo was very young and I was a mom still learning about AAC. Back then, I spent hours and hours programming weekly vocabulary and spelling words on his device. For every science unit, I made sure there was a page that contained words like cumulonimbus.  It wasn’t until much later that I realized that back then I didn’t view his Dynavox as a means for him to communicate anything he wanted across his life time.  I did not program his device in such a way that he could achieve spontaneous novel utterance generation (or SNUG). Instead, we were primarily focused on whether he could simply respond like everyone else in the classroom.  Once that unit was done, we often wiped out that vocabulary list to make room for the next one.  We thought we were leveling the playing field by giving Mateo access to the same words as all the speaking children.  Looking back, maybe we were in denial and hoping this was something temporary.

Now I cringe at the mere thought of fringe vocabulary. It makes me absolutely crazy.

AAC devices must be built around core vocabulary, words that we all use all the time every day. We want communicators to create spontaneous novel utterances and they can do that if they have access to these core words. Core vocabularies consist of words identified as being important for an individual to express anything they want to say across activities,  environments and communication partners.   With a few hundred words, a person can say over 80% of what is needed.

We use just 50 words 40-50% of the time
We use just 100 words 60% of the time
We use just 200 words 70% of the time
We use just 400 words 80% of the time

For school-aged children, there is a temptation to customize communication devices and apps like crazy, often with an emphasis on vocabulary that is introduced in the classroom.  The device is then used as a means of assessing a child’s acquisition of these concepts. Children can be given access to fringe and academic vocabulary using a word bank or word wall, if needed.  Better yet, we can model language in the classroom to help children build on their core language communication while still demonstrating their understanding of academic concepts.  It means changing our mindset as communication partners.  As a result, the child will gain more practice in using their core vocabulary and become a more competent communicator.

Let’s contrast two science discussions:

Scenario 1
Teacher to AAC learner: Name the biological process that results in a caterpillar changing into a butterfly.
AAC learner: Metamorphosis (using pre-stored fringe vocabulary)

Scenario 2
Teacher to AAC learner: Tell me about metamorphosis.
AAC learner: Caterpillar change and turn to butterfly (using all core words)

As parents and professionals, we must give children words they can use to communicate anything they want to say every day.  A parent asked me this week, “Do you think he will gain enough speech to be able to express his needs?”  This child is three years old and we’re introducing AAC.  My response: “Maybe, but whether or not that’s the case, that’s not enough for me.  I want more for him. I want him to tell me anything he wants to say.” 

Lessons learned from Camp (posted on PrAActical AAC)

Wow!  What an honor to be invited by PrAACtical AAC to submit a guest blog about Camp ALEC!  Many, many thanks to Carole Zangari for letting me share my experiences and some of the many lessons I learned.  I included stories from the amazing week spent last summer with campers and educators who traveled from all over the U.S. and Canada to be a part of our first year.  You’ll also find some tools, such as spelling boards and information on helping kids get published on TarHeel Reader.

Here is the link to my guest blog:

http://praacticalaac.org/praactical/aac-goes-to-summer-camp

Applications are coming in for Camp ALEC 2015, which will be offered August 9-15 at the beautiful barrier-free Indian Trails Camp in Grand Rapids, MI.  If you’re hoping to send your child to camp, please get your application to us soon. Adults are also welcome to apply because this camp is NOT just for kids! We promise teachers, SLPs and administrators a week–with literacy experts Drs. Karen Erickson and David Koppenhaver and some of the world’s most spectacular children–that you will never forget.  Educators who have already attended a week-long Level 1 training with this dynamic duo are eligible to apply.

Here is the link to Camp ALEC:

https://campalec.wordpress.com

True Inclusion

So there is a push for more and more inclusion these days.  One body of evidence supporting this trend is the pressure placed on intervention specialists and speech-language pathologists, for example, to deliver services in the general education classroom.  Some professionals are uncomfortable with this model and others are diving in head first.  For many, I think, both their enthusiasm and fear place them somewhere in the middle.  The more I think about it, though, the more I’m convinced that inclusion has little to do with where services are delivered or how.

I’ve been watching our son Mateo run cross country for his third season in a row.  His first seasons were spent in the 7th and 8th grades of middle school.  We were encouraged to have Mateo join the cross country team by a principal and our special education director back then.  It didn’t cross our minds for a moment, despite the fact that Mateo has a runner’s body and a whole lot of energy to expend.  We had our concerns, but Mateo was willing to give it a try so we jumped on board.

Unfortunately, no one informed the middle school cross country coach of this plan and she was utterly ill prepared.  Before his first season even officially started, she tried to turn Mateo away from practices.  She said she couldn’t properly supervise the team PLUS him.  She cited a fear of him getting injured (couldn’t any runner get injured?) or getting lost (he is a human GPS) because he’d fall so far behind the other runners.  Suddenly, a team that had been a “no cut” sport for years and years had criteria that had to be met in order for a runner to make the team.  And this same coach told me very clearly that she didn’t think Mateo would be able to make the team.  Well, he did exactly that.  And he proved this coach was wrong on his own. Still, we cited our concerns to our superintendent and director of special education, armed with documents from the Office of Civil Rights regarding inclusion in extracurricular and athletic activities. Truth be told, we always felt that the teachers and administrators were supportive, but having Mateo on the team was simply out of the comfort zone of this particular coach.

The coach insisted he run with an adult aide in races “for safety” despite protests by the entire IEP team, the assistant coaches, and Mateo himself that this support was not needed.  Finally, for the last race of his 7th grade season, he ran solo.  Well, kind of.  Unbeknownst to us until later, the coach had asked a high school runner to accompany him since the IEP team formally determined once and for all that he should run on his own and she still disagreed. But he ran on his own in 8th grade and got stronger and stronger with each race.

Mateo ran for the middle school for two consecutive years, despite this coach, and never finished a race last.  He finished his first middle school race as a 7th grader in 19:20 and completed his last race as an 8th grader on the same course in 13:32.  His finish time improved in every race.  Mateo’s successes didn’t soften this coach in the two years he ran with this team.  I can count on one hand the number of times I witnessed her speak to him.  It was heartbreaking for us to talk to him about the situation.  We were honest and admitted that there are simply people out there who think he is not capable.  We encouraged him to prove to that coach (and anyone else standing in his way) what he can do while acknowledging that we cannot change people.

Despite the role model set by this particular coach, his teammates stepped up.  They accepted him as a member of the team.  We watched as members of his own team encouraged him on the course during races, shouting to him, “Stay with me, Mateo!” as he tried to keep pace or, better yet, “Come on and pass me, Teo!”  We were stunned when runners and family members from other teams cheered for him by name. We often overheard other spectators comment on his improved time meet after meet.

Fast forward to this year.  Mateo is now a freshman and a varsity cross country runner.  He began practicing with his high school team in June.  We learned about a four-night running camp the entire team was expected to attend. When we asked his new coach about it, it was simply assumed Mateo would be there.  It’s true, the coach admitted he was a little nervous about it.  He asked questions about Mateo’s diet, his method of communication and his needs.  But here’s the difference: the coach talked to Mateo about all this.  Together, they made a plan to ensure that camp would be successful for the entire team and Mateo was part of the team. Mateo came back from camp with dozens of pictures of his teammates taken with his iPad, new campfire stories, a pile of unbelievably smelly laundry and a bunch of new friends.

Today, Mateo returned from an overnight meet in Columbus.  He didn’t go on his own only because you can’t keep Manuel away from his races.  Mateo had an entire cheerleading squad made up of his incredible big sister, Madeline, an uncle, an aunt, cousins and extended family and friends who live in the area.  Mateo achieved another personal record, shaving off a minute and a half from his last best time.  He ran his fastest mile ever and finished the 5K race in 23:06. By comparison, he finished his first race of this season in 28:59. He is getting stronger and faster.

He is 100% a member of his varsity cross country team.  He is joined at meals by his teammates.  He’s congratulated by the entire team for his successes and he does the same for the other runners.  He attends team dinners, joins conversations, huddles up with the guys for meetings, pitches in for fundraisers and works his butt off at every single practice so that he can perform better and better with each race. He commiserates with the other runners over sore muscles and bad test grades. They give him a hard time for sitting with 8 girls at lunch every day. He’s just one of the guys.

Today, Manuel told me that he observed Mateo approach his varsity coach and his coach pulled him in for a hug and quietly said, “love you, buddy.”

I think inclusion is a conscious decision.  I think it takes an open dialogue and considerable planning.  I don’t think it’s easy but the pay-off is HUGE for everyone.

On a slightly related note, our director of special education asked Mateo to deliver a short presentation before our school board to give the members some insight into AAC.  Mateo thought about what he wanted to say for a very long time and put a lot of effort into his message.  His speech was open and honest and he delivered it this week with such confidence and dignity. I’m grateful to our school board for listening to his voice.  His words were absolutely from the heart.  Here’s the link:

http://youtu.be/dY3UvMigc3c

October is just a few days away.  It’s AAC Awareness Month.  I challenge everyone to take a moment to imagine not having the ability to speak.  Think about spending just a few hours without talking.  In fact, ditch your paper and pencil too because so many of our children who cannot use their natural voices also struggle for years and years to obtain access to a reliable means of writing too.

Language + Literacy = Empowerment

You know, it’s occurred to me that this blog isn’t at all what I expected it would be. But then, my journey is taking me on all kinds of wonderful twists and turns.

Coffee talk: communication, reading and symbols

Camp ALEC is just two months away.  We’ve worked hard to create brochures and applications, send out emails and letters to families, post on Facebook, Tweet, write guest blogs and share the news of this program with friends, families, colleagues and organizations everywhere to fill the last few camper spots. We are finalizing some of the nitty gritty details related to scheduling.  We are still brainstorming on activities that will ensure campers take home stories of zany activities shared with their new friends.  All the while, I’ve also been trying to re- immerse myself in research regarding literacy assessment and intervention with children who have significant disabilities.

This week, I was asked by a friendly and unsuspecting coworker about my summer plans while we were refilling our coffee mugs. She probably expected to hear about our upcoming vacation or our next home improvement project.  Instead, she heard more about assuming competence, AAC and literacy than she bargained for.  I cannot rein in my excitement when I start talking about Camp ALEC.

Quite simply, many children with significant disabilities are not taught to read and write.  Their instruction never moves beyond readiness skills, such as letter and/or sound recognition.  Or they are taught to recognize a limited number of sight words. Their instruction never enables these students to read and write to gain or convey meaning.  Fortunately, things are changing — slowly but surely.   Expectations for children with significant disabilities are being raised across the country, driven by changes in education laws and savvy parents and educators who are hoisting the bar.

Here are just two tidbits about communication and symbols filling my brain at the moment:

Literacy IS language.  If your child struggles to be understood and understand what is said to him, this is all the more reason to teach reading and writing.  For children who are nonverbal or who rely on symbols to communicate, written language is the best way to communicate with the world because there are no limits!  No matter how many symbols we provide to represent spoken language, there is no way to provide a symbol to represent every single word.  Given the ability to spell (even creatively!), however, a child can communicate anything!

Symbols and pictures support communication and serve a very important role in visual schedules, instructions and navigating in the community, such as finding those public restrooms!  Often, educators pair symbols with text (sometimes every word or almost every word!) to make printed words more accessible. There are many software programs and apps available that do this.  To teach reading, however, those symbols inevitably steal the child’s attention from the text and make it difficult for him to read and comprehend the words, which is the goal, of course.  Further, these symbols make it impossible to determine whether the child is able to read the printed text with comprehension or is simply garnishing meaning represented by the syllables. Karen Erickson, PhD and her colleagues at the Center for Literacy and Disabilities Studies recommend that we avoid pairing text with symbols because there is no evidence this practice supports gains in reading comprehension. In fact, it makes it harder to learn how to read because those symbols distract from the reading process.  She recommends presenting text only, but keeping those symbols nearby in order to talk about what is being read.