Setting AAC Goals: Please And Thank You

Can we please stop expecting kids who use AAC to end every request with “please”?  I’m talking about those emergent communicators who are just learning that their voice empowers them.  I’m referring to those beginner communicators whom we are desperately trying to move beyond requesting “goldfish please.”  The goldfish may be hugely motivating, but saying “please” — no way!  Although politeness is admirable, if you push for “please” at this point, you may end up with overgeneralization due to a lack of understanding of that concept as new core words are introduced.  That’s when you hear things like “I see goldfish please” on a fieldtrip to the aquarium.

We often get hung up on increasing mean length of utterance (MLU) before it’s developmentally appropriate.  Let’s think about Brown’s Language Stages.  If a child is using just 75 words (such as go, help, more, stop) and speaking in single words, he’s at Stage 1 (MLU: single words).  When he says “more” he may really be shouting “Give me more right now!”  He speaks single words to direct another person’s actions, express negatives and make requests. We can use aided language input to model extended phrases like “want more,” “I want more” or “give me more” to teach this beginning communicator how to sequence words meaningfully. I wouldn’t demand “please” just yet.

Now let’s look at Stage 2 (MLU: 2.0).  This child is putting 75-200+ words into 2-3 word phrases, but still producing a lot of single words.  He’s added some new words to his repertoire, such as “need” and “all done.”  He uses some fringe words, like “milk” and favorite toys such as “ball.”  This child is directing another person, expressing negatives and making requests by combining words with phrases like “want more,” need help” and “want that.” Yes, you could begin expecting “please” but there are SO many other wonderful, powerful core words out there!  I’d still wait before demanding it.

At Stage 3 (MLU: 2.75), things get really exciting!  This child has a vocabulary ranging from 200 to 1,000 words and is beginning to use morphemes, the smallest units of meaning.  Phrases and sentences are 2-3 words in length. Utterances might not be grammatically correct, but they really pack a punch.  The child is communicating with pronouns, negatives, prepositions, simple past tense and plurals.  He might say things like “he going,” “I coming in,” “my trains,” “she stopped” and “look it going.”

When a child reaches Stage 4 (MLU: 3.5), he’s using 1,000-2,000 words to produce utterances like “I fell down,” “don’t like,” “mommy’s drink,” “what is it?” and “I saw train.”  He’s asking yes/no and simple “wh” questions and experimenting with irregular past tense verbs and possessive endings, as well linking verbs such as “is” and “are” correctly.  He’s using adjectives to describe things.

At Stage 5 (MLU 4.0), the child is using 2,000-3,000 words–including the articles “a” and “an”–and acquiring new words all the time.  He’s beginning to use verbs that end in “s” for third person regular present tense and has generally figured out the concept of past tense, using irregular past tense verbs to describe things that have happened.  Utterances might look something like this: “mom’s car broke,” “dad was helping” and “he plays a game.”

When a child reaches Stage 6 (MLU: 4.5+), he has 3,000+ words in his vocabulary.  He is able to use all parts of speech and segment words into the correct word order in sentences.  He is producing complex sentences with conjunctions like “if” and “because” and can pose negative questions.  Examples of sentences at this stage include: “I needed you to fix it,” “She’s afraid because it’s scary,” “That’s the folder you put it in” and “Where’s some food I can eat?”

Let’s go back to those early stages of communication where I’m often asked to help move children beyond using single words and requesting only.  I think that’s where we often get stuck because requesting a favorite toy or snack is so motivating!  But given consistent aided language stimulation (model, model, model!) and new communication objectives, children gradually see the power of other words.  For example, although we parents and teachers might not enjoy experiencing it firsthand, rejection and cessation are two of my favorite objectives to address using target words like no, not, don’t and stop.  The word STOP is key to self advocacy.  If a child is at the level of single words using the communication device, imagine the opportunities to model expansion of those words:

  • Stop it!
  • Stop that!
  • You stop!
  • I stop!
  • Stop + verb (stop talk)
  • Object + stop (music stop)

Notice I didn’t say anything about “stop please.”  Yes, it’s a possibility, but is it the best word choice in these early stages? I don’t think so, but perhaps I need to work more on my own manners.

There are so many opportunities to work on the word “stop” for the purpose of rejection and cessation and beyond.  Keep in mind that the word “stop” is a powerful word with many meanings and we need to model the use of this word across many contexts and settings.  Here are some ideas:

Stop activities3It’s been my experience that we spend so much time modeling and working to expand the utterances of children who use AAC that we often overlook what we expect their typical peers to say when we pose exactly the same question to them. We forget how we communicate on a day-to-day basis with our friends and family. As a result, we push for longer sentences every time and the end result isn’t always natural.  Let me give you some examples:

Expected Speech2

“Please” isn’t my only pet peeve.  I have another.  We often insist that children insert names into their messages when it’s unnecessary and unnatural.  For example, some teachers insist on being greeted with something like “Good morning, Mrs. Smith” or “Hello, Mr. Jones” while changing classes in hectic school hallways when the other students are not expected to use the adult’s name in a similar scenario.  How often do we greet coworkers by name when we say hello at the coffee pot or in passing in the hallway?

Of course, it’s different when we’re working on attention-getting strategies. Then, it’s entirely appropriate and effective to begin a message with a name.  For example, “Mrs. Smith, I need help” or “Mr. Jones, I don’t understand.” Of course, there’s nothing better than hearing “Mom, mom, mom, MOM!” Helping AAC users grab the attention of their friends and loved ones is fun and hugely rewarding. I recommend encouraging individuals to get into the habit of starting with the name first, then adding their message. That way, the listener is cued in and ready to listen to the rest of the message.

Why do we often demand DIFFERENT speech of our AAC communicators in natural conversations?

Let’s not demand lengthier sentences, artificially padded with words like “please” for the sake of increasing a child’s mean length of utterance.  Instead, let’s help AAC communicators add meaning to their communication efforts with greater detail and more information.  Let’s set realistic goals based on natural language development and model, model, model.  Please and thank you.

Happy AAC Awareness Month!

 

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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 – Listen to Me

Let me tell you about something that has happened to me many, many times over the course of my life as Mateo’s mom.  It’s happened when we were chatting in restaurants as a family, standing in line for attractions at Disneyworld and riding on trains and planes.  It’s happened at the Grand Canyon, Cleveland Indians games, monster truck shows, campgrounds, beaches and waterparks.  People are intrigued with how Mateo communicates and he communicates EVERYWHERE.  There is nowhere he goes without his device or, when he needs something that fits in his pocket, he uses his iPod touch with an app on it.  He tells us it doesn’t bother him anymore when people appear to be staring.  I think it used to make him feel uncomfortable because there was a time he was very reluctant to speak in public places, refusing to order his meals in restaurants, for example. Now he proudly sings the National Anthem with his own voice for crowds.  Don’t get me wrong. He wishes he could use his “real” voice if he could, but with AAC he can say anything that’s on his mind.

AAC has been a part of our lives since Mateo was four years old.  He’s attended camps to promote his communication, gain confidence, meet other AAC communicators and learn to advocate for himself.

Before meeting Mateo, many people have said to me that they’ve never met someone who communicates using AAC.  Others have said to me that they’ve never met an individual who is able to communicate as proficiently as Mateo or who could truly communicate anything they’d like to say.  To me, this is still so surprising to hear.  Maybe that’s because we’ve been fortunate to be a part of an amazing extended family all brought together by Joan Bruno and her beautiful Camp Chatterbox.  Maybe that’s because I’m a speech-language pathologist.  Maybe it’s because I’ve met cool kids at Camp ALEC as well.  There are AAC communicators all over the world.  Thankfully, we are not on this crazy rollercoaster ride on our own.

So, here I am on my soapbox again.  Individuals who are nonverbal can only communicate exactly what’s on their mind if they are able to write.  Mateo uses a robust core vocabulary program called Picture Wordpower 100 on his Dynavox Maestro.  But, despite all my efforts to convince him that he’d be faster if he used his core vocabulary, he prefers to spell and use word prediction for the bulk of his messages.  That’s because he can.  Language + Literacy = Empowerment!

I want to show the world how Mateo communicates–and how others are empowered with AAC as well.  He’s given me his permission to do so.  Here he dishes about Camp ALEC in an interview.  We’ll post more talks soon.

Want to show off your mad AAC skills?  Just getting started and proud of those early words?  Let me hear you ROAR!  Email a link to your video to me at voices4all@gmail.com and I will share it.

If you’d like to learn more about Camp ALEC, a literacy camp for AAC communicators offered August 14-20 at Indian Trails Camp in Grand Rapids, MI please visit http://www.campalec.com.

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.

What I learned from camp

It’s been a week since I returned from Camp ALEC.  I’m still trying to wrap my brain around everything I experienced and learned throughout the week.  I do know with absolute certainty that Drs. Karen Erickson and David Koppenhaver are the most amazing educators I have ever met.  I knew they were extraordinary individuals when my dear friend Gina and I first approached them about conducting this literacy camp for children with complex communication needs.  I had seen the impact their work had on my son Mateo when he attended a similar camp in Minnesota for two consecutive summers.  But it wasn’t until I saw them in action that I TRULY appreciated that they wholeheartedly share the same commitment to changing the world as we do.  And I will forever be grateful for this incredible opportunity to learn from them and collaborate with them.

This was the first Camp ALEC and the first camp of its kind offered in the United States. Together, we gathered 15 campers and 14 educators, speech-language pathologists and school administrators from the U.S. and Canada at Variety Club Camp and Developmental Center in Norristown, PA for a week of reading and writing assessment and interventions–plus a typical summer camp experience.   Each camper received a total of 17.5 hours of individual and small group assessment and instruction throughout the week.  The goals of Camp ALEC included building the skills of the adults who participated and determining how the campers like Mateo can be supported in further developing their reading and writing skills during the coming school year.  At the conclusion of camp, parents had an opportunity to have a conference with their child’s educator,  as well as Karen and David, and left with a report detailing the results of their informal reading and writing assessment and instructional recommendations.  Our hope is that parents will share those recommendations with teachers so that they can implement evidence-based instructional strategies that will ensure greater progress in school.

I cannot express the joy I felt watching our campers work with David, Karen and the educators throughout the week.  These amazing children and young adults came to camp ready and willing to work HARD and have a blast while they did it.  Many of our campers had never been away from their families on their own before.  We witnessed homesickness and it broke our hearts.  We tried our best to comfort these kids while learning from veteran camp counselors about tough love.  This was particularly challenging for us “Camp Moms” and we got ourselves into a lot of trouble trying to maintain a balance between nurturing and pushing the kids to ditch their cell phones and embrace the entire solo camp experience.  I am so incredibly proud of every one of our campers!

Throughout the week, I began to question my decision to leave the schools–at least for now–to work in a hospital outpatient pediatric rehab setting.  Truth be told, watching these educators work with our campers often made me wish I were headed back to my own classroom in a few weeks.  But I’ve absolutely loved my new experiences at the hospital where I am working with children before they even enter the school system.  Here, I can begin to help children find their voices earlier!

“If a functional communication system has not been put into place with a child, his only recourse is behavior.” – Dr. Temple Grandin

Down the road, I’ll share specific strategies for helping children with complex communication needs build independent reading and writing skills.  For now, I’m just basking in the glow of this beautiful experience, catching up on some sleep and beginning to plan our next Camp ALEC!  Stay tuned!

Language + Literacy = Empowerment

 

 

 

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.