Incorporating Communication into the

MDS Behavioral Classroom

Students with Complex Communication Needs

Activity

• Find a partner• NO TALKING! (either partner)• You may use whatever you have at

your disposal (within reach)• One partner is a non-reader• Find out 2 things about your partner

that you didn’t know• Switch roles – your partner must use

a DIFFERENT mode of communication!

Discussion

• What was hard?• What was easy?• What tools did you use?• Which role was easiest? Why?

What is Communication?

• A range of purposeful behavior • used with intent within the structure

of social exchanges • to transmit information,

observations, or internal states, or to bring about changes in the immediate environment

Communication…

• Verbal as well as nonverbal behaviors are included, as long as some intent, evidenced by anticipation of outcome, can be inferred

• Therefore, not all vocalization or even speech can qualify as intentional communicative behavior

(Susan Stokes, CESA 7)

Communication takes place within a social context

• there is a desire or intent to convey a message to someone else

• communication and social skills are tightly interwoven and interdependent

YOUR kids!

• Does anyone have a student in the classroom who does not communicate?

• How do they get through the day?• What are their goals?• What are your expectations?

Communication Modes (“the tools”)

• One size does NOT fit all! (think about the activity we just did)

• All kids communicate!• Observation/motivation/behavior• PECS• Signing• Verbal• Spelling• AAC low to high tech

PECS

• PECS vs. PCS• What is PECS?• Ways to modify the system

PECS Myths

• If we’re using pictures of any kind, we’re using PECS.

– Uses pictures, but is a STRATEGY based on 6 distinct phases of teaching as well as strategies and knowledge of ABA

• We’re using a visual schedule, so we’re using PECS.

– Visual schedules target COMPREHENSION, while PECS targets EXPRESSIVE LANGUAGE

Myths

• PECS is only for people who don’t speak at all.– System targets initiation and purpose – may

be an augmentative system or an alternative system

• PECS is only for young children.– Can be effective across all age ranges

• PECS only teaches people to request.– Requesting is the first skill taught, but the

later phases teach commenting

Myths

• If we use PECS, the person will not learn to speak.– As with any augmentative communication

system, PECS may provide a bridge to verbal communication in those for whom this is possible

• PECS is only for those with autism.– Although originally developed for students

with autism, the strategy may be helpful for a wide range of communication disorders

What does it look like?

Question

What about children who no longer needPECS to initiate communication and

• have not developed functional speech?or

• need visual support to produce speech?

Communication

• PECS was essential in learning to initiate interaction with others

• Could use PECS to request and comment

• Uses around 100 PCS symbols (several books)

• Starting to generate words independently and through copying staff

Benefitswhen managing a pointing system

– speed

– fluency

– creativity

– portability

– maintenance

Concerns

• Loss of familiar system

• Not building up a complete sentence

Loss of familiar system

• Maintain 2 resources for a time

• Maintain an element of PECS system eg timetable

• Incorporate the new system within the PECS book initially

– ‘Want something more flexible’– ‘Feel he wants to elaborate on things’– ‘We lose symbols’– ‘He likes to point to things’

CONCLUSION

• PECS can be an important first step in the path towards social interaction

• When this first step has been achieved, other methods should be considered for further developing communication

Signing

• May provide a bridge to increasing communication skills

• Most successful with students with good fine motor and imitative skills

• Issues:– Idiosyncratic signs– Interpretation by communication partner– Partners not familiar with signs (i.e. CBI)– Rate of acquisition

Vocal/Verbal

• Issues?• Intelligibility• Echolalia• Perseveration

Echolalia

• Repetition of verbal information stated by others (conversation, books, videos, TV)

• can include repetition of part of the utterance as well as an identical repetition of the entire spoken utterance, sometimes including an exact replication of the inflectional pattern used by the speaker.

Echolalia• can be both immediate (a repetition of something

they have just heard) or delayed (a repetition of information heard previously - minutes, hours, days, weeks, months, years!).

• occurs in normal language development yet decreases as the typically developing child gains more spontaneous generative language

• reflective of how the child processes information – whole "chunk" without processing the individual words

that comprise the utterance • Also process part of the context

– including sensory and emotional details

Echolalia

• echolalic utterances are generally being repeated without a clear or complete understanding of the meaning of the utterance

• Non-Communicative Purposes – utterances which do not appear relevant to the

situation or context – may be triggered by something in the situation or

context – may be used as self-direction for his own actions – May be reaction to stress or anxiety

Communicative Purposes

• Conversational turn taking – recognizes when he is to take a conversational

turn and that some sort of response is required – lacks the spontaneous generative language to

engage in the conversation

• Initiation of communicative interactions – beginning to recognize and notice others – lacks the spontaneous generative language

skills to initiate a communicative interaction with someone,

Communicative purposes

• used to initiate or maintain a communicative interaction, and the child anticipates a response

• the child repeats the speech act either immediately or shortly thereafter, even after receiving a response.

Non-communicative purposes:

• repeats the utterances/questions without anticipating a response from someone

• may be calming or pleasurable to the child

Requesting

• to request a desired object, action or event– "Do you want a snack?" to indicate that

he wants a snack.

Indicating affirmation in response to a previous

utterance uses echolalia to respond

affirmatively to the previous utterance.

• Another person says, "Want to go swing?" The child responds with the echolalic response, "Want to swing?"

Perseverative speech/incessant question

asking • persistent repetitions of speech or

questions which can be used both communicatively or non-communicatively

• Perseverative speech and incessant question asking may be related to the child's processing difficulties and/or his emotional state

• Consider use of visual strategies to decrease this behavior

AAC – Low to High Tech

• All modes we have previously discussed ARE AAC!

• Any time we ADD a component that supports communication we are using AAC

• Not just “the black box that talks”

What is AAC?

• AAC (augmentative & alternative communication):– Compensates for or replaces speech– Provides supports for development of

language– Includes no-tech, low-tech, high tech– Sign language, pictures/symbols,

writing, keyboarding– email

Benefits of AAC?

• Increases output• Improves

understanding• Facilitates speech

development• Improves behavior• Increases

participation

• Concrete• Multisensory• Motivating• Social

AAC is uniquely suited for promoting engagement in

ASD:

– Visual– Inanimate– Static, predictable symbology– Recognition rather than memory– Buffer & bridge between partners– Inanimate tools– Scaffolded for more complexity

Myths About AAC

• Students won’t learn to speak.• AAC is done only with the SLP.• High tech is better than low tech.• Students don’t need training.• There is no funding available.• Students will be self-motivated.• AAC is for school only!

Tools and Strategies

• No tech– Eye or finger pointing– Manual signing– Prompts– Environmental arrangement

Gestures Objects Graphics Text

Low Tech

• Writing• Visual cues and strategies• Manual communication boards/books• Single message vocal output systems

– Big Macks– One-Step Communicators

Mid -Tech

• Multiple message vocal output – digitized speech (recorded)– Go Talk– Cheap Talk– TechTalk/TechSpeak

• Portable writing tools (i.e Alphasmart/NEO)

• Whiteboard and marker

High Tech

• Multiple message vocal output systems• aka VOCA, SGD, TALKER

– Digitized and/or synthesized speech– Dynavox products (V, M3, IChat)– Prentke-Romich Products (Vantage, Springboard,

Vanguard)

• Computers with specialized software– Speaking Dynamically Pro– Other text to speech – Symbol plus text to speech

• Clicker• Writing with Symbols• Boardmaker Plus

Alternative AAC resources

• Books and charts

• Speech output devices

–accessed by pointing

Communication is a MESSAGE sent and

received.

Language is the structure and rules that apply to that message

What is language?

• What words mean• How to make new words• How to put words together• What word combinations are best in

which situations?

The presence of language does not necessarily mean

that communication will follow,

the absence of language does not always mean that

communication will not occur.

(Downing, 1999)

Communication Issues - SYNTAX

• Syntax: The rules that govern the form or structure of a sentence, specify word order, sentence organization, and the relationships between words and word types.

Poor Communicators often:

• use one or two word messages.• have difficulty with both receptive and

expressive word order tasks.• use atypical syntactic structures.• omit words that appear frequently in

their language (e.g. verbs, articles).• use simple clauses, with limited use of

complex structures such as questions, commands, negatives, and auxiliary verbs.

Possible Solutions:

• Provide access to a rich, single-word vocabulary set.

• Provide learners with models for combining symbols in a flexible manner and create frequent opportunities to practice.

• Use color-coding to differentiate the parts of speech. (Fitzgerald Key)

• Teach syntax!http://aac.unl.edu/vocabulary.html

TALK by Jo Crawford-Schock and Tracie Sponeman-Hrnicek - mthrnicek@yahoo.com

Phonology

The rules that govern the structure, distribution and sequencing of

speechsounds, relating to the ability to read,

spell, and write (literacy and academic success)

Poor Communicators:

• are considered to be at risk for delays in the area of phonology.

• experience difficulty learning to read, spell, and write as a result of decreased phonological awareness.

Solutions:

• Create communication pages and activities to enhance phonemic awareness.

• Allow messages to be sent to a talking word processor.

• Modify an existing keyboard. Place phoneme sounds on each letter.

• Use options to provide auditory and visual feedback during literacy activities.

ASHA 03DynaVox Systems LLC (S. Williams

Semantics

The understanding of words and how they relate to one another.

Poor Communicators:

• experience deficits in this area.• do not play a part in the selection of

vocabulary.• do not receive visual and auditory

feedback as they make selections on an AAC device.

• do not have access to new words to demonstrate vocabulary development.

Solutions:

• Provide access to dictionary pages (can be low or high tech).

• Allow the student to participate in the selection of vocabulary.

• Provide access to new vocabulary - even if they don’t know the words yet.

• Encourage curiosity about language.

Morphology

The rules for building and changing words.

Poor Communicators:

• experience deficits in this area.• lack access to the word forms they

need to demonstrate morphological awareness.

• choose efficiency over accuracy to increase the speed of communication.

Solutions:

• Provide access to the vocabulary the user needs to make necessary morphological changes.

• Encourage the user to choose morphological accuracy over speed

Pragmatics

The rules for using language contextually for social purposes such as conversation.

Poor Communicators:

• do not take an equal role in conversations.

• tend to take obligatory turns but tend to forfeit his/her nonobligatory turns.

• are considered to be passive communicators.

• have difficulty maintaining a topic in conversation.

Solutions:

• Select and organize vocabulary that will allow the student to interact in conversations (comments, social etiquette, turn taking vocabulary, vocabulary to appropriately initiate, maintain, and terminate conversations).

• Provide access to additional vocabulary on a wide range of topics.

Beukelman, D. And Mirenda, P.

Creating Interactive Comboards

• Key vocabulary• Driving vocabulary (beginning, middle,

ending words)• Directive Vocabulary• Interactive vocabulary• Commenting vocabulary• Exiting vocabulary

Creating Interactive Communication Boards

• Observe typical kids; what do they say; what do they need to hear to interact?

• Include words the student does NOT know; he/she will learn them by exposure to them.

• Include descriptors, comments• Each communication board is specific

to a particular environment.

Vocabulary Selection

• Interview

• Observation

• Scripting - handout

• Standard vocabulary lists (examples)

# Mattson

(2006)

Gray

(2006)

Deffner & Johnson(2004)

Beukel-man et al.(1984)

1 I I It I

2 It It I To

3 You The A You

4 The You The The

5 Do A And A

6 To That You It

7 That Do Do My

8 A To That And

9 One What We In

10 Is Have To Is

Core Vocabulary – Research

Core Vocabulary Fringe Vocabulary

Social

Request

Describe

Question

Direct

Give Information

Language Functions

Core versus Fringe Vocabulary

• Core - highly functional words and phrases typically beginning with items related to basic functional needs, brief social exchanges, and other information necessary across most environments

• Fringe - words are particularly content-rich, topic-related, and specific to particular individuals, activities, and/or environments

Level 1 Core and Fringe Vocabulary

Level 2

Level 3

Level 6

Spelling/Text Based

• Some systems are text/spelling based• Magnetic letters• Alphabet boards (manual)• Keyboards/computers• NEO/AlphaSmart, Dynawrite, LightWriter• With or without auditory feedback• Be sure to look at CONTENT of

messages – are they really communicating?

Communication: Where does it fit into my day?• Break into 5 groups (count off by 5s)• Each group go to a numbered easel• List 3 activities you do in your

classroom and the communication requirements for each activity (what does the student need to SAY?)

• Add the supports in the final column (what communication modes/strategies do the students use to get through the activity)

Discussion

• What’s working?• What’s not working?• Where are the gaps?• Are all students being successful?

(meeting their communication goals?)

Individual day Mapping

• Using the same format, map your classroom schedule

Assessment

• What tools are you currently using to assess communication skills?

• What about LANGUAGE skills?– Language structure (syntax/grammar)– Meaning (semantics)– Social language (pragmatics)

• How do you determine a baseline in order to write valid goals for communication (receptive and expressive)?

Framework for assessment

• What’s working? What’s not working?

• Begins with consideration• Do we need to consider a

mode/strategy other than what is currently being used?

• Assessment should be a collaborative process (team)

Assessment framework

• Gather relevant information• Pinpoint areas of difficulty• Discuss POSSIBLE solutions, including

those already in place• Set up trials and Team Action Plan

– Implementation– Support– Data collection

Assessment….

• Review information gathered• Make changes as necessary• Team consensus on tools/strategies to be

used• Acquire tools if necessary• Revise implementation plan• Supports needed? • Revise IEP if necessary• Ongoing, dynamic process – back to

CONSIDERATION!

What information do we need?

• The Student • What does the Student need to do? • What are the Student's special

needs? • What are the Student's current

abilities?• This is where you “plug in” formal

assessment information

Information…

• The Environment• What materials and equipment are

currently available in the environment? • What is the physical arrangement? • Are there special concerns? • What is the instructional arrangement? • Are there likely to be changes? • What supports are available to the

student? • What resources are available to the people

supporting the student?

Information….

• The Tasks• What activities take place in the environment? • What activities support the student's

curriculum? • What are the critical elements of the

activities? • How might the activities be modified to

accommodate the student's special needs? • How might technology support the student's

active participation in those activities?

Information…

• The Tools• What no tech, low tech, and high tech

options should be considered when developing a system for a student with these needs and abilities doing these tasks in these environments?

• What strategies might be used to invite increased student performance?

• How might these tools be tried out with the student in the customary environments in which they will be used?

Team Members and Roles

• General considerations:– Assessment should be a collaborative

process– Each team member brings important

information and perspectives to the table

– Each team member has specific skills and knowledge that are important to a thorough assessment process

The Team • Responsibilities should be

determined at the outset (who does what ?Data collection? Creation of modifications/programming if necessary?

• Who is on “the team”?

• Can vary from situation to situation

• Communication issues:

– Speech Language Therapist

• Formal language testing• Informal assessment and

observation• General knowledge of

alternate tools and strategies

– Teacher• Environmental

observation• Curricular needs• Other pertinent

assessment info (reading, math, writing, etc)

– IA• Knowledge of

student and tasks– Parent

• Knowledge of student

• Different perspective

Team– Parent

• Knowledge of student• Different perspective

– Psychologist• Formal cognitive assessment information• Behavioral issues

– OT• Access issues if needed• Sensory issues

– Vision, hearing etc• Symbol selection• Auditory feedback

– Review of outside assessment information

Data Driven Decision Making

• Baseline with current mode/strategy/tool• Data collection with trial strategies/tools• Determine activities for data collection

– “use the new thing in the old activity”– Student should know the routine of the

activity you choose– Data is OBJECTIVE and will determine the

next step

Implementation

• Need a plan • Staff Responsibilities

– Who needs training?– Who will do programming?– Who will create overlays/boards/symbols?– Who will collect data?– Who will charge device (if needed)?– Where will device and any related items be

physically located?– Will the device travel home every night?– Who will be responsible for making sure the

device goes home?

Implementation

• What vocabulary/messages are required to meet communication needs?

• During which activities?• Communication partner training

IEP

• Consideration page• Present ed levels drive goals

– Baseline– Assessment information

• Where does it fit?• Goals – what should they look like• SDI• Related services

Who you gonna call???

• Consideration• Call for support IF:

– Team cannot make knowledgeable decisions– Team needs more information to move ahead– Team has tried everything!– Team cannot come to consensus– Can call AT Consultants for general consultation to

classroom – does NOT need to be a FORMAL assessment process

– AT consult is NOT only vocal output - assistance with activities, strategies, setup, engineering the classroom, etc.

– DOES NOT HAVE TO BE STUDENT SPECIFIC!

Sample goals

• S will independently request 3 needed items during a variety of classroom activities, 4/5 times, during 3 consecutive weekly trials

• S will independently request 3 needed items during a variety of classroom activities, 4/5 times, during 3 consecutive weekly trials using a single message vocal output device