First, if you have a student with a communication disability, do not treat them any differently than other students. We have more in common with the other students than you may think we do. This also includes playing favorites. Not only is it unfair to the other students, it also embarrasses us. We are different already, we don’t need more attention.

Encourage us – just as you should do with any other student. I have had teachers in high school tell me that they didn’t think I would make it in college. Five years and a Bachelors of Science degree later, those memories are still with me today. You don’t want to be that teacher, do you?

Finally, you should give the student as much independence as possible. In high school, my aide was glued to my hip all day, every day. Not only did it prevent me from making friends (nobody wanted to talk to the girl with the adult around), it did not help me prepare for college whatsoever. At college I only had an aide come four times a day. So, please, if you take one thing from this blog post, please help your student become more independent!

 When I ask people to describe a particular student with autism that may be on their caseload or in their classroom, I often hear about the student’s challenges. I might hear about the fact that the student isn’t motivated to learn or that they have significant behavior challenges.  While I recognize (and respect) that these challenges are very real, I long to hear about the student’s amazing sense of direction or about how they are really good at following the steps in a sequence.  Those who work in the school setting are faced with juggling students with diverse needs and abilities.  There never seems to be enough time or support to get things done.  It can be very easy to slip into the swamp of negativity.  

I started a new job several years ago.  It was a completely new role for me and required me to move across the county to a new city where I didn’t know a single person.  I can definitely say that I was outside of my comfort zone.  I remember sitting at a coffee shop talking on the phone with the phone company trying to get my internet set up (You can’t start a new job without internet!!).  The stress must have been written all over my face.  I’m sure the woman sitting next to me overheard most of the conversation.  When she walked by to leave, she placed a Post-it note on my table.  It simply read, “Don’t sweat the small stuff.  This too shall pass.”  To quote Oprah, I had an “aha moment.”  From that moment on, I decided not to worry about all of the potential challenges I might face with the new job, I decided to focus on the positive and to use my strengths to get me through the challenges.  I jumped in and did what needed to be done and didn’t allow myself to become overwhelmed by the things that didn’t really matter.  I am happy to report that the job experience was one of the best I’ve ever had and I learned to be a positive thinker. 

By applying these same strategies when working with students on the ASD spectrum, we can begin to focus on their strengths instead of their challenges.  While skills and abilities vary from student to student, it is important to think about the fact that many students with autism understand concrete concepts, rules and sequences very well.  They also often think in a visual way and are able to recall visual images and memories easily.   In addition, they can typically understand context specific language (language that can be directly related to an experience) and be extremely focused during pleasurable tasks.  These students can also understand better when he sees something vs. hear it (Thank goodness for visual supports!).

If you really think about it, it is the strengths of our students that can lead us to a solution to the challenge.  For example, if the student is not motivated to participate in social interaction with others (challenge), but is really good with following a routine (strength) then we can potentially address the challenge by making the social interaction with others a part of the routine (solution). 

You’ve probably heard the saying “it takes way more facial muscles to frown than it does to smile.”  Well I believe that it takes way more energy to “admire the problem” than to think positively and come up with solutions.  Try to follow every challenge statement with a strength statement.   By focusing on the strengths of the students we are promoting a positive communication and learning environment.  And don’t forget to repeatedly tell your students about their strengths (ex., “Wow, Jill.  You are really good at following directions!”).  

For more information about the strengths and solutions for students with autism, watch the Behavioral Supports for Individuals with Autism video  on the DynaVox Implementation Toolkit.  This video will highlight some of the strengths and characteristics often demonstrated by students with autism. 

For a nice list of Strengths Related to Autism Spectrum Disorders, visit http://www.ct-asrc.org/docs/strengths.pdf. 

Download FREE visual supports (and thousands of other communication/learning boards) at BoardmakerShare.com.  

To learn more about promoting positive communication environments, visit the Communication Partner Techniques Learning Path  on the Implementation Toolkit.

Previously, we discussed basic visual characteristics of AAC that might be considered during the evaluation process for both light-tech and high-tech AAC when an individual demonstrates visual perception problems.  I shared how these visual characteristics are reflected in DynaVox products and potential modifications to these characteristics which might be applied based on the needs of the individual.   

Below, I will discuss a few of the specific visual issues we might see in individuals following neurological event and some practical methods of addressing them. 

Note:  Consult your physician regarding diagnosis of visual issues following a neurological event.  Consult your medical/clinical supports (physician, speech-language pathologist and/or occupational therapist) and to assist you in selecting compensatory strategies. 

 Visual Field Cut – Inability to see portions of the typical range of vision (e.g., various degrees of loss of peripheral vision, loss of half the visual field).  An augmented communicator may not see a portion of the book, board or device. 

• Position the device within the useful visual field. 
• If the entire device cannot be placed within the visual field, consider using the portion of the screen within the visual field for content. 
• If appropriate, teach the individual to compensate for the visual field cut by moving his head to scan the entire screen (see additional ideas in “Visual Neglect” below). 

Visual Neglect – Decreased attention to or awareness of one portion of the visual range.  If a left visual neglect is identified, the individual may not be aware of what is entering, present in or leaving his visual field on that side.  When using AAC, he may not attend to vocabulary on the left side of the screen.   

• Place a colorful strip of paper or tape down the side of the device (on the device casing, not on the screen!).  Cue the individual to look all the way over until he sees the line.
   
• If additional assistance is required to remind the individuals to which direction to look, you could add an arrow pointing the appropriate direction as well.   
• Strategies related to Visual Field Cuts may also be beneficial based on the individual’s level of awareness of his deficit. 

Rancho Los Amigos National Rehabilitation Center has a useful handout describing Visual Neglect and Visual Field Cuts available at http://www.rancho.org/ot0033.pdf. 

Involuntary Eye Movement (Nystagmus) – Repeated, uncontrolled movement horizontally or vertically which may affect vision.  

• Politano & Scharre (reference below) suggest that “many patients experience an area within their visual field where the nystagmoid movement is decreased” (called a null point) and to “consider null point when determining optimal position for the display.”

 Double Vision 

• Some patients with double vision have indicated to me that larger type and/or images that are not as visually complex are easier for them to discriminate and use.  Ask the individual to share her preferences with you by showing two or more options and asking which is better.  I would encourage you to provide a way for the person to indicate that they are the same as well.   

Decreased Visual Acuity – Reductions in the clearness of vision. 

• Consider larger targets and less complex visual displays (see previous blog).  
• Use the Zoom feature in the V/Vmax and Xpress which increases the size of an area around a point you select based on the criteria you set (e.g., percent increase, etc.).   Read more about this feature in the Knowledge Base by typing in “zoom” and selecting the device that you have.
  
  

 The suggestions above have focused on providing compensatory strategies to make use of visual skills.  It should be noted that visual representation of language which is used most frequently in AAC can be supplemented with auditory feedback as well.  

As we age, many of us experience changes in our vision (as well as many other things!).  Each time we pull out our reading glasses, ask someone else to read something to us or realize that our arms just aren’t long enough, we realize the importance of our vision and the effect that vision has in functioning during daily activities.  

Neurological events can result in visual issues.  It is important that these are effectively diagnosed and treated regardless of the individual’s communication status.  However, it is essential for those who use AAC which typically represents language visually.  

Reference:

Politano, P. & Scharre, J. (n.d.).  Functional Vision Skills for AAC Systems.  Retrieved from http://tigger.uic.edu/~politano/VISION_FOR_AAC.htm  on April 30, 2010.

As he did so, I began to think, “I wonder what accom…”  It was there that I stopped myself.  I was about to say, “I wonder what accommodations he will need for participating.”  I was including all physical aspects of playing baseball in my thought process – batting, throwing and catching the ball as well as running.  I stopped myself because I realized, much to my dismay, that I was making a judgment about this young man’s ability in baseball overall based on what might be a challenge in one area (running).  I had no way of knowing if his orthopedic issue would affect his batting, throwing or catching.  Maybe he is a home run hitter – the next Albert Pujols (who was the home run leader in 2009)!  Maybe he has an incredible arm and will be the youngest person ever to break into the 100 mph club!  The point is that he will never show his full potential if those around him place a cap on their expectations of him assuming the need for accommodation or, even worse, assuming inability. 

This caused me to consider the effect of expectations on students with communication impairments.  Judgments are made about their abilities to understand language, enjoy social interactions, participate and succeed in academic activities because of difficulty in one area – communication.   Just as the presence of an orthopedic impairment does not negate one’s ability to play baseball, the presence of communication impairment does not negate one’s ability to perform academically. 

 In 1985, Donnellan suggested that educational decisions be made based on the “criterion of the Least Dangerous Assumption” which she defines as follows. 

The criterion of Least Dangerous Assumption holds that in the absence of conclusive data, educational decisions ought to be based on assumptions which, if incorrect, will have the least dangerous effect on the likelihood that students will be able to function independently as adults.    

Donnellan, A. (1984). The criterion of the least dangerous assumption. Behavioral Disorders, 9, 141-150. 

Using this criterion, we can say that there is no conclusive data saying that the baseball-playing boy will need accommodations.  If he is ever going to grow up to play baseball independently with other adults, he needs the opportunity to play and play as independently as possible now.  

Following the same logic, there is no conclusive data that students with severe communication impairments cannot perform academically.  There is, however, danger in not providing the opportunity for them to do so in that they will not learn the skills needed to function independently as adults.  Therefore, the “least dangerous assumption” would say that we need to provide opportunities for such performance to take place and expect it to occur. 

My initial expectations of the young man at the park district would have limited his opportunity to demonstrate his capabilities.  What effect are your expectations having on your students with severe communication impairments? 

For more information on the “Least Dangerous Assumption”, review the Article-at-a-Glance at in the Articles-at-a-Glance Learning Path on DynaVox’s Implementation Toolkit.

Of course looking dapper is a good tool when you are trying to attract the opposite sex. I have received a lot of advice that I need to be wearing the right designer wear clothes and apparel if I am going to attract the right kind of person. However, I still have this philosophy that it is more important to show that you a genuine person than being dapper at a hot nightclub. I have heard the saying many times that you will never find your spouse at a nightclub and I pretty much agree with that statement. At most of the clubs I have gone to there is the unmentioned assumed contest of who looks the coolest in their outfit and I am most often at a noticeable disadvantage. 

What I found out in my mature age, I am a few months away from thirty, is that being dapper is not the end-all for being attractive. I had more success with women showing my intelligence and artistic ability than I ever had with only being dapper. These women liked me not for my outer appearance but because of who I was as a person. I think that is a value we should remember as people with physical disabilities – that while we may have challenges attracting people purely based on our looks, the people that we do attract will hopefully like us because the caliber of our character as people.

I write all my talks on my PC. Some AAC users might use their device to write, but for me it’s easier to write on my PC. I’m a Linux user so I use OpenOffice for my word processor. I have an editor who looks over what I’ve written, checks my grammar and spelling, and cleans up each of the many drafts as I go. Although it is my own words as much as possible, it is always my own thoughts. Then when I am close to being done, my editor will ask me if I meant to say this or that, or he’ll suggest more things to put in, or rearrange things for better flow – with my permission of course. My editor likes to keep some of my strange grammar or word or phrase usage in the final version because he thinks it better reflects my unique “dialect” or accent. So when something sounds a little strange, it’s usually because we left it that way on purpose.

Since we have a home computer network with a file server, that’s where I save my files. My editor can see what I wrote from his PC, I give him file permissions so he can edit my work over the network, and we go back and forth that way. For instance, if I add things to a talk or this blog, he can look at what I wrote from his PC, or if he changes some things then I can look at it from my PC, because we both have access to the file server from our own PCs. And we use Instant Messenger to talk back and forth while I write my talk or we edit because we are in different rooms.

Then for a talk or a presentation, I put the final file on my Vmax.  I also print out a copy of the file for my editor to mark up. Then I play it to see how it sounds and my editor notes any changes we want to make as he listens to the presentation. We want to make sure it sounds as natural as possible when spoken. That’s because it sounds different on a device than if someone speaks it. To get it right we usually have to work on changing punctuation, and sometimes we have to misspell words or replace them with better sounding words or phrases. For example, the word “and” has to be changed in some places to “andd”. I usually have to add more commas and periods in some places. One trick we have discovered is to put two commas in places, to ensure that the device pauses long enough where it should.

I discovered that the Vmax is sensitive to the kind of file types it can import for speaking so I use Open Office and save the document as a Text Encoded file.   Sometimes the device doesn’t say words correctly, and I have to work around the particular speech synthesizer’s quirks.  For instance, the word “blog”. Either you have to capitalize the “B” or you have to go into the punctuation exceptions and misspell it in lower case as “bhlog”. With some words the device spells the words instead of saying them so we try capitalizing the first letter of a word to get the device to at least try to pronounce it.

Those are just some of the tricks we use to get the presentation to sound right. We do this “Listen and Change” process as many as ten times or more to get it to sound right. I look at the printed copy of the file my editor has marked up during the listening session and I put those corrections back into my copy in the word processor on my PC and the file server, and then I copy that corrected version back to the Vmax. It sounds complicated, but it is easier for me to do it that way.

After I have my file finished and loaded, I present it using a special page I made just for talks or presentations. On it I have a big button to speak either a sentence or a paragraph at a time. It’s very large so I don’t have to look at my device instead of looking at the audience. And I also have fourteen other medium-sized buttons for editing and other uses, such as to go back to a previous paragraph, or go forward to a next paragraph or moving between words and lines. I have a link button to go back to my main keyboard page just to fix a word if we are listening to my talk. I have a button to load my talks from files. I have a button that says “Hi, can everyone hear me ok?” and another that says “Please have your questions ready, I will answer them when I am done with my talk.” And another that says “If you cannot understand my device, please feel free to interrupt me, so I can repeat it.”

With someone with developmental and cognitive disabilities like me, we often have a very hard time with grammar and punctuation rules. And there are other challenges: I still don’t get or understand some things, which means someone might have to explain something I don’t understand, in terms that I can understand. In the same way, sometimes I also have a difficult time getting what I’m thinking down into what I want to write. It’s like my brain uses a different language. I know what I am thinking, but I have to translate that into words that the world can understand. At those times, my editor has to ask me what I meant and then I have to think about it, and it might take a minute or it could take me weeks to explain it in my own words.

The system I use for writing works to help me overcome some of the ways being developmentally and cognitively disabled affects my thought processes. Some people don’t know the extent of my disabilities because of how I have learned to adapt to my disabilities, so they treat me as normal, which they should. But hopefully, if they get to know me long enough, they should start to notice that I am not “normal” and they also will adapt to my cognitive delays when they interact with me, and take me as I am.

Support learning and communication
Collaborate with others on the educational team
Have a plan
Opportunities all the time
Offer help when needed
Learn your student’s AAC device

 Support learning and communication

Make sure that you create a positive communication environment and set high expectation for your students.  This will help you focus on the positive outcomes of AAC and encourage more and better communication.

Collaborate with others on the educational team

The old African Proverb that says that it takes a village to raise a child is especially true when working with students with special needs.  Good AAC intervention cannot be done by one person, so share your successes and challenges with other team members.  Work together as a team to build success. 

Have a plan

Make a plan and stick to it! Know when, where, why and how the device will be used throughout the day.  Here are a few resources that might help.

• Dynamic AAC Goal Grid
• AAC Needs Assessment
• Selecting Activities Worksheet  

Opportunities all the time

In order for AAC users to become proficient communicators, they must have opportunities to practice their skills.  Planning will help identify opportunities throughout the day.  See the resources listed above. 

Offer help when needed

It’s OK to help AAC users when they get stuck.  Make sure to use the Chain of Cues to encourage independent communication and reduce the probability of prompt dependency.   Visit DynaVox’s Implementation Toolkit to learn more about the Chain of Cues.  

Learn your student’s AAC device

You must become familiar with the content in your students’ devices in order for you to teach appropriate use.  If you don’t know where the vocabulary is located then you can’t help your students when they get stuck.

Luckily for me, I found a way to still be funny. Using my DynaVox V and the Internet I am able to download humorous sound bites and movies quotes, which I can use at appropriate times. For instance, nothing can break the ice better at the doctor’s office than hitting them with Bugs Bunny’s famous line “Aah! What’s up doc?” when he or she walks into the room.  This usually brings a smile to their face. 

When I am playing cards, I have a number of Homer Simpson’s quotes that I like to use. When I get beat in a hand, I usually give them a “Doh” and when I win it’s a “Woohoo”. If someone is not a Simpson’s fan, there are plenty more that I have in my arsenal of one-liners. 

Not only are these funny quotes good for daily life, but such humor can also be a tool. I use a lot of quotes during presentations at conferences. Nothing breaks up the monotony of a long speech than some humor. I always end my presentations in the same way – with Porky Pig saying, “That’s all folks!” This always brings down the house. 

Laughter is the best medicine. Not only does making people laugh break the ice, but I think that it makes people more comfortable.  When people are comfortable they tend to see past your disability and see the real you. For those of you interested in where I get most of my funny quotes, there are two websites that I suggest you check out, http://www.moviewavs.com/ and http://www.wavlist.com/. Here you can search hundreds of movies and TV shows for your favorite quotes and download them for free. I hope that you get as big of a kick out of some of them as I do.

If the learning experience is boring and without purpose, a loss of interest will quickly set in. In my previous blog, Success in AAC is Listening to Consumer’s Ideas, I told how I thought my arm brace was a waste of time when I was a child. I also didn’t appreciate physical therapy painfully stretching my legs. It was meaningless to me. While one leg was held down on a mat and the other one being raised up to a 45-degree angle, I vividly remember my therapist saying, “Pretend that you are climbing a curb.” It is lucky that I couldn’t talk because under my breath I was saying to myself, “She is really pulling my leg – in more than one way – for I know that no curb is that high!” Kids are smart! There must be a sense of purpose in learning something like using my leg braces to do stand up exercises after touching my toes that could have led towards a goal of my walking.

To translate this in reference to AAC I needed a purpose such as my being employed as an art therapist in 1994 to feel the need to use a device. Previously, I thought that having a job was impossibility because few people could understand my natural speech. Now, I go way beyond my imagination in working full-time aside from having a ministry to preach in churches. I am having a blast in life!

Therefore, communicating on a speaking device must be fun and fulfilling. Avoid making an AAC user say something on his/his device that is common knowledge and can be understood. The message must be motivating. Know that a child will talk differently to his peers than to his teacher. A teenager may want to speak sweet nothings to a sweetheart. Obtaining employment and increasing job skills are motivating factors for adults in using an AAC system to be successful.

Find ways that a user can play games with other kids by using a communication system. Although teaching children is not my expertise, I start out by pressing buttons to sing songs on my DynaVox Vmax that comes with a Media Player. I encourage others to do the same. It is a wonderful way to learn interactively. There are many more features on the V and Vmax that promote access, including the eBook Reader, taking pictures with a camera, email and text messaging. And of course, because of its Internet capabilities, unlimited fun activities are accessible.

 So, the learning experience with DynaVox products should be fun and interesting, ultimately leading to effective communication.

 This used to happen to me a lot, and for a while I didn’t understand it.  Some strangers don’t bother me at all; most strangers don’t bother me at all.  But every once in a while, That Person comes around; the one with eyes that you can actually feel as they look at you.  The one that you can just feel was there to validate his own views rather than to learn from the moment.  That Person!  And you can’t say anything because That Person had made no contact with you at all, so all you have is this totally unjustified feeling.

 I found a simple solution.  Just go over and introduce yourself.  Say, “Hi,” and welcome that person.  Find a way to connect with them, and before you know it, you can relax.  Either that or they expose themselves as a jerk and you can still relax.  You took charge of the situation so you can just continue with what you were doing knowing that this person’s thoughts or views are only their opinion, nothing more.

Doing this a few times actually prevents that feeling from even starting because it builds up your own self confidence.  Then, you become That Person who is fully in charge.  And when people see it, you no longer feel like people are questioning you.  When you communicate the person you really are everything else just flows.

Tags: cerebral palsy, communication, self-confidence