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SO....HOW DO YOU DEVELOP A FUNCTIONAL COMMUNICATION SYSTEM FOR A CHILD WITH SIGNIFICANT SPEECH AND PHYSICAL IMPAIRMENTS ANYWAY?

Cynthia A. Cottier, M.A., M.Ed.
Augmentative Communication Therapies
P.O. Box 2184
Arcadia, CA 91077
phone/fax: (626) 351-5402
email: cacottier@aol.com

Jill Tullman, M.A., M.S.
Augmentative Communication Therapies
P.O. Box 2184
Arcadia, CA 91077
phone/fax: (626) 351-5402
email: debubbs@sprynet.com

All too often, when a child receive a voice output communication device, the adults involved in his support systems expect him to spontaneously know how to use the device and to immediately be able to independently communicate his needs, thoughts and wants, as well as to participate in the class and answer questions.

This not only occurs when the augmentative communication device comes with application programs where vocabulary is preprogrammed, but also when the device comes with blank overlays which needs to be customized for the child. Unfortunately, little thought is given to the training process that is necessary to provide the child with the fundamental skills needed to utilize the augmentative device effectively or the vocabulary that will be most effective for the child. It is often forgotten that a multitude of skills are necessary for a child who uses augmentative communication methods to demonstrate communication competence.

The lack of planning and training when developing light tech systems occurs as well. In addition, professionals frequently neglect how no tech or light tech systems can be used as stepping stones while the child learns the fundamental skills necessary to communicate through augmentative means. At other times, the child may have an elaborate light tech communication system consisting of multiple pages of symbols; however, use of a voice output communication device may not be explored, or if they are explored, high end augmentative communication devices may not be considered because they are felt to be too expensive, too cumbersome, and/or too difficult to use.

Clearly, all options need to be explored and the development of a functional, multimodality communication device is necessary. But how will the various modalities function together and how is the appropriate vocabulary identified? J., a 6 year old boy who is diagnosed with cerebral palsy which severely affects his ability to speak and to access augmentative communication devices, is an excellent example of how a multimodality system can be constructed and how core vocabulary is selected.

Unfortunately, as with many children, J. was not provided with any forms of communication until he was 6 years of age. He has intact vision and hearing, but his physical difficulties restricts J.'s motor movements so that he is unable to directly access technology. Clearly, three objectives are of immediately concern for a child such as J.: 1) construct a multimodality communication system as quickly as possible; 2) identify and select core vocabulary, as well as auxiliary vocabulary; and, 3) train both J. and his support staff to use his augmentative communication systems efficiently and to incorporate his system into his life at home and at school.

As stated above, the first objective is to develop a reliable communication system for J. Secondary to the lack of technology provided prior to this time in his life, J. has learned, through necessity, to rely on eye gaze to express himself. However, this system is not universally understood and significantly restricted his communication potential. As has long been promoted as appropriate as best practices in the field of augmentative communication, it is clear that a multimodality communication system needs to be constructed for J. The resulting system includes not only his eye gaze system but also a high tech communication device as well as a light tech communication book and single message voice output communication systems. Each of these augmentative communication systems is necessary to allow J. to participate in all situations at home and at school. Initially, light tech options have been utilized to provide for an immediate way for J. to express himself while he learns not only the symbolic representations being used but also the corresponding vocabulary that is incorporated into his high tech device. In addition, the light tech options are necessary for J. while he is developing the ability to use a single switch accurately with auditory and visual scanning. In addition, the use of light tech is a faster and more immediate way to provide for quick communication in the classroom at these early stages.

The second objective in developing J.'s communication system is to identify the appropriate vocabulary. It is critical to provide J. with a core vocabulary on his voice output communication systems that is meaningful and motivating for J. In addition, the core vocabulary needs to be relevant for use across all environments. Various ways of identifying core vocabulary, and auxiliary vocabulary, for each environment and individual has been used including environmental analysis and surveying the individuals within the environment. The selection of vocabulary for J. resulted in the identification of the core vocabulary for daily needs as well as auxiliary vocabulary for academic participation and quick communication in the classroom. It is also important to remember that J. needs to be provided with instruction in not only how to use the presented vocabulary but also to develop his comprehension of the vocabulary itself.

The final objective is to develop a collaborative process involving the augmentative communication clinician, the family, the school team and other related therapists. Although a collaborative approach is critical, it is often overlooked. With J., it is felt that the collaboration between all members of the support team and the "buy in" from the onset, were critical elements that contributed to the success of his augmentative communication system.

Without attention to all of these areas when developing an augmentative communication system, the potential for success is decreased. The purpose of this session was to provide examples and information on all of these issues so that more young children with severe speech and physical impairments may experience the success that J. experienced.

REFERENCES

Beukelman, D., McGinnis, J., & Morrow, D. (1991). Vocabulary selection in augmentative and alternative communication. Augmentative and Alternative Communication, 7, 171-185.

Beukelman, D. R., Jones, R. S., & Rowan, M. (1989). Frequency of word usage by nondisabled peers in integrated preschool classrooms. Augmentative and Alternative Communication, 5, 243- 248.

Blackstone, S. W. (1988). Vocabulary selection: Current practices and a glimpse at the future. Augmentative Communication News, 1(5), 1-5.

Carlson, F. (1981). A format for selecting vocabulary for the non-speaking child. Language, Speech, and Hearing Services in Schools, 12, 240-245.

Cottier, C., Doyle, M., & Gilworth, K. (1997). Functional aac intervention: a team approach. Bisbee, Arizona, Imaginart.

Fried-Oken, M., & Moore, L. (1992). An initial vocabulary for non-speaking preschool children based on developmental and environmental language sources. Augmentative and Alternative Communication, 8, 41-56.

Fried-Oken, M., & Stuart, S. (1992). A few selected words about word selection: Vocabulary issues in AAC. In D.J. Gardner- Bonneau (Ed.), The Second ISAAC Research Symposium in Augmentative and Alternative Communication, (pp. 68-78). Philadelphia: ISAAC.

Marvin, C. A., Beukelman, D. R., & Bilyeu, D. (1994a). Vocabulary-use patterns in preschool children: Effects of context and time sampling. Augmentative and Alternative Communication, 10, 224-236.

Marvin, C. A., Beukelman, D. R., Brockhaus, J., & Kast, L. (1994b). "What are you talking about?": Semantic analysis of preschool children's conversational topics in home and preschool settings. Augmentative and Alternative Communication, 10, 75-85.

Yorkston, K. M., Honsinger, M. J., Dowden, P. A., & Marriner, N. (1989). Vocabulary selection: A case report. Augmentative and Alternative Communication, 5, 101-107.


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