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Toni Solano, M.B.A. and Sonia K. Aller, Ph.D.
University of Southern California University Affiliated Program
Childrens Hospital Los Angeles
PO Box 54700, MS#53
Los Angeles, CA 90054-0700
The contents of this paper were funded through a grant from the U.S. Department of Education Office of Special Education and Rehabilitative Services, Grant Number H029K970124, Sonia K. Aller, Ph.D., principal investigator. However, these contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the Federal Government.Definitions
The Individuals with Disabilities Education Act (20 U.S.C. Sec. 1401) defines an assistive technology device as:
"...any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability."
Purpose of AT for Children Ages Birth through Five
Children have a function in life, very different from that of adults. While the function of adults may be to live independently in society, the function of young children is to grow, learn and develop so they may eventually live independently in society. Disabilities may impede this process.
Assistive technology, or AT, can give a child the means to access developmentally appropriate experiences they would not otherwise have because of their disabilities. It can also prevent secondary disabilities from occurring.
For example, a child who does not have the ability to crawl may be left in a crib in a bedroom, rather than exploring the house as a nondisabled child might. The child not only misses social interactions with household members gathered elsewhere in the house, but misses learning any number of cause-and-effect events around the house. Thus unengaged, the child's cognitive functionality may also become impaired. The child may not pursue play if they learn they cannot retrieve a toy car that rolls away from them. They may in fact learn to be helpless. A scooterboard may have remedied the initial mobility issue, prevented the cognitive dysfunction and learned helplessness, and enabled play.An Underserved Population
Infants and young children have been identified by NIDRR as an underserved population. One reason may be that the "functional capabilities" of the very young have not been closely examined in light of what AT may offer. It is easy to imagine a prosthetic device enabling an adult injured in a car accident to return to work. It is not as easy to imagine the functional capabilities AT would provide to a baby seven months old with global developmental delays.
However, independence and social competence do not arise full-blown at adulthood. They arise out of a complex, tightly interwoven physiological and experiential process of genetics, biology and experience-based maturation (Schorr, 1996) beginning at and before birth. Children are genetically and biologically endowed with developmental capacities in six major domains: cognition, language, gross motor, fine motor, social-emotional and self-help (HELP (R), 1997). These capacities enable the very young to experience their own selves, their environment and the people in them. As we have seen in the example above, acquisition of individual skills in each of these domains takes on added importance not just because the capability itself is immediately useful to the child, but because the integration of those skills across domains serves as a foundation that gives rise to higher level competence and independence. Conversely, there are repercussions beyond the primary area of disability in that the child's opportunities for experiential learning, and subsequent development of functional capability in one or more domains may be impaired.
Assistive technology allows the child to access experiences which lead to acquisition of functional capabilities in the following sequence.
1. Sensory Modulation, Interaction with Persons, Interaction with Physical Environment, Access to Choice. Assistive technology can modulate the quantity and quality of environmental information the child senses. It can enable a child to interact with people and explore and manipulate their physical environment. Assistive technology can enable a child to make or communicate choices: who they want to hold them, what toy they want to play with, what food they want to eat.
2. Enhanced Attention, Enhanced Relationships, Enhanced Mastery of Objects and Space, Enhanced Decision-Making. As children encounter the world, they learn from their experiences and build on their learning.
3. Self Regulation, Secure Attachments, Self Efficacy, Self Determination. Children bring their evolving mastery of themselves and their environment to new encounters and new experiences.
4. Social Competence and Independence. This spiral of encounter, learning and mastery results in social competence and independence.
In explaining cognitive development, Piaget described this evolving spiral of chance encounter, purposeful encounter, learning and mastery in early childhood as a series of "circular reactions" and schemata (Piaget, 1952). While circular reactions have been long observed, only recently have their origins in neurobiology been uncovered.
A Neurological Basis for Development
An infant is born with approximately 100 billion brain cells, or neurons, most of them unconnected to each other. Early childhood experiences, education and other interventions, close parental relationships and their own genetic and biological makeup cause infants' neurons to grow fibers called dendrites. Dendrites enable connections with other neurons at points called synapses. Synapses enable different parts of the brain to "talk" to each other. Generally speaking, the more dendrites there are, the more synaptic connections there can be and the better able the neurologic system to process information. In this way, dendrites and synapses are the neurological building blocks of growth and development. If experiences are repeated well and often enough, the dendrites used in processing that information will become permanent and encourage more synaptic growth. If not, the dendrites wither and the synapses are lost. For a child whose disabilities make access to the environment difficult, repeated enriching experiences may not be possible, thus making adequate repeated stimulation of certain synapses impossible. As the synapses disappear, so do the child's opportunities for growth and development.
In developmental terms, children who because of their disabilities miss acquiring foundational skills do not develop a foundation for learning higher level concepts. Furthermore, research shows that in the first decade of life before puberty there are critical times for optimal development of specific types of learning. If a child does not experience the necessary stimulation to acquire this learning according to this timetable, neurological capacity may be forever impeded. (Shore, 1996). The implications for assistive technology for infants and young children are clear. "Technology can function as a prosthetic device to mimic the earliest experiences of secondary circular reactions." (Sullivan and Lewis, 1993, Brinker, 1982).Examples of AT Applications
Following are examples of AT devices for specific applications.
To dress, a child may use Velcro (R) closures rather than buttons or zippers. To eat, a child may used a modified spoon or plate. For toileting, a child may use an adapted toilet seat.
To see, a child may use glasses, speech recognition software or a typoscope. To hear, a child may use hearing aids or a sign language interpreter.
To solve puzzles and problems, a child may use specialized software, adapted toys or touch screens. To play, a child may use switch-adapted toys, appropriate off-the-shelf toys or Dycem (a thin sticky mat to keep things temporarily affixed in place).
To communicate, a child may use picture boards, PECS, CheapTalk or DynaMite. To understand & follow directions, a child may use activity sequence boards. To remember, a child may use picture boards or an agenda book.
To write or draw, a child may use adapted crayons, a slant board or easel, adapted scissors or specialized software and computer access devices. To sit and focus, a child may use a Move 'n Sit (TM) cushion, a platform swing or computer and software.
To move from place to place, a child may use a walker, wheelchair, joystick or scooterboard. A child may use an adapted tricycle. To stand or sit, a child may use a stander or corner chair. To turn lights or the television on or off, a child may use a Dynavox or Ultra 4.
Proper seating and positioning also provides an important functional capability for some children. For example, if a child does not have the trunk strength to sit upright for long, they will soon tire and be unavailable for conversation, play, eating or learning. If a child with low tone is forced to look up in order to see a computer screen or participate, they will soon tire and be unable to perform to their capability.Legal Requirements
United States law has recognized the importance of assistive technology in the lives of persons with disabilities. For infants and young children, AT has been addressed in the following laws.
The Individuals with Disabilities Education Act Amendments of 1997 mandates as follows that AT be considered in a child's Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) when identifying appropriate early intervention or school services for the child.
"The IEP Team shall...consider whether the child requires assistive technology devices and services." (IDEA, 1997)
"The individualized family service plan shall...contain...a statement of specific early intervention services necessary to meet the unique needs of the infant or toddler and the family..." "The term 'early intervention services' means developmental services that...include...assistive technology devices and assistive technology services..." (IDEA, 1997)
There are other legal mandates for assistive technology. Under Section 504 of the Rehabilitation Act of 1973, children with disabilities must have the same opportunity to benefit from a program or service as a child without disabilities, as long as the provider organization receives federal funds. Assistive technology may provide that opportunity to certain children.
The Americans with Disabilities Act of 1990 provides civil rights against discrimination for disabilities. This Act also requires accessibility through reasonable accommodations including the provision of assistive technology.References
Americans with Disabilities Act, 42 U.S.C. § 12000 et seq.
Brinker, R., Lewis, M. (1982). Making the World Work with Microcomputers: A Learning Prosthesis for Handicapped Infants. Exceptional Children.
HELP (r) for Preschoolers Assessment and Curriculum Guide. (1995). Palo Alto, CA: VORT Corporation.
Individuals with Disabilities Education Act Amendments of 1997, 20 U.S.C. 1400, 1401.
Piaget, J. (1952). The Origins of Intelligence in Children. New York, NY: International Universities Press.
Rehabilitation Act of 1973, Section 504, 34 C.F.R. 104.4(B)
Schorr, A.N. (1996). "The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology." Development and Psychopathology. Cambridge, MA: Cambridge University Press.
Shore, R. (1997). Rethinking the Brain: New Insights into Early Development. New York, NY: Families and Work Institute.
Sullivan, M.W., Lewis, M. (1993). "Contingency, means-end skills, and the use of technology in infant intervention." Infants and Young Children. Aspen Publishers, Inc.
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