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Clark County School District
Las Vegas, NV
Many of us scratch our heads when trying to teach communication skills to nonverbal children who have unique problems such as visual impairments, behavior problems, severe mental retardation, autism or children who are just difficult to motivate. We might have tried the picture exchange system and it worked to a point but wonder what to do next. Still others may be dealing with a child just learning to use a communication device and just need ideas on where to begin. A lot has been written on children using augmentative systems, but there is little step by step help in how to get the whole thing started.
After working with literally hundreds of teachers and speech therapists in Clark County Schools in Las Vegas, NV, the 8th largest school district in the nation, we can relate to these problems. We have struggled with training school professionals in how best to help these children for many years. Finally we have arrived at what we believe is sort of a step by step cook book for understanding how to get the student started and help them progress until they become effective communicators.
When beginning a new communication system, it is crucial to begin with a strong reinforcer. It is the single most important component when beginning augmentative communication training, because the strength of your reinforcer will determine how motivated the child will be to do what you ask. The child will not understand, at first, the reason for having them hand symbols or to hit certain buttons on a communication device, so you need something so important to the child that he/she will do what you want in order to get it.
Step One: Find as many strong reinforcers for the child as possible
There are three basic types or groups of reinforcers. You do not need reinforcers from each group, but it is good to look in all groups to find as many reinforcers as possible. You may find a lot from one group and none or only a few from another.
1. FOOD (snacks,including sweets, chips, crackers, pudding, drinks etc.)
2. TOYS AND DEVICES (favorite toys or objects, music, video, computer)
3. SOCIAL CONTACT (hugs, pats, tickles etc.)
Now that you have decided what reinforcers you will use, here are some things to consider. First and most importantly, do not let the child have the reinforcer except when you are using it for training. If the child desperately wants the reinforcer use that time for training. You must decide that every time the child wants that toy or food they must communicate with you. Don't give them freebies. Always make them ask for the reinforcer whenever they decide they want it.
Now let's teach them to ask for them...
Step 2. Teach the Child How the Communication System Works
We say things because it gets us things. It may be asking for a food or toy we want, getting someone to "stop" or "move" letting someone who know who that belongs to or where something is. Communication is almost always an exchange of some type. So our first step is to teach the child to exchange a message, in this case in picture form, for something they want (their strongest reinforcer). For a child using a communication device we will teach them to activate a square to request the reinforcer. For visually impaired children we may use a card with a texture on it or real objects attached to the card. We may need to begin this system with some physical prompts or cueing which we will fade as quickly as we can. From the beginning we wait for the child to make some movement to get the reinforcer so we can shape that behavior into handing the picture or pressing the message key to get the communication partner to give the child something they want.
Step 3. Teach the Child How to Make Choices
Once the child has learned to hand you a picture or hit a key on a device to tell you that he/she wants something, you are ready for the next step. At this point you cannot be sure that the child has noticed the picture on the card. Usually the picture will match the object the child is requesting but he/she may not be aware of this. The child may be simply handing you the picture to please you so you'll give him something he/she likes. Now you will need to encourage the child to discriminate the pictures and understand that the pictures represent an object, action etc. To teach picture discrimination you will, of course, need two pictures so the ability to make choices also comes into play. The child will also need to learn he/she has the power to make choices. This seems so simple but many children who have difficulty communicating learn to be passive and let others choose for them, for some children, this may be an entirely new skill.
It is time now to introduce the child to a second picture. The second picture should always be something the child does not prefer. here are some non preferred items we have found to work pretty well.
A wash cloth requesting to have their mouth wiped off at meal time.
A blank card which means I don't want anything
A picture of a nonedible at meal time such as a block or shoe.
We use non preferred items because we need to have a "wrong" answer to see if the child is truly making choices and discriminating our pictures. If the child hands you the "wrong" (non preferred item) picture and clearly demonstrates they didn't intend to request that item, present the two choices again. If the child consistently picks the "wrong" choice 2 times in a row, take the non preferred item and picture away. Give them the choice of only the preferred item and reward it when the child hands you the picture. Then reintroduce the non preferred item and picture and try again. Remember to constantly mix up the pictures so the child does not learn to make a correct choice based on the picture's location rather than the picture itself. This is especially true if you are beginning training on a communication device.
Trouble Shooting--If the child consistently fails to make a "correct " choice try:
introducing a stronger reinforcer.
introducing a different non preferred item.
using object cards, texture cards, labels or photographs instead of pictures (see trouble Shooting Picture Section in Chapter 1) making a larger visual difference between the two cards such as using a picture of the reinforcer and a blank card. Then gradually add lines to the blank card until it becomes a picture (of a non preferred item).
In a separate lesson work on picture/object matching
Step 4. Expand the Child's Picture Vocabulary
Expanding the child's use of pictures increases his/her vocabulary. Normally when children develop speech they learn words as they come in contact with them in their environment. They learn them because they need them. If you need Mommy, you learn to say, "Mommy". A picture language system should work the same way. By increasing the number of pictures the child needs to express more and more requests, we are expanding his vocabulary. Counting the number of pictures the child can use is essentially the same thing as counting the number of single words a child has.
Here are just a few examples of choices that might be offered in the classroom to expand the number of pictures the child uses:
who he/she wants to sit beside,
which song to sing during circle time,
what to do for free play,
what center to work in,
which puzzle to work,
which fine motor activity to work,
which picture to color,
what or where to cut,
what art supplies i.e. colors, markers, stamps, etc.
what school supply.e. paper, pencil, workbook etc.
which color to use
what instrument to play,
which video to watch
what computer program to use
which picture or name is theirs,
Picture Communication Immersion
The child needs the experience of seeing how someone else uses the pictures. If the child is the only one using pictures it will be a little like asking them to speak one language while you speak another. Plus it makes their language look less acceptable. Other verbal children in the classroom might enjoy using the pictures sometimes if they are given the opportunity. Picture usage may help even verbal children with language or grammar difficulties. So encourage everyone to use pictures whenever possible
Step 5. Teach the child to Combine Symbols
In the early seventies, Brown and others did several longitudinal studies on verbal children developing language. Similarities between the first words learned by these children in general were noted as well as the similarities in the kinds of messages expressed when children began using 2 and then 3 word utterances. It is generally accepted today that most children's early two-word combinations will be used to express these ideas and more:
possession--stating ownership; for example, "my cookie", "Mommy purse", "Doggie bone"
recurrence--stating that you want something to continue; for example "more milk" , "more tickle", "more shoe", "more swing" etc.
rejection--refusing something; for example, "no wash", "no potty", "no spinach"
denial--telling you that something is wrong; for example, "no Mommy('s)", "not hot", etc.
attribution-- describing something; for example, "good boy", "pretty flower" etc.
action--usually directing someone else's actions; for example, "Go Mommy", "Sissy sit", " Stop Billy" etc..
location (locative) action--stating where to do something; for example, "sit chair", "jump bed" , "put table" etc.
After the child has acquired a fairly large picture vocabulary we should begin to teach them to combine 2 word or symbols to express these concepts above. Rudimentary language based communication boards are used in engineered situations that beg for a certain type of two word utterance. For example, putting all the children's shoes in a pile and deciding who each shoe belongs to i.e. "Mary's shoe", "My shoe", "Teacher's shoe etc.
Of course it is easy to guess what the next step we feel should be...
Step 6. Teach the child to Combine Multiple Symbols
It is easy at this point to expand activities we have set up to teach two word combinations and engineer them so that more and more information is needed to communicate. For example simply asking for a big versus little cookie may be changed so that the child will need to tell you whether they want the big/little chocolate or powered cookie. Of course at this stage we will begin to teach grammatical forms such as pronouns or prepositions. We also introduce words so that our children learn literacy skills but of course, It would take a book to tell you everything. And we are in the process of writing just such a book which should be released in the year 2000.
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