Collaboration Corner: 5 Take-Aways to Support AAC, Apps and Language

TEchnology and augmentative and alternative communication

This past month, my colleague Sean Sweeney (AKA @speechtechie) and I had the opportunity to join forces and write about AAC, apps and literacy development. Our article will be in the next issue of SIG 12: Perspectives in Augmentative and Alternative Communication.

This gave us a great opportunity to discuss how AAC users can benefit from apps to enhance treatment outcomes. Here are five highlights:

Feature matching is important: When choosing AAC or apps for learning, the tool must meet the needs of the user. For AAC, this includes the size, layout and physical accessibility of features to maximize independent use. For apps, this includes Sean’s FIVES criteria, which examines the context, appropriateness, accessibility and therapeutic considerations for learning. Just like any other tool in your kit, if it isn’t a good match then opportunities for communication or learning are potentially lost.

Make CORE align with the CORE: Using generative language formats, including core and fringe word vocabulary, benefits the student two-fold: building in opportunities for language growth throughout the day, while also meeting those pesky Common Core Standards. For example, a first grade ELA standard CCSS.ELA-Literacy.L.1.1.c, “Use singular and plural nouns with matching verbs in basic sentences.” Using core vocabulary allows the student to meet this standard through basic sentence construction activities. A first grader may enjoy learning this through the “Collins Big Cat” series, a free app that reads stories out loud and then has the option of the student recording his voice (or in this case, synthesized voice). The app also has a more interactive component, which allows the student to build scenes and narrate his own version of the story.

Apps and AAC are powerful together: Students love the interactive nature of apps. “Toca Hair Salon” is a highly interactive hair salon studio allowing students to describe how they are going to cut, color or otherwise coif the animal or person of choice. Another simple app, “Pogg,” is a cute alien that hops, sings and performs other actions, all at your student’s direction during a session. Beyond paper flashcards, the apps give students immediate reinforcement, so then work feels less like work.

Separate communication tools from other tools: If you are going to use apps and AAC at the same time, one practical solution is to use separate tools. Toggling between apps and AAC is cumbersome, and slow session momentum. In addition, having separate systems prevents the user from confusing a communication device with other technology, which is an important distinction. If your tools look the same, change the colors of the cases. If you have students that like to surf and press that home key, enable guided access so that only the AAC app is available.

Model, model, model through apps and AAC: Finally, apps provide the opportunity to model AAC live, and in unpredictable ways. You have more opportunities to explore and learn together. Don’t have curling iron as a fringe vocabulary item when using your “Toca Hair Salon” app (it’s not there, believe me)? Show your student how you can give clues to what you mean and talk it through using what is available on your AAC: “Let’s see, it’s a tool, it’s hot and it makes your hair curly…what is it?

There’s your abridged version and takeaways…log in to your SIG 12 portal for more info, and to get CEUs….ASHA renewal is right around the corner!

 

 

Reference

Sweeney, S. & Davis, K. (2014). In press. Reading, writing and AAC: Mobile technology strategies for literacy and language development. SIG 12: Perspectives in Augmentative and Alternative Communication. American Speech Language and Hearing Association.

 

 

Kerry J. Davis, EdD, CCC/SLP is a speech-language pathologist in the Boston area. She holds a special interest providing services to children and adolescents with complex communication profiles, including AAC. Davis is a volunteer SLP and consultant to Step by Step Guyana, a school for children with Autism in South America.

 

ASHA 2014, Here I Come! It’s GO Time!

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Usually, the word scheduling elicits shivers down my spine. Usually that means scheduling 60 kids into speech therapy slots without interrupting ELA, math, lunch, recess, music, PE, art, intervention, OT or PT. It’s an astronomical feat when SLPs complete schedules every year. In contrast, scheduling for ASHA 2014 in Orlando has been a breeze. I’m scheduling lunch dates, meet ups, pool time, and my favorite CEU opportunities! Scheduling for #ASHA14 in Orlando is very different from scheduling therapy clients.

 

I’ve booked my flight. I’ve texted friends and worked out transportation. I’ve got a place to stay! I’ve joined up with some of my blogging buddies and reserved a booth for the exhibitor hall. Most importantly, I’ve started picking out a schedule for the courses I will take in November. I am so looking forward to downloading the mobile app this year. Since most SLPs don’t have time to wait in line for three days for the new iPhone 6, I’m hoping my dinosaur 4s phone will make it until November. The app should make managing my conference schedule a snap.

 

The Program Planner has been an easy way to browse for courses. It’s more user-friendly than my IEP writing program and my Medicaid billing programs. You can browse through courses by keyword, author, title, etc. So far I’ve searched for topics that apply directly to my caseload. My search terms were “school,” “autism,” “evaluation,” “preschool,” “apraxia” and “AAC.” Here are seven sessions that I’ve chosen so far:

 

  1. I really think research is valuable and there is just so much to choose from. I am trying to pick courses that relate directly to me or courses that really excite and interest me. In my current job I’m doing two preschool evaluations per week. I’m having the ‘articulation, phonology, and apraxia’ conversation with parents every week as I explain characteristics of each and their differences. The presentation “Differential Diagnosis of Severe Phonological Disorder & Childhood Apraxia of Speech” by Matthews and Rvachew sounds like a great refresher. I’m hoping to find some more evaluation-specific courses before November.
  2. I’m thinking the Phillips, Soto, & Sullivan presentation called “Strategies for SLPs Working with Students with AAC Needs in Schools” sounds perfect for a lot of my caseload. I need strategies for AAC students so this should be a big help.
  3. I can’t wait to see “iPad to iPlay 2: Teaching Play to preschoolers through Apps” from Tara Roehl. I love my iPad so I can’t wait to see how she is using it to teach play in preschoolers. This is really a skill I’d love to pass on to my teachers and parents.
  4. On the other hand I’m always careful to limit screen time with my students. There is a presentation called “The Impact of Technology on Play Behaviors in Early Childhood“ from Hagstrom, Smith, Witherspoon. Hopefully once I listen to both presentations I’ll feel good about balance and not leave feeling conflicted!
  5. Michelle Garica Winner is presenting four times. I’m hoping to catch “ASD Treatment: Cognitive Behavioral Therapy & Mental Health Problems Associated With Social Learning Challenges” and “Implementation Science & Social Thinking®: Discovering Evidence in Our Own Backyard”. I love her work and just can’t wait to finally see her present in person.
  6. Barbara Fernandez from Smarty Ears is presenting about one of her apps for data collection and caseloads. I can’t wait to talk to her about all the new Smarty Ears apps coming out in the future so I’ll be hitting up the Smarty Ears booth.
  7. Lastly, I decided to search my schools to check out what the faculty at Ohio University and The Ohio State University are presenting. “Skiing, Horseback Riding, & Communication With Individuals With Complex Communication Needs: Experiences From Community Volunteers” sounds really interesting from McCarthy, Benigno, and Hajjar at Ohio University. They are presenting information on recreational activities for individuals with complex communication needs. Interviews were conducted with volunteers in adaptive sport programs in New England.

 

I don’t think we will have any typical celebrities at ASHA. At least not the kind you see on entertainment television every night. There will however be some #SLPcelebrities to be found! I searched two of my favorites to check when they will be presenting. Hopefully you’ll see me posting a #slpselfie with some of my favorites SLPs over the weekend in Orlando.

That initial scheduling took about 30 minutes and I didn’t have to email 20 different teachers. Scheduling for ASHA is way more fun than making a therapy schedule. Now the countdown begins!

 

 

Jenna Rayburn, MA, CCC-SLP, is a school-based speech-language pathologist from Columbus, Ohio. She writes at her blog, Speech Room News. You can follow her on Facebook, Twitter, Instagram, and Pinterest. Jenna is one of four guest bloggers for ASHA’s convention in Orlando.

Collaboration Corner: AAC & AT: 5 Tips, Myths and Truisms

AAC

 

Look around at every stop light and you will see the soft addictive glow of smartphones. Minivans off for a family vacation are burgeoning with tablets and some other thumb-numbing form of entertainment.  For more particular consumers, any technology prefaced with an “i” will do.

For people with complex communication needs, tools for learning and speaking have become more affordable and accessible.  But this easy access is not without its challenges.

It’s true that augmentative and alternative communication (AAC) platforms have made it into the cool kid circles, but this can make it more confusing for families and therapists to make informed decisions. Beyond You Tube and Candy Crush, it is important to remember the why and how of AAC and assistive technology (AT). Here are some points to ponder before getting too bedazzled.

  1. “AT and AAC are the same thing.” Not so much. While AAC falls under the umbrella of assistive technology, it requires a specific skill-set. Just as “related service provider” or “allied health services” includes SLP services, I would not assume the job of my physical therapy colleagues and start recommending orthotic devices. Same with AAC and AT; both tools aid and assist, and include low tech (such as a pencil grip, picture schedules) and high-tech interventions (anything that plugs in). The difference here is who is involved: AT includes a wide range of professionals well-versed in making recommendations, from special education teachers to AT certificate holders. AAC does not. In AAC, the “C” stands for communication. It is within our scope of practice per ASHA guidelines. As far as I know, it’s not under the domain of other disciplines. Period.
  2. “I don’t get it, he has an ipad, he should be able to (fill in your random ability here).” A large reason for device “abandonment” is a mismatch between the tool and the user. As SLPs your job is to consult with other experts to make sure it fits the child’s needs in terms of accessibility; fine motor, vision, and positioning are just a few considerations. AT, particularly high-tech AT, requires additional considerations, with the primary focus being, does it aide and assist?
  3. “Everybody has one.” ‘Nuff said. Social pressure should not guide recommendations. AAC is prescriptive. I know it can be difficult, but stay strong and focused on what is appropriate and effective.
  4. “He is so good at using technology, so then why can’t he…?”  My 10 year-old can use keys to unlock the door, but I wouldn’t give him the keys to drive to the store and pick up milk. Technology is a tool. AAC is a tool that requires explicit teaching. SLPs and parents are teachers that guide the process. Here is where it is important for us to educate, model and educate some more. As evidence-based practitioners, we need to take data. Data guides us on what’s working to guide what needs to be changed. For my students with autism spectrum disorder, it has been so helpful working with, and learning from, certified behavioral specialists, and come up with a system that everyone can use.
  5. “She uses it at school, and home is a time to relax, not work.” Consider the social circles of communication partners described by Deanna Wagner and colleagues (2003):
    diagram(adopted from Wagner, Daswick & Musselwhite, 2003)

    Becoming a confident communicator means practice: practice at home, practice with friends and friendly acquaintances, familiar and unfamiliar people, and within the context of different places. Don’t aim for perfection. Just aim for opportunities to practice!

Kerry Davis EdD, CCC-SLP,is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer.

As Adults With Intellectual Disabilities Live Longer, They Need More AAC Support

AACpic

Communication for adults with intellectual disabilities and complex communication disorders is a team effort. People with these disorders are living longer, higher quality, independent, and more productive lives thanks, in part, to alternative and augmentative communication technology.

Speech-language pathologists need to understand the settings in which these adults live. No longer do they live in large institutions but in more intimate and natural independent or small group homes.

A crisis may also be at hand as aging caregivers, whose adult children with intellectual disabilities and complex communication disorders live at home, can no longer care for them. According to The State of the States in Developmental Disabilities (2013), in 2011, 71.5 percent of people with these disabilities lived with family caregivers. Over the next few decades this group will flood the group home system as their parents age.

Communication is always important and critical for a person’s independence. Family caregivers may tend to speak for the adult with a disability and anticipate needs more than staff at a group home. Independent means of communication becomes that much more important once that adult moves into a new environment. This is where the SLP has a major responsibility in finding the most appropriate, functional evidence-based AAC intervention.

Many factors exist beyond the skills of the adult with intellectual disabilities and our AAC recommendations, however. Future AAC success is a team effort between the SLP, families and paid caregivers/group home staff. Some staff members are highly supportive; some are not. Informal assessment of the environment in which the affected adult lives is crucial. It can be a delicate process to help the staff member see the purpose of AAC. If the group home staff does not “buy in” to the AAC device recommendation and plan, there is a high risk of abandonment.

Group homes, although typically a better solution than nursing homes for those without complex medical conditions, have their own challenges. Moving to a group home is a major life change for people who have typically lived their whole life with their families and who often have a significant difficulty adjusting to change. In the state of Pennsylvania, where I practice, I have been encouraged to see that the group home system has placed a high level of priority on communication over the past few years. As a result, I have been seeing more adults with intellectual disabilities and complex communication disorders in my practice.

Another challenge in group homes is staff turnover. The State of the States in Developmental Disabilities (2013), reports that hourly wages for workers in community intellectual/developmental programs averaged only $10.14 per hour. A report published by the Paraprofessional Healthcare Institute in 2011 noted that almost half of direct care workers (including group home staff) live below the federal poverty level. Meanwhile, their work can be rewarding but is often psychologically and physically challenging, so it is clear why staff turnover is high. And, unfortunately, frequent staff turnover is confusing, frightening and can lead to a lower quality of life for these adults.

I have seen many adults with intellectual disabilities and complex communication disorders go years if not decades without AAC intervention. It is especially painful when, as children, they used AAC in school and transition into the adult world with no reliable means of expression because either the device was returned to school or the device had become obsolete. There is also a high level of abandonment of AAC devices once the school support is gone. In nursing homes, there can be speech therapy support available. In group homes residents must be seen for therapy as outpatients. Once the resident is back home, it becomes the responsibility of the group home staff to ensure the AAC device use is supported and maintained.

As part of the intervention plan, we must assist the group home staff to add communication goals to their mandated plan of care. We must also train the staff members in the care, maintenance and programming of the recommended device. Adults with ID are living longer, and, as technology has become an accepted part of all of our lives life, AAC interventions will continue to be a necessity. We should remember that an AAC device recommendation is not a once and done process. An adult with ID may need numerous device upgrades throughout their lives. Determining the best AAC device is not the end of the process, it is only the beginning.

Carrie Kane, a speech language pathologist at the Good Shepherd Rehabilitation Network in Allentown, Pennsylvania,  specializes in AAC assessment and treatment for adults with communication disabilities. She developed and is the coordinator of the adult outpatient AAC program in Good Shepherd’s Assistive Technology Center.

Thoughts on ‘Apps for Autism’

iPad on Tanmay's jeans


Photo by Chirantan Patnaik

First a disclaimer: I don’t work with patients with autism, in fact I haven’t done so since grad school, and even then I only worked with the population sparingly. iPads on the other hand, are awesome, and I use mine daily (much to my wife’s chagrin) for nearly everything (including this post) besides treatment (unless you count documentation, for which I use an iPod Touch), and that’s only because it doesn’t make much sense for my setting, not yet anyways (this is the point where I stop making parenthetical statements). But I am a speech pathologist and I do know a thing or two about communication, and that’s why I watched last Sunday’s 60 Minute segment, Apps for Autism, with much anticipation and excitement. I generally have respect for the show, but at the end, I just felt ‘meh’ about the whole piece. And let me tell you why.

When you watched the segment, did you notice the peeps with autism struggling and ultimately failing to use paper letter boards to communicate, which was immediately followed by the same person using the iPad exceptionally well to convey their message? This scenario was shown a few times throughout the piece and it felt like an As Seen On TV infomercial. Besides that, it completely ignored the decades worth of research and development that has been done in the field of Augmentative and Alternative Communication (AAC). It’s as if the Lightwriter, Dynavox, Prentke Romich, Tobii-along with a host of other companies-devices have never existed. That the idea of using technology to help people communicate is one that is original to the iPad. And that, of course, is rubbish.

It also seemed to prescribe the iPad as a panacea for autism treatment, you know, just give the kid an iPad and he’ll be on his way to communicating and that it’ll unlock an new and undiscovered portal into their minds that we never knew existed. Forget the fact that the successful use of AAC devices require training, especially for those with cognitive deficits, and forget that speech pathologists and special education teachers are needed to foster language development and literacy skills in order for the iPad to even be a viable option. A Twitter friend, @JohnduBois, said it right: “I felt it ignored the point that AAC is a tool and requires proficient users and teachers-too much “Apple magic”. Indeed sir, indeed.

And what was with that lady doing hand-over-hand assistance with the kid who had no apparent interest in the task? It was way too reminiscent of facilitated communication, and we evidence-based practitioners do no want to go there. Most likely, and hopefully, she was simply providing cues and trying to engage the kid in activity, but I cringe at even the slightest hint of FC.

For all of 60 Minute’s shortcomings, it must be said that the iPad is most definitely an inspiring piece of technology, and it is capable of capturing the attention of of children and adults alike with its boundless applications. But we need to be mindful that when teaching social skills to children, we teach them to use turn-taking skills, theory mind and what have you with people and not machines. If a child is captivated by the iPad and is able to direct their attention to something purposeful and meaningful, that’s great, but its all for naught if those skills do not generalize to the world at large.

The iPad is a wonderful and powerful tool, and has numerous applications for autism treatment, and the broader speech pathology and special education fields as well. But let’s place our focus on the end goal and not the bright and shiny gadgets that serve to facilitate such goals, lest we become victims of the latest fad and fail to view the iPad for what it is: a tool.

(This post originally appeared on slowdog)

 

Adam Slota M.A., CCC-SLP is a speech pathologist working in long term care and long term acute care settings, primarily with tracheostomy and ventilator dependent patients. He is also the author of the blog slowdog where he writes about various topics in speech pathology and beer, among other frisky and/or mundane missives.

 

 

AAC and the Digital Divide. Access and Money

Old fashioned census device

Photo by Pargon

(This post originally appeared on the SLC Therapy blog)

I am the first to raise my hand or nod in agreement when and if the question “Do you think current top of the line AAC devices are cost prohibitive?”

Absolutely they are! They have always been. A lot of things are expensive…

As a consultant and evaluator of Assistive Technology, I was and still am excited about how the world is moving to create technology devices for people with disabilities. I am impressed with the Apple iPad, iTouch, and iPhone products. I am excited about the Android apps. I am thrilled with Tablet touch screen computers. I am enthusiastic about the technology reaching the consumer level.

I just wish someone would just say that the iPad, iTouch, and iPhone were created for all consumers. If they were completey geared towards people with special needs..challenges seen in Motor Access, Visual Access, and Hardware flexibility would not be present. Do I own Apple products? Yes! Do I use them in assessments? Yes Do I recommend them? Sometimes.

I am glad that so many useful apps are being created. I am saddened that training is not a component. The apps for AAC seem to present to consumers as a magical button to families and make the non-tech SLP an AAC expert. It looks visually welcoming and more socially acceptable than a larger dedicated speech generating device. The apps meet the demand without quality assurance or review…consumers are screaming for the tool that will work for their family members with communication impairments. It is our job as a profession to impart knowledge, training with whatever tool is being recommended.

Along with challenges of motor and visual access is the economic access. Insurance is nonsupportive in reimbursement or paying for non speech generating devices. Most people want and should be able to use their medical benefits. Not every family can afford to purchase with experimentation and hope that this new app will get Johnny talking!

Sure the medical insurance panel community should step into this century. At the same time, we need to have more reasons for recommendations than “it works”. They need data…and so should SLPs and other AAC Consultants. I’m amazed at the number of professionals abandoning sound analysis and sacrificing that last $700 a family has to use an iPad. Let’ make our analysis look like a true evaluation with a process map that will actually get the person talking. If the iPad is the recommendation, so be it! But give them a plan to actually get talking.

Last Christmas the Hollyrod Foundation accepted donations for the iPad and the Proloquo2Go. It was/is a wonderful program. I gave and was happy as an SLP that the child’s SLP had to be listed and actually be part of the planning of the device.

Here is a link to a white paper by AAC-RERC discussing AAC apps and mobile devices.

My utopia wish:

  1. Develop an affordable AAC device using the One Child Per Laptop mode.
  2. Insurance Panels allow people to use their benefits for durable medical equipment suitable in this century.
  3. Stop the cool AAC app and focus on quality control and letting parents know what the apps are capable and incapable of doing…and asking parents “Does this app work with the communication vision you have for your child?”
  4. Apple donates iPads to families as learning tools as a way of saying Thank you to a market they did not think of when they created the iApple family products.

Landria Seals Green,M.A., CCC-SLP is a speech-language pathologist and Executive Director of SLC Therapy. Mrs. Green enjoys her work as an assistive technology consultant.

Mobile Information and Communication Technologies (ICT) – New Tools for the SLP

iOS tablets in various sizes

Photo by Kevin Marks

The iPad, iPod, and the competitors of these products that will continue to emerge in the next months provide SLPs with unique and flexible additions to their “toolbox”. In particular, the applications for augmentative and alternative communication (AAC) have been widely embraced by SLPs as a low-cost alternative to expensive, purpose-built “dedicated” speech generating devices (SGD). Third party payers from schools to private insurers are jumping on the “least expensive alternative” bandwagon (although it is unlikely that Medicare or Medicaid will ever consider an iPad as “durable medical equipment”). These tools are generally affordable solutions to individuals with disabilities and their families (even if it takes a little saving up for…). The available “apps” range from automated flash cards to well-developed, evidence-based software conducive to the development or re-acquisition of language.

Here we have a classic good news – bad news situation! The good news – we have another tool that will be effective for some individuals as their primary AAC device, or as a scaffold to more complex systems, or for some, for use as a back up device or part of a multi-modal system that includes a dedicated SGD, signs/gestures, vocal approximations, etc. The bad news – practitioners may be pressured to abandon what they know about appropriate practices in matching technology to the individual’s needs in favor of the inexpensive (and perhaps, more readily obtainable) option. So – the bottom line is to remember all we know about appropriate practices in assessment, advocate for those practices, and remember that AAC includes both devices and, importantly, the services to SUPPORT the use the of device in order to obtain effective and efficient communication.

SLPs and others interested in this topic should also review the “White Paper” recently issued by the Rehabilitation Engineering Research Center on Communication Enhancement. The White Paper is based on interviews with more than 25 AAC “thought leaders” between January and March, 2011, representing multiple stakeholder groups. In addition, I encourage you to join SIG 12, to be part of ongoing discussions on these technologies on the SIG 12 listserv!

Amy S. Goldman is an associate director of the Institute on Disabilities at Temple University where she directs Pennsylvania’s Initiative on Assistive Technology. Amy has specialized in AAC throughout her long career as an SLP and is chair of the steering committee of ASHA’s Special Interest Group on AAC (Special Interest Group 12).

Meeting the Extreme Makeover Challenge Part 2

This post is the second part of The Extreme Makeover Challenge Room Re-Design

Before and after images of student workstation

Link Visual Strategies To Support Expressive Communication with Alternative-Augmentative Communication ( AAC )

As consultants, we meet these extreme makeover challenges every day by assisting caregivers and professionals to physically re-structure living and learning environments, and by implementing and linking tailored visual strategies to support expressive communication with Alternative-Augmentative Communication ( AAC ).

We define AAC as the use of materials, techniques and equipment to compensate for expressive communication limitations individuals may exhibit, and to provide varied methods that allow for success in the communication process. AAC methods are tailored for individuals based on cognitive level, physical abilities, academic needs and communication settings, and include the following most common methods:

  • Speech Generating Devices (SGD)– SGDs are electronic equipment with speech output capabilities, that may be programmed,
    and offer the individual with increased communication opportunities. In Rising, we discuss various uses of SGDs such as in this device which allows children to communicate information between school and home. Other applications include communicating messages to answer questions, participate in academic lessons, offer social greetings, relay information, exchange thoughts, and interact with significant members in their lives at home, school, and in the community.\
  • Picture Exchange Communication System ( PECS )– PECS is an augmentative communication system designed to facilitate quick, effective, functional communication. It is a concrete visual-based program that encourages communication. Although speech emerges with some individuals and verbal speech is indirectly encouraged, PECS is not specifically designed to teach speech. Its primary objective is to establish an understanding about the purpose and method of communication exchanges, and to facilitate communication by providing the opportunity to relay messages through pictures. We have found a number of our students have been very successful communicating via PECS.S
  • Symbolic Language System–We define symbolic language systems as any method of communication that utilizes
    an action or material, assigns specific messages to it, and relies upon it consistently to relay meaning to the listener. A symbolic language system provides a consistent and easy-to-interpret method of relaying messages when a verbal message cannot be presented intelligibly. Pictures of items or places, labels of products, objects, gestures, and vocalizations are most commonly used to depict representations of desired messages. Rising illustrates many types of symbolic language systems to relay messages for many communication situations such as communication boards, eye gaze charts, and communication binders.

These are some of the elements required to meet the challenge of a successful re-design. We have observed children with autism, other PDDs, and AAC , achieve organization and success, improved behavior, social skills, and communication success when adults implement the strategies we’ve shared.

Carol L. Spears and Dr. Vicki L. Turner are Speech Language Pathologists, Assistive Technologists, and Alternative/Augmentative Communication Specialists. They utilize extensive professional experience, continuing education, and personal perspectives when working with students with autism and other pervasive developmental disorders to provide evidence based interventions. They are co-authors of the book, Rising to new heights of communication and learning for children autism. They are partners in the private consultation practice, Communication by Design Specialists, LLC (CoDeS). CoDeS, located in Northeast Ohio, provide caregivers and professionals with compassionate support and training in homes, educational institutions, and workshop settings. You can follow then on Twitter at @autismplus and find them on Facebook at Communication-by-Design-Specialists-LLC.

Affordability and AAC

Money sign and hand with cross-through


Photo by Neubie

Affordability and augmentative communication are two terms that typically do not ever appear in the same sentence, unless in the negative context (i.e. ‘augmentative communication is not affordable’). This belief is one that is generally accepted as the reality of augmentative communication, and assistive technology in general.

The major alternative/augmentative communication (AAC) device makers have long claimed innocence under the argument that it has been their own research and development dollars that have gone into producing these devices. To that end, they need to keep their prices high in order to maintain a high quality product. Although that argument does have its merits, one has to wonder whether a $3,000 or $4,000 communication device is really a justifiable price. In fact, such costs impede any single user from purchasing such a device out-of-pocket. Instead we, as clinicians, and our clients rely on insurers and grants to subsidize the costs that we incur.

Considering all of the years that AAC technology has been out of reach of the mainstream computer market, it is incredible to see that only in the past year or so, some brave companies have stood up to say ‘We have a communication solution that’s also cheap.’ With the advent of such personal computing devices as the iPad, the iPod and tablet PC’s, someone made the realization that AAC doesn’t necessarily have to be expensive anymore.

One can trace the emergence of today’s low cost computing to the surge in popularity of the netbook (those adorable 9 or 10 inch computers that seemed to go mainstream almost instantly). With some very capable low cost touch-screen computers out there, it makes a lot of sense for individual users to put together their own AAC systems for around $500 or $600. The process to create your own device involves buying a touch-screen tablet PC, iPad, or other device and then the associated communication software. The best part of such systems is that they are not dedicated communication devices, meaning the user can access programs aside from the communication software on the system. Whether it is the adult stroke victim or the autistic child, having a variety of applications available (e.g. email, games, word processing, etc.) in addition to communication software is great thing to provide a client with true accessibility.

Of course, there are drawbacks to creating your own AAC device. Such systems would not be paid for by any insurance company, as they are not dedicated devices. In addition, for less tech- savvy users, it may be a bit of challenge to tackle technical issues with your hardware and software coming from different places. Lastly, even $500 may be too much for many individuals paying out-of-pocket. That being said, most of us are already accustomed to paying premium prices for modern computing technology, so the price of a netbook or an iPad seems like a drop in the bucket.

As a software developer and clinician, I know both the technical issues involved with AAC as well as client needs. I feel strongly about providing my clients with communication solutions that work for them, and a lot of the time that means something easy, portable and practical. As speech-language pathologists working in the domain augmentative communication it is our obligation to provide education to our clients regarding all of the options that exist. Do-it-yourself AAC devices may not be for everyone, but they certainly fill a major gap in the market of devices currently available.

José A. Ortiz, M.A.CCC-SLP, is a speech-language pathologist and software developer in Brooklyn, NY. He currently works as a clinician providing Spanish-English services in a variety of settings, including rehabilitation facilities and autism education programs. José is also the owner of PAL Software Designs LLC, a software company that creates products for language professionals. Jose is a dedicated advocate for bilingual education and accessibility to augmentative communication. You can read more from José on his blog.