Device Modeling as Prompting Strategy for Users of AAC Devices. Meher Banajee, Ph.D., CCC-SLP Nino Acuna, M.A. Hannah Deshotels, B.A.

Transcription

1 Device Modeling as Prompting Strategy for Users of AAC Devices Meher Banajee, Ph.D., CCC-SLP Nino Acuna, M.A. Hannah Deshotels, B.A.

2 Introduction What is dual device modeling? Review of literature Anecdotal report Single subject design Discussion Limitations Future directions References

3 Introduction Variety of prompting strategies is used during intervention with individuals to develop competence while using speech generating devices This presentation will demonstrate the efficacy of using dual device modeling Single subject design (ABAB) will be used to demonstrate the effectiveness of this strategy Limitations of the study and future research directions will be discussed.

4 Literature review Speech language intervention for individuals using speech generating devices has traditionally been conducted in a skill and drill fashion Facilitators traditionally are prone to conduct symbol training as a prerequisite for symbol production training (Gossens, Crain & Elder, 1992) Symbol language training is conducted in a skill and drill fashion The individuals using speech generating devices are instructed to point to symbols of objects or actions The clinician maintains a tally of the successful responses. This training is very different from the manner in which children acquire language

5 Literature review Most children understand and learn how to use language by hearing language used frequently and interactively The same principles apply to teaching children how to use their speech generating systems If an individual is to learn to use their speech generating devices to communicate, then they need to see the use of speech generating devices used frequently and interactively This is referred to as augmented input (Beukelman & Garrett, 1988) or aided language stimulation (Gossens, Crain & Elder, 1992) Aided language stimulation or augmented input is a teaching strategy in which the facilitator highlights symbols on the speech generating device of the user while he or she interacts and communicates verbally with the user.

6 Literature review What is aided language stimulation or augmented input? First and foremost it is similar to good verbal stimulation Use single word (symbols) and short grammatically correct phrases (symbols phrases) to talk about what the child is hearing, seeing, doing and feeling Speak slowly insert numerous pauses Use repetition as you describe ongoing events Whenever the child indicates something nonverbally, provide the child with the single word (symbol) needed to communicate the exact same intent Whenever the child indicates something with a single word (symbol) expand the message into a semantically equivalent two-word (symbol) combination

7 Literature review What is aided language stimulation or augmented input? Use natural situations Respond immediately and consistently Use augmentative communication across activities and environments Pair voice output devices, symbols, sign language, and speech Use sabotage

8 What is aided language stimulation or augmented input? Literature review Highlight symbols An index finger A light pointer more salient and does not hid the symbol Squeaking finger Nonverbal or helping doll with a pointer finger

9 Literature review Why does it work? Teaches receptive language (symbol recognition) and use of expressive language functionally Symbol comprehension training must be conducted with interaction within an activity It cannot and must not be conducted as an activity by itself Children understand language as a result of hearing language used frequently and interactively To learn to use an AAC system frequently and interactively, the child must be provided with frequent models of interactive use The child can begin to establish a mental template of how symbols can be combined and recombined generatively

10 Literature review Communication issues of individuals with autism spectrum disorders Impairment in social interaction Impairment in communication At least one third to one half of children and adults with autism have no speech Failure to develop any functional speech Idiosyncratic use of spontaneous speech and language Restricted behavior (no new ideas) or repetitive/stereotypic behaviors

11 Literature review Limited consonant inventory and less complex syllable structure The vast majority go through a period of using echolalia or reenactment strategies (primitive communication strategies that might lead to regulation of others behavior) Communicative repertoire limited to reenactment strategies such as seen in echolalia

12 Literature review Echolalia Immediate or delayed Equivalent to a single word or serve as a label for an event or situation Serves multiple communicative and cognitive functions Requesting Protesting Affirmation Declarative Calling Rehearsal Self-regulation

13 Literature review Normal children learn to talk by imitating adult speech Over time they use these gestalt forms purposefully in communicative interactions Break down the echolalic chunks into smaller units to form a rule-governed language system However, child on the ASD are unable to make the transition The child is unable to break down the echolalic chunks

14 Dual device modeling Uses strengths of aided language stimulation or augmented input Based on the principles of aided language stimulation or augmented input Capitalizes on echolalic utterances of individuals with autism Modeling using a similar device as the individual with complex communication disorders

15 Anecdotal report Subject CS 16 yr old male Diagnosed with a history of autism at 6 years Unintelligible verbal output Frequent use of perseveration (repetitive speech), and echolalia (imitative speech) Receptive and expressive skills below functional limits for daily communication needs

16 General communication Deficits in prosody Monotonous Rapid rate varies in loudness (inappropriately too soft or too loud, screams and high pitch squeals) inconsistent or inappropriate use of stress Limited pragmatic skills Lack of initiation Communication functions limited to requests for actions and objects Limited use of joint attention Reciprocity (limited turn taking skills and responses to communication attempts)

17 In therapy Echolalia Perseveration (on device as well as verbally) Inconsistent attention to clinicians cues and prompts Followed a structured schedule Enjoyed working with peers in a group Comprehension of picture symbols Excellent ability to spell Ability to navigate to appropriate page with minimal prompting

18 Baseline summary Could not independently navigate between pages on his SGD. Needed constant redirection to maintain interaction during activities. Limited spontaneously initiate or engage in conversation using his SGD. Disruptive behavior Frequent vocal outbursts during group therapy

19 Therapy goals To increase expressive language skills To increase receptive language skills To improve pragmatic language skills To decrease echolalia in his speech Via use of speech generating device

20 Short terms objectives: CS will using his device: Greet communication partner at the beginning and end of treatment session with a model on a similar device Answer 5 questions about himself given verbal cues and a model on a similar device across 2 consecutive sessions Initiate interaction with communication partner with a verbal cue and a model on a similar device 5 times across 2 consecutive sessions Engage in reciprocal communication across at least 2 volleys with verbal cue and a model on a similar device across at least 3 volleys.

21 Short term objectives CS will using his device: Comment on different or activities (such as a story or a game) given verbal cue (i.e. are you having fun? ) and a model on a similar device 5 times across 2 consecutive sessions Engage unfamiliar communication partners in conversation across at least 2 volleys outside of the therapy room with a model on a similar device 1 time per session across 2 consecutive sessions Navigate to an appropriate page on his device when asked questions about himself and about the calendar (ex: today, tomorrow, yesterday) with a model on a similar device 5 times during an hour-long session across 2 consecutive sessions.

22 Short term objectives CS will using his device: Indicate the date (today, yesterday, tomorrow) given a model on a similar device 10 times over 2 consecutive sessions Indicate different emotions in functional situations given a verbal cue and a model on a similar device 5 times over 2 consecutive sessions Identify road signs (railroad crossing, stop sign, speed limit, etc) with a visual cue (such as scenes using the street signs), and a model on a similar device at least 5 times over 2 consecutive sessions Identify various coins and dollar bills given a model on a similar device at least 5 times over 2 consecutive sessions

23 Schedule for therapy session Greeting About myself Music time Reading Game Calendar Snack Good-Bye

24 Progress on short term objectives CS will using his device: Independently answer at least 5 questions about himself during a session across 2 consecutive sessions Engage unfamiliar communication partners outside of the therapy room independently 1 time per one-hour session across 2 consecutive sessions Navigate to an appropriate page on his device independently 5 times during an hour-long session across 2 consecutive sessions Independently indicate the date (today, yesterday, tomorrow) with 10 times over 2 consecutive sessions

25 Overall outcomes Increase in production of target responses Decreased perseverations on SGD Progress in terms of icon recognition and SGD page navigation. Reduction in vocal outbursts during individual and group sessions. Increased attention to task. Increased vocalizations per session (unexpected, but welcomed outcome)

26 Video

27 Research questions Does dual device modeling help quicker responses? Does dual device modeling help with reducing the number of prompts needed to produce an appropriate response? Does dual device modeling eventually lead to spontaneous use of the device?

28 Single subject design Subject TJ Twenty-three year old male diagnosed with autism Used Dynavox Dynamite during school Job coach supported employment AAC assessment Vantage Lite funding applied for and purchased Subject TJ was echolalic He hesitated and needed confirmation to press the location on the device even though it was correct Self stimulation using loud noises

29 Baseline measures (A1) video

30 First intervention phase (B1) Video

31 Results 250 Results of Dual Device Modeling No. of prompts A1 B Sessions

32 Discussion Changed dynamics of the intervention session Progressively less number of prompts More responsive Less hesitation to press locations Curious about what the clinician was doing on her device Thought it amusing that the clinician was using a device Wanted to imitate the clinician s responses

33 Limitations Both subjects on ASD Both used direct selection access methods Need to use with subjects of different age Need to use with subjects of different diagnosis Need to use with subjects with different access methods Small number of subjects

34 Future research directions Replicate study with individuals with other diagnosis individuals with other access methods individuals of different ages Replicate study with greater number of subjects

35 References Beukelman & Garrett, K. (1988). Augmentative and Alternative communication for adults with acquired severe communication disorders. Augmentative and Alternative Communication, 4, Goossens, C., Crain, S., & Elder, P. (1992). Engineering the classroom for interactive symbolic communication: An emphasis on the developmental period, 18 months to 5 years. Birmingham, AL: Southeast Augmentative Communication Publications. Prizant, B. M., Wetherby, A. M., & Rydell, P. (2000). Communication intervention issues for children with autism spectrum disorder. In S.F. Warren & J. Reichle (Series Eds.) & A. M. Wetherby & B.M. Prizant (Vol. Eds.) Communication and Language Intervention series: Vol. 9. Autism spectrum disorders: A transactional developmental perspective (pp ). Baltimore: Paul H. Brookes Publishing Co.

36 11 TH Annual Conference Augmentative and Alternative Communication (AAC) PROFESSIONAL PREPARATION FOR SPEECH-LANGUAGE PATHOLOGISTS AS AAC PRACTITIONERS When: January 24-26, In collaboration with the Assistive Technology Industry Association (ATIA) Orlando Conference January. Where: Caribe Royale All-Suite Hotel and Convention Center, Orlando, Florida Topic: Effective approaches to pre-service and in-service professional preparation for speech-language pathologists For more information on lodging and registration: