Wednesday, March 5, 2008
Speech Generating Devices - One
Speech Generating Devices (SGDs) are a tool that any parent of a non-verbal or barely verbal child with Autism Spectrum Disorders should consider. Basically, these are machines that talk for your child, thus helping your child communicate successfully and at the same time providing an auditory model when needed and functioning like a digital word tutor.
Parents are afraid that having a machine like this will reduce their child's motivation to talk--but just the opposite appears to be true. Regardless of how it occurs, every successful communication event seems to encourage a child to communicate more and verbalize more and try to say words more often. The reason for this is not hard to grasp. Imagine yourself plopped down without an interpreter in China or Africa or someplace where you don't know the language. Imagine that you get a little machine which can say things in the native language like I am hungry. Where is the bathroom? I am lost, please help. How much does this cost? No, go away! Every time you hear your little machine say these words, and you are able to communicate and find food, a toilet, your hotel, the right amount of money, freedom from the pleading words of a street beggar, you are more likely to memorize these words, having both heard them often and having found that the words were useful. This is what happens, apparently, when a child who can't talk, gets a machine that says what he or she wants to say. If it is possible for the child to learn to talk, he or she will learn faster. And this is the story most the time.
Some children with autism will not learn to talk for many years or at all--neurologically the act of communicating verbally is too difficult. This is the other story but even it has a happier ending with the introduction of a SGD. For these children, introducing an SDG earlier allows the child to become a proficient SGD communicator earlier. One way or another, there is no excuse to leave any child without a way to communicate for years and in this technologically bountiful age, non-verbal children should have SGDs just like kids who can't walk should have wheel chairs.
Someone out there is going to ask but why not use a picture communication systems or sign language? I love and use pictures all the time with children and teach children about communication with pictures. By all means use pictures with children who have ASD--there is great research to support the benefit of using pictures for many reasons and in many ways. If you purchase a SGD, you will still be using pictures in a variety of ways. But there are some limitations to pictures as the only communication system. First, some acts of communication are hard to accomplish with pictures. It is hard for a child to call his or her mom with a picture, or tell a sibling or the dog to Go Away! with a picture, or yell Trick or Treat! at the neighbor's house on Halloween with a picture. Some communication requires a voice. Then there is the issue of making and organizing all the pictures that a child communicating with pictures will need. Somebody has got to do this work and it becomes overwhelming and very time consuming. Some of the devices that are basically small computers and include a library of several thousand pictures start to seem like a bargain to the person who has to organize and haul around books of pictures. And these devices can say the words aloud too,which makes the bargain about double.
So, what about sign language? Sign language can be helpful for many children with ASD. If you both say the word and sign the word for your child, he or she is more likely to learn to say the word. If he or she can't say the word, he or she may be able to sign the word, if not precisely at least well enough to be understood by others who know the sign. And that is the only problem--not everyone knows the sign. I encourage families to learn signs for a core vocabulary of important words and use them with a child who has autism because signs have the advantage of always being available. It is also true that the hand movements act as a cue and help some children remember the verbal word. If you are willing to learn sign for your child--please don't be discouraged by this discussion. But you still may want to consider a SGD for your child. No one solution really solves all the communication problems of being non-verbal. SGDs solve some problems, sign language solves other problems, picture communication systems solve other problems, gestures and facial expressions solve other problems and learning to read and write can solve still more problems. Don't rule out any solution entirely in favor of another--rather find and teach the solutions that work best in each situation. While communicating in the bathtub, for example, you might rule out machines!
So, what are we talking about, exactly when we say Speech Generating Devices? We are talking about a variety of machines from a simple one button device which is like a mini tape recorder with a place to put a single picture to a complex computer that will take some big dollar investment and at least a little technological know how.
The single message devices might be used by your child for everything from calling the dog, to telling mom I'm hungry! to saying grace at dinner time. I have actually set them up to do all these things. Including the dog training. They can be placed in strategic places around the house or classroom and used by anyone who wants to say the message recorded on the device. Your turn to say grace, dad. And dad takes the button and bows his head and presses it. Single buttons are easy to add to the communication habits of a family or classroom.
SGDs also include similar devices which hold two or four or eight or twenty pictures (as pictured on this post), where a different word is recorded into each spot on the device behind each picture. The child pushes a particular picture (button) and the device says the pre-recorded message. These devices can be set up for particular activities and a different set of words will be recorded for each activity so that the non-verbal child can say some of the things that one might want to say while playing, for example, a puzzle game. See the next blog post for an example of a device used in this way. Any kind of picture can be used in these devices but I used Mayor Johnson Symbols on the one pictured above. I sometimes draw pictures by hand and often use digital photos to make the grid of pictures used in this kind of a device. It is a bit of work to provide pictures on these devices just as silent picture communications systems are work. But, I use this kind of device frequently in therapy and many of my families buy them because they are relatively inexpensive and offer a child a way to experience the power of verbal language.
Finally, there are several SGDs that are basically small computers with software that allows the child to push on a touch screen to activate any one of thousands of possible messages. I will do a post soon to explain the pros and cons (so far as I understand them) of these machines. I will end today, however, with the encouraging news that these talking machines are becoming more affordable, easier to program, and more kid friendly (colorful, toy-like shapes and portable sizes). If your child is non-verbal or struggling to become verbal, these devices should be considered carefully and this was not so true even three or four years ago. Considering recent research, my own experience, and the changing technology available, I start thinking about a device like this for any child that I see who is not communicating verbally within a year of intensive communication intervention.