Thursday, October 30, 2008

More on Machines that Talk

Here are a few thoughts about when and how I have begun to approach the issue of getting a nonverbal or minimally verbal child to the point where he or she has a high tech communication device.
  1. First, the augmentative communication machines are better, some are a bit less expensive and there has been more research to support the use of these machines with children who have ASD in the last few years, so I have been far more inclined to seriously consider using them with younger children (as I work with preschool and young elementary aged children exclusively.) The first step is to give this option serious consideration.
  2. Here at my clinic I usually get preschool aged children playing many games with parents within six months. This means that the child has developed many joint attention skills, including letting parents know in some way that he or she wants to play a game. By this point the child is responding positively and willingly becoming involved when parents suggest playing a game--at least a good percentage of the time. The child is staying in a game for an extended period of time--taking many turns. If we have found the right games, the child is showing pleasure in some games and preference for some games over others. The child has learned that it is fun when mom and dad imitate what he or she is doing and will purposefully do things so that a parent will imitate. The child has learned to imitate parents, trying out new ideas, however simple, when a parent does something new that is cool. Usually by this time, children can choose a game by looking at a photo of something that represents the game or at a Mayor Johnson Boardmaker symbol picture. By this time, we have modeled some useful single words and short phrases thousands of times in these games both at home and in our clinic. If a child has learned all these Joint Attention Skills and still has not started saying some intelligible words, we start to think seriously about augmentative communication. We have not given up on communicating with speech but we know that a social foundation for speech and language is in place and now the problem is that the child cannot say words. Even if it is a temporary assistant, we will use augmentative communication systems so that the child can successfully communicate as much as possible as fast as possible. The more time a child spends unable to say what he or she wants to say, the more discouraged that child will become. The child needs to use the words not just hear them in order to develop language skills. Problem behaviors will be much more of an issue, as well, if we don't get the child a way to communicate.
  3. Just as a side note, if six months has past and the child has not learned these Joint Attention Skills, I know that it is going to be a long haul for any number of reasons, but I still start thinking about using an augmentative communication devices--just perhaps not a high tech device just yet.
  4. We use talking buttons with all non-verbal children right from the start usually sending one or two home with a family as soon as we can get a game established using the buttons. We may have shown a child and used and perhaps sent home mid-tech talking machines like the GoTalk20+ which is why you can find several video models using this device on this blog.
  5. If the GoTalk20+ seems to be useful, we teach a parent how to program this machine (very simple indeed) and how to think about new activities using this device (not quite as simple) and we encourage a parent to get involved in the process. We are looking to see if the child can communicate more things using this device than he or she can without it and if the machine is increasing the frequency of communication. If using the machine is going well, and the parents can afford to buy one of these, I suggest that they do. Sometimes there are other funding sources that we access. I never wait for schools at this stage because, in this area of the country, it generally takes too long. Sometimes, though, schools are ahead of me in using the device and I am really happy when that is the case. After a parent has purchased the device, and has found ways to use it at hime, he or she will often ask the school to use the device at school too if this is not already happening. Parents need to go in and show the school staff how the machine is being used at home.
  6. When it becomes a pain in the rear (sometimes almost immediately) to make new overlays for the GoTalk20+ this means that the child has outgrown this device and is ready for a high end devices. I tell parents that it will not be a waste of money to buy the simple device first because 1) we will be able to collect data to support the funding of a high tech device this way and 2) the high tech device will need repairs sometimes and the child will still have a voice and be able to use the low end device while the machine is gone back to the factory.
  7. We have recently purchased a couple of Springboard Lites that we can use as trainer/loaner machines here and I expect that this will make the process easier. I am, as I said in my previous post, not interested in moving forward unless a parent is willing to learn all there is to know about whatever machine we decide to purchase for the child. It is a burden I would like to spare the parent but I don't believe the machine will be truly useful unless the parent has made this committment and learned these skills.

This in a nutshell is the process here. Parents are highly involved from the start. If a parent does not show any interest in supporting the process--I don't move forward. Some parents have just bought a high end device and not even messed with school funding or insurance funding. It is an expensive committment but it sure moves the process forward in a hurry. Mostly, we have begun the laborious process of getting funding for a machine once we are at this point--but we have collected some pretty good data that a child will be successful and this is very helpful.


Bonny Sawyers has put together a brief overview of terms that are useful on her blog to help you understand some basic ideas about augmentative communication options and she has a good list of links on this post.

Our clinic has recently purchased two Springboard Lites from this company. They have a terrific website with more information and training than you can learn in a month: The Prentke Romach Company:

Another company with a great deal of training online is DynaVox. Over the years, we have helped several kids use machines from DynaVox Technologies:

One place to buy a GoTalk20+: and should you buy one in November 2008, give them this number SRC08 and the clinic where I work (entirely supported by donations and grants) will get a little kickback. If you buy anything on this site in November we will get a small percent. More about that next post.

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