Thursday, April 8, 2010

When to Start a Child on an Augmentative Communication Device

I wait less time than I used to in getting children who are nonverbal onto an augmentative communication device (a device that talks for the child). I wait less time because I am learning that these devices are useful for getting speech and language started even for children who end up becoming verbal and that if a child remains nonverbal, which unfortunately is sometimes the case, the gradual introduction of these machines into the child's life cannot start too soon.  All the while that a child is nonverbal, that child has lots of things to say.

We are constrained like so many other institutions by the cost of these devices and often start with an inexpensive machine that has about twenty buttons and is really no more than a complicated tape recorder.  We happen to use the Go Talk 20+ but this is not a recommendation of this device over all others--it is just what we own as a clinic and can lend out to families.  With a device like the Go Talk, you record a short message on each button and then put some kind of a picture on the button so that the child (and adults) can remember what the machine will say when that button is pushed.

Some children are far more interested in using these machines than others and figuring out what messages to record is always tricky but if we choose correctly for a particular child and model the use of this machine over and over in situations where it is useful to communicate (from that child's perspective) then most children start using the device to communicate independently.  We don't record a message on all the buttons at the beginning--rather we record  a few words that we know will be useful in many games and situations like Go and All Done  and More and start with these.  Gradually, we add pictures and recorded messages to other buttons and never, ever, (if possible) change the location of buttons that the child has learned to use.  Moving buttons around seems to confuse many children--not unlike how I would feel if the letters on my keyboard were moved around all the time, I guess.  We quickly add the names of people who are important to the child (mom, dad, teacher) so the child can call for important people or talk about important people.  We gradually add other buttons we hope will be important--some buttons that can be used to request important activities like (eat, drink, toys, go outside, swing, jump) and some buttons to express emotions like mad, happy, sad and and emotional expressions of joy or dismay like COOL! and OH! NO!

It is thrilling to me and to parents when the child spontaneously uses the machine to say things that he or she could not say without the machine.  This week, for example, a child hit the mad + Dad buttons when his father left the house then immediately hit Mom + more + go to get his mom to continue the game of spinning him around in a chair since his dad had left and could not keep spinning him. Nobody had taught him to use those buttons in that exact way and, in fact, we were only modeling the use of two buttons at a time. He is truly understanding how to communicate with this simple machine and soon will need a more complex machine to say the things that he will want to say--all long before he is able to use speech to communicate.  Because we have built a strong case for his capacity for communication with the Go Talk, we will be able to get funding to get him a more complex machine and I think we will have to do this soon.  We have not given up on speech with this child, we just know it is not a given and at best, for this child, it will take too long.  For some children with autism, motor planning difficulties make speech a very hard skill to master and we know that we need to find an alternative means of communication quickly. For a child to be able to use words to say that he is mad at his dad and wants his mom to spin him in a chair, this is so precious an event that I can't bear to have a child miss being able to do this. This is why I don't hesitate to start using augmentative communication devices--whatever happens, using these devices is a win-win proposition.


Sue said...

Hi Tahirih,
we are going through this whole process with a studetn at our schoool at the moemnt. magic stuff :)

Niksmom said...

Oh how I wish more speech therapists felt this way. In my son's (old) school, they really only pushed PECS and a 4-button talker.

It took us nearly 8 months to accomplish but we got my son a Vantage Lite just recently. (6 months was just trials to see if it truly was the right device for him.) He is making rapid progress and really discovering the freedom of being able to make himself understood. The changes are fantastic.

Love your analogy to moving the keys on your keyboard! I think that's why PECS didn't work for my son...too random and required too much difficult concentration to figure out what things were, let alone how to use them to covey anything meaningful.

Tahirih said...

I am really happy that you got a Vantage Lite for your son and it is working. As Sue said, when it works,and it often does, it is magic!

Liz Ditz said...

The iPhone /iEverything apps developers are going wild:

There's Grembe

There's one new to me:

Looks pretty slick, and if a parent already has an i-device, the cost is low enough to try it out.

Paulene Angela said...

I'm in total agreement with Niksmom.
Thanks Tahirih x