iSupports for Children with Autism: Photo-Sort and iCommunicate

My first goals for helping parents start to use the iphone, the ipod touch or the ipad to support their child with communication are:

1) Teach parent to communicate with a child using inexpensive programs (apps) that can be put on the ipod touch, the iphone, and/or the ipad.  Many parents have purchased one of these devices because they already use photos or picture symbols with a child and want to keep all those hundreds of pictures in one handy place.  For those parents, I teach the parent one way to organize photos or pictures symbols so that it is easy to find a picture  or a group of pictures and use them.  For some parents, this is a new idea and then we talk a lot about why it is helpful for a parent to do this. This is Parent to Child Communication.


2) Teach a child to  communicate in new ways on the device--usually by touching photos that will say words when touched.  For children who are nonverbal or restricted in the way they use language to communicate, giving the child an easy way to say new things is a powerful support to communication learning.  This is Child to Parent (or others) Communication.

Lately, I have been using two apps most often, Photo-Sort and iCommunicate.  I teach the parent how these apps work and then we start solving communication problems and teaching new communication skills with whichever app is more appropriate.  I suggest this one/two approach for anyone reading this.  First, get these apps and learn how they work by going to the developer websites or playing around with the app--or getting a teenager to show you.  Then, take one communication problem or goal at a time and work on it with your child.

I love these devices because they allow a child to have good communication supports in all environments.  With nothing but these two apps, you can do more to help your child cope with communication limitations and more to help your child develop new communication skills with a few minutes of work than parents were able to accomplish with hours of work in the past.


Photo-Sort Video







Photo-Sort is an app that allows you to quickly select photos from the photo albums that you have stored on your device and show your child a few of these photos at a time.  For example, I might have a photo of every kind of food that my child likes on my iphone or ipod touch or ipad because I want to use these photos to help my child participate in grocery shopping.  I don't want to use all the pictures on any particular shopping trip, I just want to use the pictures of items we are going to buy today.  Photo-Sort allows me to select just the photos that I want for that days shopping trip.  After we are done shopping that day, I delete the whole folder and make another one the next time we shop.  It takes only minutes to create a visual support that is perfect.  You can see how to use a visual shopping list with a child in this video.  This is Parent to Child Communication.

iCommunicate Video




  
iCommunicate allows you to do the same thing only add sounds--including sound effects, words, phrases, or whole sentences. This way the child can touch the photo and say something--which is Child to Parent (or others) Communication.  I love iCommunicate because this app (and some other similar apps) make it possible for a child with autism to have wonderful voice output communication device for hundreds of dollars rather than thousands of dollars.  There are so many ways this app can be used that the only limitation is the imagination of the parent or whoever is creating communication boards for the child.

Here is one example of how iCommunicate could be used. Suppose you are trying to help a child participate in choosing items to put on the shopping list while still at home. You might be trying to help a child learn how to use language to plan.  In this case, the child needs to be able to communicate his or her ideas to the parent.  This would be a good time to use iCommunicate because with this program, the child can suggest ideas about what to buy at the store even if he or she does not yet have the verbal skills to using language this way.

Watch for more ideas on how to use iCommunicate in upcoming blog posts.  I have been collecting video clips with lots of kids using this program successfully and I can't wait to show them to you. 

Follow Up on Augmentative Communication Devices

In the comment section below my last post, Liz Diz provided some links to some new options for families who are considering using an augmentative communication device.  I want to publish these on the blog itself rather than the comment section because I think it might be of interest to others:

Liz Ditz said...

The iPhone /iEverything apps developers are going wild: There's Grembe http://www.grembe.com/ There's one new to me: http://mytalktools.com/pHome.html Looks pretty slick, and if a parent already has an i-device, the cost is low enough to try it out.

Please comment if you have tried either of these options and have good information about pros and cons.  These new options are interesting and although I have not tried any of them yet I am hopeful that such options will result in getting a device into the hands of more children who need a device to support communication. It is also possible that when the software is created for devices that we are already familiar with like the iPhone, it may be easier for families to learn how to use the application.  For older children, using an iPhone has a certain Cool appeal that is attractive.

Here are some more links sent by Liz Diz:

I wanted to add a few more iPhone apps for your readers to check out. Some of the links lead to reviews and some to developers' pages.

I don't think there's "one ring to rule them all" -- one app that is perfect for everyone.

There's a blog covering Apple products and disability, ATMac, http://atmac.org/

ATMac covers all Apple products with a slant towards disability. We have an interest in users with a disability, adaptive and assistive technology, and making accessible programs and content


Go look at:

http://www.converseapp.com/, iConverse, a really simple AAC.


For those with hearing impairments, check out http://www.apptism.com/apps/soundamp SoundAmp

There's a ASL tutor app: http://idev2.com/iSign/iSign.html, iSign. There's a similar app, , http://atmac.org/sign-smith-asl-animated-dictionary-for-iphone-and-ipod-touch/SignSmit

h ASL

The "time timer" is a tool a lot of us use. Now there's an iPhone app version: http://www.appstorehq.com/timetimer-iphone-79828/app.

Grembe also makes iReward: http://www.grembe.com/home/ireward

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.

Using a ZAC's Browser to Provide Social Interaction

Guest Blog by: Joanna Rien,
UMD Graduate Student

This video clip is of a child and his play partner reading an e-book on ZAC’s browser about a train and animals. As you’ll see, the activity is repetitive and cyclical in nature (client does something, play partner does something, computer does something, and repeat). The use of the concrete animals provides the client with the opportunity to connect what he is seeing on the computer to something that is happening in real-life. This activity is also useful in that it allows the client to complete MOST of it independently (watching the video and communicating on the Augmentative Communication Device saying “go”, “turn page”); however, he still needs a play partner to hit a button on the computer to turn the page and provide the animals. Each person has an important role in this activity.

Many of us use the computer as an opportunity to escape interaction with others, if only for a few minutes, whether it’s to check our email or play games. For children with autism, this is not the ideal. ZAC’s (Zone for Autistic Children) Browser is an educational website created for young children with autism, pervasive developmental disorder, and asperger syndrome. It allows time for the child to use and learn the computer in a safe manner, however if used by a young child independently, the child is apt to learn that he or she can escape social interaction very happily this way. If more interaction with others is the goal, and it is, then ZAC’s browser can be used but the way one uses it should be carefully thought out. If used appropriately and with intention to increase socialization, ZAC’s browser can be utilized to increase communication and interactions with others. You can see one way that this was accomplished in this clip.

Talking to Others and Talking to Ourselves

Andrew is five years old and he has been struggling unsuccessfully to hang on to words for years. Somehow a word just disintegrates in his mind even after Andrew learns a new one and that word may not be heard on his lips again for months or years . It is frustrating for him and for his family because in a situation where he was able to communicate last week, he may not be able to communicate this week.

A few months ago, we started to show Andrew how to use a special computer that can talk for him--a Springboard Lite. He was using PEC's quite well at school, and it has been a wonderful communication system for him, but his mother found it difficult to keep track of all the pictures that he needed at home and he never seemed to have the right pictures to communicate things that he really wanted to communicate anyway. Andrew was most motivated to communicate when something new and interesting happened like when he discovered a stop sign on the Oreo Cookie package. There was no way to talk about this with the PEC symbols that he had. But with the talking computer, because there are thousands of picture symbols already programed into the machine, it was possible for mom to create a page about the stop sign on the cookie package in about five minutes. On occassions like this, Andrew would be running back and forth across the room, touching the stop sign picture and flapping his hands until when his mom could hand Andrew the newly programed computer and he would then start talking with his machine right away saying something like, There is a stop sign on the Oreo Cookies. Awsome! That few minutes of programing would give Andrew something to talk about for two days.

One cool thing is that Andrew seems to be retaining words that he uses often on the talking computer. We don't know if he would truly retain these words over an extended period of time since we are not taking away the talking computer to see, but he does spontaneously speak using words that he previously only said on the talking computer. Where before Andrew might have said one word, cup, at dinner, now Andrew has at least twelve foods that he can spontaneously ask for with or without the talking computer. Andrew is doing a lot of self-therapy to learn new words since he spends time on the page about food pushing the buttons over and over even when he does not want to eat. This is true of the food page and it is true of other pages as well. Preparing him to take a train ride recently, his mom found a YouTube video clip of the train that they would be taking and Andrew and mom watched this clip a few times. Then she made him a page on his computer to talk about the upcoming train ride. Andrew pressed buttons on this page over and over in the days leading up to the train ride day. Andrew did not have his talking computer with him when he actually went on the train ride but he was able to say all the things he had practiced saying about the train ride appropriately. We are going on the train. This is fun! We are going over the bridge. I like trains.

Language is such an important human capacity and even I underestimate how important it is and need to be reminded. Andrew reminds me every week as he uses this machine better and better and for more and more purposes. Here is the story that got me teary today. Andrew has been unwilling to have a bowel movement on the toilet even though he can urinate in the toilet independently. His family has worked hard to convince Andrew that he should consider this option but to no avail. They know that Andrew does things in his own time. A few days ago, Andrew started pushing buttons on the talking machine to say You need to use the toilet. Mom did not program the computer to say this, he just found the buttons on his own to say this phrase. When mom thought he might be communicating a request to go to the bathroom, he made it clear that he did not want to go at all but he persisted in pushing those buttons over and over for two days. She wondered why he was saying this over and over but, after all, he is five. On the third day, Andrew's big brother called his mom excitedly saying, Mom, Andrew is pooping on the toilet! Andrew had independently decided to do this. Apparently he talked himself into using the toilet by telling himself to do so for two days and working up the motivation to do it on his own. He is now out of diapers.

We imagine that a child who can't communicate verbally with others is none-the-less able to communicate with himself or herself. But apparently, not so much for many children with autism. They do not have the language skills to tell others what they need, think, feel, remember, wonder, imagine, plan, wish, consider..... Nor the language skills to tell themselves what they need, think, feel, remember, wonder, imagine, plan, wish, consider....

It seems like a lot of work and money to provide a child like Andrew with a computer that is complicated for everyone to learn and costs about as much as a good used car. But giving Andrew the ability to communicate with others and communicate with himself is proving to be truly beyond price.