Showing posts with label non-verbal. Show all posts
Showing posts with label non-verbal. Show all posts

Practical Ways for Teaching Nonverbal Learners--Come Join Us!

   You are invited to join the conversation between Peggy Ployhar and myself on October 1, 2019 at 8pm (Central Time Zone). We'll be talking about ways you can teach your nonverbal children and teenagers. This conversation is directed at families who homeschool but is relevant to nonverbal learners in the school system as well. Bring your questions about adapting instruction and evaluation and we'll give them our best go!

If you haven't yet seen the awesome website SPED Homeschool sponsoring this event, it's a MUST SEE for families living with special needs. While the target audience is homeschooling families, all families living with disability will find a wealth of information and support at this site. There are articles and videos galore from experts with a wealth of information and personal experience. Many of the topics address issues extending outside the school day, such as incorporating therapy into the day or making religious instruction accessible to kids with a variety of special needs. If you participate in Facebook, SPED Homeschool sponsors some groups that sound pretty fabulous. Take a few minutes to browse the site and you will be impressed.

See you on October 1st!
Rose-Marie

AAC and Rett Syndome

Those of you who may not yet know of Carole Zangari's AMAZING blog, PrAACtical AAC, you are in for a fantastic treat. For any parent or teacher supporting a non-verbal child, Carole's blog is such a wealth of information!!! She has so much information there, it will take months for you to go through all of it.

Today, PrAACtical AAC is featuring an excellent guest post by Dr. Theresa Bartalotta. In this post, Dr. Bartalotta gives a concise, helpful overview of Rett syndrome and ways to support communication in children and adults with the disorder.

I appreciate how Dr. Bartalotta addresses the challenges our kids with Rett face as they relate to communication:
  • physical limitations
  • response time
  • non-standard communications that can become highly meaningful
She also talks about particular AAC interventions that can be useful, including techniques, partner training, and low- and high-tech solutions that have been shown to be successful with some kids with Rett syndrome.

Those of you who know me well know that I take exception to the description of the Rett syndrome that assumes "most individuals are severely cognitively challenged" because we simply don't possess the tools to measure that. If you can't prove it, you can't presume it, right? Better to give the benefit of the doubt and provide rich opportunities, letting kids bloom to the greatest of their potential. That's my soapbox and I'm not stepping off, sorry.

For an introductory article on AAC and Rett syndrome, Dr. Bartalotta covers a lot of ground! If your child has Rett syndrome, it's worth passing on to your child's speech therapist.

Then, once you do that, go back and browse the PrAACtical AAC site. You'll be glad you did! Seriously, go check it out!




The Role of "Yes"

If you interview 1000 parents of typically developing kids, 999 will say that their children learned the word “NO” before they learned the word “YES” (Anyone have the real statistic? I made up numbers to make a point, but then I have editorial privilege here). Because this is the typical pattern for learning these two words, I have long advocated that we teach these words in the developmental order of NO first, followed by YES. You can read about that here.
I still maintain that this is true. However, there is some interesting discussion going on in the AAC circles about this order right now.
Pati King-DeBaun, whom I greatly admire, is a long-time authority and advocate for children with severe communication needs. She posted an interesting discussion on her blog about “yes” on its own. You will find it here.
What Pati says is that acknowledging a child’s “yes” response gives them the ability to communicate through partner-assisted scanning. If you aren’t familiar with this communication procedure, it means that a partner lists off choices for the speaker, whether verbally or with symbolic choices (pictures, line drawings, or objects) or both. The partner indicates when the item of preference is offered. PODD, or Pragmatic Organization Dynamic Display, typically uses partner-assisted scanning.
Traditionally, we have asked kids during partner-assisted-scanning to tell us “no” for each of the non-preferred items and stop us with a “yes” (as in, “That’s it!”) when we reach the item of choice.
But Pati says “yes” alone will give the kids the ability to use partner-assisted scanning. She suggests kids don’t even need a “no” response to be able to successfully communicate using this system.
Does this conflict with my opening statements about teaching the word NO before the word YES? I say not. They are compatible practices and here’s why.
Pati is acknowledging the child's signal of affirmation of desire. This is innate in infants; just watch them. When baby sees Mama rustling up the ingredients to make up a bottle, he starts squiggling with anticipation. At another time, he reaches and kicks his feet when Daddy holds up a favorite toy. This occurs long before the child is developmentally ready to begin conventional word use.
This same baby will likely not respond when Mama gets out the cat food and can opener to feed Kitty. He has no interest. He does not yet pay attention when Daddy picks up the newspaper (give him a few months and that will change!).
These are the same innate reactions Pati talks about in her blog post. If we observe our kids, they have signals to affirm their desire for something. By ignoring what they don’t want, they are withholding affirmation and that is adequate for us to know they don’t desire it.
I really appreciate Pati’s thinking for several reasons:
            1) It allows children to communicate successfully before they have two consistent responses. All they need is an affirmation response. It is our job to observe what that response is. For kids with strong motor challenges, this need for a single resonse is such a gift.
            2) It saves a great deal of physical energy, since the child only needs to respond once out of all the choices offered. It also speeds the rate of communication…a LOT! Again, what a benefit to kids with motor planning issues.
            3) Developmentally, this is consistent with the ability to affirm desire before the acquisition of words (or, for non-verbal students, symbolic expression, including sign, picture symbols, etc). How wonderful that it allows kids to communicate before they are ready to leap into more complex developmental stages!
Now, all that said, I still maintain that when teaching the words yes/no expressively¸ “no” is most easily learned first. This is because word acquisition typically develops at the same time that autonomy rears its little developmental head. “No,” as a means of rejecting, is concrete and easily grasped and gives Little Miss Autonomous a way to voice her new interest. “Yes,” on the other hand, often represents more abstract concepts, such as things that are intangible (feelings, for example), future events, or simply agreeing with that Mother-Who-Threatens-My-Autonomy. And what toddler would want to agree with that awful lady?
For all the good things that acknowledging the affirmation of desire signal alone can do to help kids communicate through partner-assisted scanning, I am so grateful Pati opened up this discussion!
What do you think about this? Does signalling an affirmation of desire without a corresponding “no” work?
And if you haven’t read Pati’s post yet, please do. It gives us important things to think about.
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You might also be interested in reading "Yes, No, Maybe so..." 


Building Blocks for Communication

Watch a loving parent interact with her young baby. Baby babbles “oooo” as mama picks up a teething biscuit. With great enthusiasm, mama responds “Yum, you want a cookie!” Baby gets that cookie and, even more importantly, she gets adoring interaction with one of the most valued people in her life.
"Yum! You want a cookie!"
Mama never doubts her little girl will learn to talk. Her hope inspires her to repeat scenes like this thousands of times over the next couple of years. The two go through this ritual of babbling in the context of an activity, pairing the babble with a word and a reward, and language naturally unfolds. Replay this scene over thousands of years, over millions of families. It is timeless, universal, and seems effortless because it is fueled by hopeful expectation.
Children without the ability to develop verbal speech deserve that same support as they develop alternative communication. The sad thing is, it rarely happens this way for them.
I don’t know why. Maybe people view non-verbal communication as “broken,” needing to be “fixed” rather than naturally caught. Maybe because it is not the way the adults naturally communicate; they feel it must be structured and purposefully developed. They’ve never seen it modeled. It may take planning to have materials ready…
True, something outside our experience may need more structure for us to teach. BUT that doesn’t mean we have to leave behind hope for communication or to impose unnatural strategies.
Perhaps even more than their peers with speech, our kids need the benefits of the kind of support illustrated in that mother-baby story setting the stage for our discussion.
What does the mother from that story teach us about building the foundation for effective communication?
1) Build relationship. We value the child, we express that value to the child.
We value their efforts. We pay attention to them. We notice when they are trying to communicate. For some of our kids, the motor effort is so tremendous that they simply haven’t the energy to repeat themselves. Eye gaze is a very quiet response mode; you have to be watching or you will miss that telling glance.
Teachers, therapists, even extended family that doesn’t see the child daily need to remember that it takes some time to build a relationship. If a child doesn’t try to communicate with you right off the bat, they are no different than many speaking children. It can take time to become familiar. Give yourself time to tune in to the child’s subtle cues. Give the child time to feel safe with you.
Relationships that nurture are those that believe the best in someone. We hold high hopes. We expect good things for them. We expect that they will progress and grow. All kids deserve this kind of expectation.
Our illustration showed mama cherishing baby’s stumbling efforts, shaping them with a loving model spoken correctly. We accept whatever our kids can offer, assign meaning to their efforts, and lovingly model a way they can express that idea more clearly. We expect that they will show more clarity down the road.
2) Build trust. The child has to trust that you are listening—really listening. And you have to trust that the child means what she says. We do this when we take what he says at face value. He knows we will act on his requests, honor his choices and opinions...just like we would for a speaking child. That is going to make him continue trying and learning.
He may make mistakes. He may touch the symbol for “asparagus” when he really wanted “ice cream.” That’s okay.
You don’t ask him, “Are you sure? Show me again.” That shows him you doubt what he has said, and doubt stands opposite of the trust you are trying to both show and to cultivate in him.
Nope, you offer him a bite of asparagus, just as he asked. He’ll purse those little lips in refusal. That opens the door for you to say, “But you told me you wanted asparagus. Have you changed your mind?” There—you have affirmed what he said, and you have given him a way to back out. You trusted him; you acted in a way that allows him to trust you.
You offer him the symbols again.  This time (hopefully!), he’ll touch “ice cream.” Over repeated practice in different situations, you can trust that this mix-up won’t happen again. You may never be able to get him to choose asparagus again (try steaming it ever-so-lightly...makes a big difference).
In our opening story, mama didn’t ignore the baby. She didn’t refuse her the cookie because her request wasn’t perfect. She didn’t pull a fast one, swapping out the cookie for a healthier snack. She is teaching her that she can trust mama to meet her requests, however budding they are right now.
3) Build conversation. Communication grows when people reach out to one another to share ideas. It does not grow out of drill.

One of my favorite mantras as a teacher was “Teach, don’t test.” A reasonable communication corollary would be “Talk, don’t test.”
We teach—we talk—by living life alongside our child. We give them natural reasons to listen and to express themselves.
If you want to teach colors, talk about the colors in your world. Marvel at the blue of the sky, the green of the trees, the red of the tomato as you point them out. Support him—both receptively and expressively--with the color words he needs. Give your child a choice between outfits/blocks/cars of two colors.
Don't hold up a banana and quiz her by asking what color it is. There’s the possibility she'll assume you aren't clever enough to figure it out yourself. And if you ask her to repeat herself over and over, she will give up trying to teach someone who simply cannot learn, no matter how many times she has tried to teach you that a banana is yellow.
Similarly, if the child tells you he wants the red crayon, give him the red crayon! Don’t ask him to repeat himself a dozen times! Sadly, this is a HUGE and heinous problem non-verbal communicators face. We do not do this to speaking children. Our non-speaking children deserve the same respect.
I can't tell you how many kids get branded as incompetent when it was the teacher who set them up for failure by 1) asking stupidly obvious questions that insult the child, 2) asking the child to repeat themselves ad nauseum, until finally 3) the child gives up (and is, at that point, saddled with all kinds of demeaning labels).
Our mama heroine did not demand that baby repeat her “word” over and over, and especially not  until it was pronounced with dictionary precision. She didn’t stand at the counter and ask her, “What’s this?” No, mama took baby's initiation and responded. She kept the conversation going even though the baby could not add anything more. This is a child who is not at risk of giving up.
Three simple, critical building blocks foster communication: relationship, trust, conversation. Our story illustrates all three. If your child's story doesn't illustrate them yet, how can you change that?

You might also like these posts:
Building Communication through Play
Let's Talk: Get the Conversation Started
"She Talks with her Eyes"

Photo by abbybatchelder. 

The Power of Waiting

It was inevitable. The accident we’ve worked so hard to prevent came to life this afternoon. My daughter’s myoclonic jerking knocked her to the floor. I was trying to dress her while she stood, my hands were busy, and I just couldn’t catch her in time as a jolt of myoclonus sent her lurching against a cupboard door and down onto the linoleum. She was crying, obviously shaken. There were no obvious signs of injury—thank goodness!


Now, a mother’s instinct is to want to know right now what is hurting or bothering their child. I am as much driven by that same instinct as the next mother.
However, I have found that when our daughter is upset, trying to get her to express why she is upset pushes her into overload. It seems to work much better to reassure her that we will talk about the problem later, after she has calmed down. This accomplishes several things:
  • it lets her relax, knowing that she will have an opportunity to discuss the problem. She wants to be heard. But immediately is not necessarily the best time. What may be best is soon after the child is calm (just never, ever forget to hold that promised discussion if you want your child’s trust).
  • it lets her deal with the problem at hand, avoiding the added stress of communicating. Dealing with pain or frustrating emotions is hard work. Communication can also be hard work for our kids, even though it may come easily for you and me. We need to remember that. In an already-overwhelming situation, having to communicate about the issue may just push them over the top.
  • it lets me have some time to organize my questions and her possible responses. This (usually!) reduces frustration in the long run. If I’m not tuned in to my daughter’s feelings or don’t have the right choices ready for her, both of which are likely faux pas in the heat of the moment, that adds stress upon stress. Stress does not tend to smooth communication. Better to come back to the issue later.
This policy of coming-back-later to an upsetting problem, be it pain or an emotional upset, seems to work well at our house for supporting communication. My daughter is a teenager; sometimes teens get upset or frustrated for mysterious reasons not obvious to the adults around them. I find this strategy to be especially helpful with unexplainable tears. But it applies just as well to known issues…and to younger children. In fact, it was during early elementary school that we stumbled across this technique of promising to let our daughter tell us what was wrong later, after she was calmer.
Now, of course we offer comfort right away. That’s a parent’s job. We just don’t necessarily ask for our kids to talk about the problem right away.
There may be exceptional non-verbal communicators who can communicate in the middle of an upsetting situation. But many others, like my daughter, find that the stress of an upset makes communication to be the proverbial “straw that breaks the camel’s back.” They are already processing as much as they can handle, just dealing with the situation. Asking this group of communicators to talk about the problem in the heat of the moment is expecting them to do more than what is humanly possible—for them. Let’s respect their humanity…
So, what about today's accident?
I snuggled my daughter immediately after her fall till she calmed down, then let her rest on her stomach so her muscles could relax while the myoclonus resolved, and after she was fully calm we talked about the accident. She told me her mouth and shoulder hurt right after the fall, but they are fine now. Mostly what had her upset was the frightening noise of hitting the cupboard.
I didn’t have the heart to ask if the fall shook her faith in my ability to keep her safe. I’m not sure I’m strong enough to hear the answer…

How about you? Does it work better for your child to communicate after there has been time to calm down?

"Yes," "no," maybe so...

Communication is a BIG topic on several Rett parent lists I participate in. Parents often ask for information as they think about getting their 18-24 month old girls started with communication. One of the questions that comes up very often is "How do we go about teaching 'yes' and 'no?'" It's such a great question; these are abstract, intangible ideas that typically-speaking kids latch onto without being directly taught, so how do we go about teaching them directly? Perhaps it might be helpful to talk about that now.


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I think it is critical to look at typical chronological development with kids this young. At 18-24 months of age, our kids with Rett haven't had time to fall very far behind, and their emotional status is often right on par with their typical peers. We can use these facts to our advantage in teaching communication skills, particularly the less concrete concepts of NO and, later, YES. 

I’m not a speech pathologist but a special ed teacher with lots of training on language development. What I share may not be what every speech pathologist would do but it worked for my daughter and for many other kids with Rett or similar issues. You will also see that everything I do with expressive and receptive communication works towards developing literacy skills, because I fully expect any of our girls to learn to read in time.

Eighteen to 24 months is a time in chronological development when kids with Rett can develop communication skills right alongside their peers. The timeline may be a bit different for kids with other severe disabilities, depending on their early experiences and health issues, but the process is the same. Think about what you hear from verbal kids as they are turning two years old..."NO, NO, NO!" and "MINE!" It's an age when kids want control and to assert themselves, most often negatively. Ah, toddlers! You gotta love 'em! So in teaching yes/no, start with NO. Offer your child something you know she isn’t fond of and have the picture symbol for NO at the ready. When she refuses the object, whether by turning her head or pushing it away or however she rejects things, hold up the NO card and say “No, you don’t want ___.” Encourage her to look at or point to the card. Certainly don’t make her have the item! Just do this one time (no kill and drill!!!! We have to instill the trust with our kids that we believe what they say the first time!!!), but repeat the process often throughout the day: as you see she’s getting full at a meal, when an errand is an option (use her coat as the object), if there is a book or toy she’s not particularly interested in…. The whole purpose of this is to give voice to what the NO card means. When she is first learning, don’t offer NO in a non-negotiable situation, because it adds too much confusion about control. After all, smart parents don’t ask any two year olds if they “want” to nap when it is obvious a nap is needed; they simply announce that it is time, no discussion.

Once your child is effectively using the NO card, begin to present it to her at the same time as you present the undesired object. Something to keep in mind is that you want to present the NO card in the same hand every time. The goal here is consistency that will allow the child to develop something we call "motor automaticity." This is a fancy term for memorizing where something is going to be in space, such as we do with the brake pedal or turn signal in our cars. Motor automaticity speeds up communication by reducing the need to visually scan among choices, especially when the child is using many symbols at once. At our house, I hold NO in my left hand, and I’ll get into the reason why later. Now at the end of her meal, you would ask “Do you want more broccoli (holding up the spoonful) or no?”

Some speech therapists suggest offering a fist for no and an open palm for yes. While I love this idea, I will confess my daughter refuses to use these signs. I wish she would, and believe me, we have tried to teach it. Perhaps if you do this from the very beginning, it would work.

While a child is learning no, she is also learning to label objects. Whether she will prefer photo representations of objects or line drawings is a very personal thing to be tailored TO HER (for more discussion on the kinds of symbols to use, see this post on selecting materials). Always LABEL the card, because this way you are 1) laying a foundation for literacy and 2) insuring that all people using the cards with her are assigning the same meaning to her cards. Be sure to start with items that are highly meaningful and motivating to her: favorite foods, people, toys and books, pets. Also include verbs with this…two year olds use verbs!!...for activities she enjoys: a bath, swinging, eating, drinking, etc. I suggest starting with favorite objects and activities, just because that is highly motivating and will help direct her interest. But once the connection is made that objects can be represented with symbols (or pictures), you can add in others that are neutral or non-preferred.

Now that she has a nice little symbol vocabulary and NO, you can start pairing choices. If you want to make sure she is rewarded regardless of what she chooses, offer cards of two preferred items. However, keep in mind that this can create internal conflict in ANY two year old, because most kids that age want BOTH at times and will get upset that they can only have one! So some kids do better emotionally by offering a favorite paired with a neutral item. You can also pair a card with NO.

As far as which hand to hold cards in or, if you prefer to use a Velcro strip or board, the cards should be placed from HER LEFT TO RIGHT in the same order as you offer them. This develops a left-to-right orientation necessary for reading later. This is also true for yes/no down the road…we tend to say “yes or no?” so hold them with YES in your right hand and NO in your left; we are mirror image to our communication partner.

On to YES! I personally would wait until a child's had plenty of opportunities to practice the other things because they are more concrete. Ideally, she would have NO down really well before you introduce YES, because the concept of YES can be interpreted as “not-no” in the mind of a toddler. That's mighty abstract! Now you are going to offer a favorite along with the YES symbol, and the NO symbol. She won’t want to pick NO, because she wants the item, so she’ll look to the item and you can point enthusiastically to YES say “Yes! You do want a cookie!” Just as you did with no, take her response at face value and give her the cookie. Again, do it one time and repeat many, many times in the day. What you are trying to teach now is that YES can be acceptance of any offer. You’ll be able to cut back to just YES (no accompanying object symbol) and NO before long.

Other abstract word pairs that I find extremely helpful are more/all done, stay/go, now/in a minute/later, great/okay/gross.

At some point as a child's development expands, she will want some word or phrase to stand for the gray area between yes and no. It should be whatever feels comfortable to you and her: “something else,” “neither,” “something different,” etc. This becomes particularly important when choices are not cut and dried, but deserve further conversation. A case in point was once when a boy asked my daughter to the 6th grade dance. She was only offered YES/NO, so she told him “no.” Perhaps she truly didn’t want to go with him. BUT maybe she meant she didn’t know if she could attend the dance at all, or if she needed to ask her parents first, or she’d rather go with a group of kids and not just him alone. Obviously, she needed an option of “something else” to keep the conversation going with that one!

I'm really encouraged by how far we've come in the last 10 years in our attitude about presenting young kids with communication technology. While we may have room to grow, "we've come a long way, Baby!!!"

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P.S.--My apologies for the goofy formating. :0( I'm just learning Blogger, and what you see in on your design page isn't always what you get when it's published! Thanks for bearing with me...and if you have any tips on how to get formatting consistent, I'm all ears!!!

Materials for non-verbal communication, Part Two

Yesterday we left off figuring which type of symbol your child can use best to express herself. This can take some time and experimentation, and that's just fine. My own daughter went straight into simple line drawings and that worked well for her.

Today we'll look at backgrounds and sizes of symbol cards.

Card size is determined by several things. The most important consideration is your child's visual and developmental needs. Very young children and those who have difficulty seeing tend to do better with larger symbols, such as 3" or 4" squares. This size is also sometimes needed if children require a large target to swat. 2" is a fairly standard size used by many kids and classrooms because it's still easy to see, and has the advantage of being large enough to be handled individually or pointed to on a board of several symbols. Symbols smaller than 2" can be a bit tricky to use (mostly for the person communicating with the child!) and are usually reserved for children with AMAZING pointing abilities or for access on computer screens.

Situations also dictate symbol size. If you are adapting a book to read along with symbol support (I'll cover this in a future post), the size of the book may require smaller symbols just so they will fit. If you need your child to make LARGE head or arm movements so you can see them easily (i.e.: watching in a mirror while riding in the car...be sure you are a PASSENGER interpreting your child, not the driver!), you might need to make oversized symbol cards for that situation. And here, I must digress to share a heart-warming story about large symbols...

My daughter had the most FABULOUS kindergarten teacher ever! This wonderful woman was a general education teacher embracing A, with all her unique challenges, into her typical classroom. Mrs. C had never had a student like my daughter before but she adjusted with grace and style. We created large yes/no cards--5 or 6" across and laminated onto cardboard--so A could respond to questions during circle time when all the students sat on the floor gathered around the teacher. In a fit of sheer brilliance (maybe it was frustration, but I consider it brilliance), Mrs. C asked ALL the students to answer her questions "talking with your eyes, the way A does." The cards were large enough that the whole class could respond with only their eyes...and thus the "silent response" was born. Mrs. C discovered that this response style calmed her enthusiastic little crew on those wiggly-noisy days when a productive circle time would have otherwise been impossible. Best of all, it gave the kids practice with A's communication and made them more watchful partners. I don't know if it helped A feel more blended into the group or an honored member but, either way, she loved it. Mrs. C had always taught her students sign for the letters of the alphabet, which I admired because it built an appreciation for an alternate way to speak (and it kept busy little kindergarten hands doing something constructive). Now the students had several non-verbal strategies to communicate...valued, natural, normal methods. How blessed are they to bring such an outlook to life!

Symbols don't have to be printed on colored backgrounds, but there are some benefits to color-coding. When children move from selecting between a few symbols to a whole board, color codes help them find the symbol they want more quickly. Color codes are especially helpful when children start combining symbols into phrases. But probably the biggest help is that they remind the adults talking with their non-verbal kids to pay attention to the kinds of choices we are offering. Are we teaching and talking only about things? Are we giving our kids chances to request activities? To comment or ask questions? Are we modeling and offering language rich with descriptors? When our symbols are color-coded, a quick visual scan at the options we have set out will answer that very quickly! Remember, just as the nutritionists tell us to "eat a rainbow," make sure you also "speak a rainbow!" The corollary is to make sure our children also have the opportunity to speak rainbows. If ever we find ourselves offering choices from only one color category, we need to change what we are doing.
 
The most important thing with color coding is to be consistent with the colors you chose. Fitzgerald (1954) created a key that is the most widely used today in high-tech devices, so it is a good one to start practicing with early on. In fact, if you suspect your child will someday move onto a computered voice output device, you might check out what colors are used on these devices and incorporate them from the beginning (i.e.: VS Communicator used on the Tobii devices assigns purple to items in the "places" category, light gray to "time" items).  

Goossens', Crain, and Elder (1992) created another key for color-coding that was the standard for use in special ed preschools for years, although I don't know if that is still the case today.


Color coding can mean printing on colored paper (which means you need to be very organized and plan ahead), printing solid colored backgrounds (if you own stock in a company that makes printer ink refills), colored in with highlighter pens (if you have unlimited time) or printed with colored borders (for those of use who have to limited money AND time). Three guesses as to how we color code at our house...I have neither time nor money!

One quick side note:  I do print YES on a solid green background and NO on solid red. It makes for some quick looking!

As we talk about sizing and adding colors, making the symbol cards starts to get more time consuming if you are using a word processor. If there is a way you can afford--or find funding for--a commercial symbol creating program, you will thank yourself.




Materials for non-verbal communication, Part One

You and your non-verbal child are probably already using some tools to communicate. Even tiny babies start early with objects, so let's begin there.

"Objects" would be just what you expect...the very toy, book, DVD jacket, snack food, shirt or whatever other item you might be talking with your child about. If you hold up Goodnight Moon or Bartholomew Bear as you offer to read your baby's choice and she points to Ba Bear, she has just used the book as an object to express her choice. It's an intuitive thing for both parent and child to do, and can be a very convenient way of incorporating choice-making in a natural way.

Even though my daughter is a teenager and capable of reading, we still grab objects when they are the most convenient, natural option. If she's choosing a movie, why not simply hold up the DVD jackets? It's quick and involves no extra work of creating a symbol to represent each movie. The same process goes for choosing outfits to wear or music albums. Sometimes it's appropriate to be able to select from a whole library of options, but when we need a quick choice, the simplest method is to snatch up the actual objects.

Some speech therapists subscribe to a theory that we must begin with the most concrete of symbols--objects--and progress through a specific sequence towards less concrete ones. My child development background causes me to cringe at that idea; I say we figure out what works for a child where they are now and start meaningful communication at that place. Personally, I believe that by the time we realize a child is not going to use speech, they have already had a great deal of practice with objects as a means to express their choices. Most will be ready to move to some form of symbolic expression about the time their peer group is learning to talk unless they have a visual disability and can only decipher meaning by touching a 3-dimensional object. If your child pays attention to illustrations in the picture books you read together, particularly if he looks to an item you mention specifically, you know he is capable of moving to a symbol system.

Paper symbols are easy to use and store (okay, storing the symbol cards can be a bit of a challenge, but folks have come up with some clever systems over the years). Symbols come in several varieties, each with their own benefits and drawbacks. While I'll present the paper symbols from most to least concrete, please don't think your child has to "progress" through every type! One will probably have greatest meaning for your child, and that's where you jump in.


1) Photographs, such as these from http://www.wpclipart.com/:


Ayrshire                 carrot 3

Real pictures of real items and actions can have very clear meaning. It is important to highlight in a photo ONLY the idea you are trying to have your child express. If you take a photograph to represent the child's pet, for example, ONLY the cat should appear in the photo...no living room, no kitty toys or food dishes. The cat's head or body would be photographed against a plain background, clearly identifiable as the cat. If you want to show "running," narrow in the focus to a single child running across an open field or blacktop rather than capturing the whole playground in the field of view. This visual clutter distracts from the meaning of the photograph. Become close friends with the crop tool if you take your own photographs. You might want to explore some of the commercially produced photo symbols.



 Clear photograph of "egg" with no distractions. It could be improved with a higher contrast background.


  Confusing picture showing "eggs." The child might focus instead on the bag, the arms, the shirt, the idea of "carrying..." Even if you were to draw a circle around one of the eggs to highlight it, there is still too much visual information.

Advantages of clearly photographed objects as symbols:  smallest cognitive jump from objects, easily personalized for the people/places/objects in the child's world, any item or activity that can be captured on film can become part of the child's vocabulary.

Disadvantages of photographs:  complexity of photos can be distracting (ie: child studies people's faces rather than making choices), cost of colored ink, learning curve for taking/editing excellent photos, challenge of illustrating abstract ideas (ie: how do you photograph "on" without the child being distracted by the objects in the photograph used to demonstrate the concept?).

2) Realistic drawings, like this: 
cow sketched
(http://www.wpclipart.com/)

carrot at rest
(http://www.wpclipart.com/)
         
These share some of the same advantages and disadvantages of photographs. Drawings tend to be fairly obvious. Sometimes the detail can be distracting, especially if there are a large number of choices presented at once.

3) Line drawings, such as these PCS symbol from Mayer-Johnson:

These can be printed in color or, for higher contrast, in black and white. Simple line drawings have the advantages of being quick to recognize from a large number of choices, drawn quickly if you are artistic, and purchased commercially. A disadvantage for some children is that they are more abstract than either photos or realistic drawings.

4) Words. Once kids can read, they may be able to use written words as a "symbol" choice. After all, words are symbols that literate people use every day to gain and send meaning. Words can be printed on cards or written on dry erase boards, provided the letters are large enough to support the child's visual needs. Advantages to words as symbols are that the set of choices is limitless and meaning is clear. Disadvantages are that children must be able to read and that the possible choices are not always visually distinct, which slows scanning across the available choices.

(courtesy of Mayer-Johnson)
Let me state a bias here that all paper symbols should be labeled. This not only helps develop awareness of the written word, it clarifies for everyone just what the symbol means! As hard as we try to make clear the meaning of a photo or line drawing, sometimes they are still a bit ambiguous. A label addresses this problem.

Paper symbols can be made with several commercial software programs. These programs tend to make the process of creating symbol cards quite efficient. As your child's vocabulary grows, you may find this to be a wise investment. Symbol cards can also be made in a word processor by inserting pictures or drawings into a table. While this is a time intensive process, it is an inexpensive way to get started...and it's something you can do today.
Tomorrow we'll look at symbol size and color. In the meantime, today would be a good one to try a variety of symbol styles to see which style works best for your child.

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You might also be interested in:

Resources for Free Communication Software

Materials for Nonverbal Communication, Part Two

Getting ready for non-verbal communication...

When most of us think about becoming parents, our dreams include the sweet things our children will say out loud. We imagine the cute babbling noises, the pet names our children will invent for their favorite blanket or toy, the "I love you's;" we know that we'll look back...in twenty years or so...and laugh at those innocent social blunders our little ones will make in front of strangers.

When it becomes clear our children won't be using verbal speech, those dreams are dashed. We are left without much direction, because most of us are only familiar with traditional speech, or perhaps sign, as a means of communicating. It feels pretty overwhelming and it's hard to know where to start. Our family was in that same boat, even though my own mother was a speech-language therapist and I taught special ed. The world of non-verbal communication is pretty small, but the navigation isn't so bad. There are some amazing speech therapists around the world who have dedicated their lives to helping our kids and they have developed creative ways to help our kids communicate even without speech. I am deeply indebted. These brilliant pioneers have helped me adapt to a world of non-verbal communication.

The very best first teachers, though, are our own kids. [Warning:  my bias is going to show here, as my child development background shows very strongly.] ALL kids start life communicating without verbal speech. Have you ever heard a newborn spouting off full paragraphs? Of course not! They learn to make little signs to us--cries, smiles, coos, waving arms and kicking feet, longing looks--and we respond by giving them what we think they need. Over that first year, they shape our responses and we shape those signs. While we surround our babies with an abundance of talk, song, stories, we don't expect them to repeat these back to us just yet. We learn to read our babies' expressive signs. Together we learn to communicate without words. This is what non-verbal communication is all about. It is fairly intuitive...and it carries over into more "standardized" non-verbal communication. While it may feel daunting to think about helping your child develop a method of expression that fits outside the mainstream, try to view it as an extension of what all children do instinctively. We are just expanding on that.

There are physical and cognitive limitations to deal with, of course. Some children have the ability to point or touch while others cannot control the movements of their hands. Some point eloquently with their eyes while others have no vision. Some wish to convey abstract concepts early on while others will be rooted in concrete thinking for a long time. Just as we individualize our responses to our newborn infants, so we will be individualizing for our children as they grow.

The place to begin non-verbal communication with any child is with the mindset that he or she is already expert at it. And really, we as parents are not too bad at reading those early signs. It isn't all that foreign or mysterious. It is our job to help them shape their expressions so they are more easily understood, and there are tools and techniques available to make that happen. That isn't so bad, now, is it?

Tomorrow we'll take at look at materials you can use for touch or eye gaze responses. I'll bet some are things you are already using...

Eye Gaze Techniques

Here are some additional pointers about communicating with eye gaze using objects, symbols or words. I left the post as I wrote it for the Rett Girls AT Ning because it didn't really seem to call for any changes. There are some concepts repeated from Friday's post but these are very important to internalize. If there are any things you would like me to elaborate on in the future, would you please drop me a note or leave a comment? Thanks!

I posted these suggestions on using eye gaze to another list, but thought maybe it would be helpful to repeat here. My daughter uses eye gaze to communicate, what I have learned is from her and other eye gazers I've worked with informally. Other folks' experiences may vary from ours, but here is what our experience has taught me:

1) Just because the concept of eye gaze is simple, reading eye gaze is not necessarily easy. We need practice and experience to become competent partners. Not all kids use the same techniques, in part because the end goal for each child may not look the same (see #2).

2) Eye gaze response procedures should keep in mind technologies to be used in the child's future. If a child will be using a dwell-click with head mouse software, for example, then it is important that they learn to hold their gaze to a choice for a specific length of time. Children who will not be advancing to a head mouse may find it beneficial to confirm their choices with eye contact to the communication partner, especially if they are socially motivated.

3) Similarly, if head mouse use is in the child's future, helping them learn to turn their head along with their eyes will support that technology. This can roughly be considered "nose pointing," although the child is merely directing the nose toward the choice, rather than touching it with the nose. If head mousing is not in the child's future, it's fine to hold the head still and cast long sideways glances with the eyes.

4) Motor ability must be considered. The length of dwell to a choice should be reasonable...five seconds (a standard dwell time expectation in too many IEP goals, sad to say) is WAY (WAY!!!) too long for most children, both in terms of head stability and attention span. Try it...five seconds is an ETERNITY and it slows conversation down to a pathetic pace. At our house, .90 seconds is a good dwell time and doesn't interfere with the flow of communication.

5) Positioning yourself as a receiver is very important. You must be able to see the child's eyes clearly. However, some children fixate on the face of the reader, so you need to be flexible. Head-on (180*) will work for students who do not fixate on faces, but for children who are hyper-fixated on faces, an angle just over 90* may be more appropriate. You learn from the child what they need as far as positioning in relation to the partner.

6) Children with hyper-fixation to faces may benefit from loose symbols held side-by-side in front of the reader's face, then slowly moved apart. The child's eyes will (hopefully!) follow the intended choice as they move.

7) Boards intended for finger-pointing tend to have symbols spaced too closely for all but the most skillful eye gaze readers (and users). Loose symbols allow you to distance the choices at optimal points from the user. These can be held in the hands or affixed to velcro-sensitive boards (I personally like 3"-wide strips of indoor/outdoor carpet mounted to mat board, 15-18" long. Post-It makes poster board that can be cut into strips that holds symbols temporarily as well).

8) Not all days are necessarily the same. Some "off" days may require few choices spaced at farther distances, while other "on" days may allow a child to handle many choices placed closer together.

9) Along these lines of "off" and "on" days, if the child suffers neurological swings, it is imperitive to tailor our expectations to the child's ability at the time. This may sound basic, but it is a point often overlooked in our hurry to take data.

10) Some children do very well with fixed frames. These are nice because they free the partner's hands and can often hold many choices. There are directions for some wonderful PVC frames online (
http://www.cdl.unc.edu/link/Tech-It-Easy/Tech%20It%20Easy/Tech%20mo..., http://www.everhart.leon.k12.fl.us/downloads/pvcbook.pdf and others). There are also commercial e-Tran frames of Plexiglass (Cogain and others). Again, you must keep in mind the child's preferences and tendencies to fixate...

11) The goal of eye gaze communication is COMMUNICATION! It is NOT testing! Kids pick up on the fact that they are being heard or being tested, so make sure you honor what they tell you!!! This is probably the single most important point in all the discussion of eye gaze. For some reason, we tend to doubt eye gaze responses. This is because of our OWN insecurity in reading the answer correctly. If we honor a child's response, they learn to trust us as communication partners. If they indicated what they intended, we validate their answer. If they answered in error, we STILL validate their answer and demonstrate that we honor what they say. The children learn they must change their strategy to communicate the accurate answer and that they must find ways to negotiate to get what they had meant to tell us.

12) When you are unclear of a child's answer, DON'T repeat the same question. Ask it a different way. Try asking it in a way that would require they show a different answer ("Do you need more time?" becomes "Are you all done then?"). Show respect by letting the child know that you are the one having difficulty understanding; it is not the child's fault.

13) Try to keep the same placement of symbols offered for choices. This allows the child to develop motor automaticity. You may start to see eyes heading to a location before a symbol is even offered; this definitely suggests the child has achieved motor automaticity.

14) Not all children need to demonstrate "scanning of all the options" before making a selection. Motor automaticity may come to play, as well as peripheral vision skills. This does not mean kids aren't expected to know what all the choices are, but it does mean that "scanning" them may not look quite like we expect. An example is this: A teacher offered my child yes/something different/no in the same order each time (hurray! Way to build motor automaticity!) but would not accept the answer until she had gazed at each choice first. This is both unnecessary, slows communication, and discounts motor automaticity.

15) As soon as possible, eye gazers need to have introduced an option to indicate that what they want to say is not among the choices. This can be most anything ("something else," "not here," "different idea," whatever works for you and the child), but it is not fair to force a child into choosing only between choices they don't really want. Otherwise, the only option we give them is to NOT choose...and then we've set them up to be labeled as "non-communicative."

There are usual communication strategies that we can't forget: motivating topics, making the child responsible for sharing information that they alone would know (highly motivating!), respecting the answer, GENUINE conversation...

I hope this helps. Again, it's just what I've learned from walking in the trenches.

Rose-Marie



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You can find more like this here:

"She talks with her eyes"

"Yes," "no," maybe so...

"She talks with her eyes"

"Not being able to talk
is not the same
as not having anything to say."
                       Unknown

One of the biggest challenges my daughter faces is being unable to speak. She has thoughts, wishes, dreams, needs, frustrations...but she cannot tell them in words. Because of motor issues that prevent her from using her hands for gesturing or sign language, she has only her eyes and her facial expressions to make herself understood.


Her silence lead me to dig deep into the world of Augmentative and Alternative Communication (AAC). I feel so blessed to have been trained in Special Education because it provided some excellent resources. One of those was the mindset that "if something doesn't work, look for another way."


Over the next few days, I'd like to share rewrites of some posts I've contributed to professional AAC and AT (Assistive Technology) listservs. I think the messages they carry are critical for all children who rely on their eyes to communicate.


Below is a rewrite of an entry I wrote on May 29, 2008 for the Rett Girls AT Ning on the "Principles of Communication." [Side note:  As some of you are aware, while Ning.com has generously grandfathered educational groups under their free use policy, they have otherwise switched from being a free forum to a paid service. When a well-respected service such a Ning switches over from free to fee, I get a bit nervous that information will become difficult to uncover. One reason for reposting is to keep this information available to anyone who might benefit from it. Keep your fingers crossed that Blogger.com will continue providing its services free of charge!]


Here are some very basic principles on non-verbal communication. We have found them to be really important for our daughter before ANY assistive technology interventions can be successful. This isn't an exhaustive list at all, so I hope others will add from your experiences! I wish I had more time at the moment for a longer list and great detail...sorry!

1)  Presume competence. Children with motor apraxia issues face enormous challenges and it's really difficult for them to show what they know. Insist that others speak respectfully to the kids as well. Insure they are surrounded by opportunities for receptive input. What slips out in the way of knowledge at the most unexpected times can be amazing.

2)  Hold high expectations. Kids sense this and will work harder for people who convey belief than they will for those who convey doubt. Children are also highly perceptive of times when people expect little or nothing from them. This is exactly what they will hand back.

3)  When you are communicating, CONVERSE, don’t “test!!!” Take answers at face value. If the answer doesn’t make sense or you think the child is fixing to one side, rephrase your question to require a different response from an answer on the other side. Let her know YOU are the one having difficulty understanding what she means by her answers. Just don’t keep hammering the same question. Boredom from repetition can be a problem. It's ok to "test" when you ARE evaluating, but remember not to let conversation digress into tests.

4)  Maintain consistent placement of answer choices. This leads to motor learning. Try to place them in the same order left to right as you speak, to reinforce reading direction. So, if you consistently ask "Do you need more time or are you all done?," then put “more” on the child’s left and “all done” on her right. If the child works with a variety of staff during the day, it may help to mount choices permanently on choice strips so everyone is presenting choices with consistent placement.

5)  If personal connection to others is a higher priority to the girl than giving a response (hmmm, wonder where I learned about this one! Does it sound familiar?), it helps to have loose symbol cards that can be held side-by-side to block the view of your face. This may encourage her to look at the response; as you slowly pull the cards apart, her eyes may follow the intended symbol card. Children who are capable of finger pointing may respond more easily if cards are laid on a table to get them out of line with the speaker's face.

6)  Inconsistency is the one consistency girls with Rett syndrome--and some other neurological disorders--have. Many factors, both visible and internal, can be at play without our awareness. Children may be capable of selecting from 8 choices one day and only 2 the next, so be flexible. While we we want to set up to encourage a variety of response modes, such as pointing or hitting switches, a child may not be capable of that physical action on a given day. If that is the case, remember that eye pointing is still a valid form of response.


7)  I must underscore that physical discomfort will interfere very much with communication. For girls with Rett syndrome, it is often gastrointestinal, but there are many other sources. It's really tough--and frustrating!--for the girls to pinpoint and communicate what exactly is hurting them during the pain episode, but they may be able to do so after the pain is relieved. With repeated practice and shortening the time between the episode and the questioning, the girl may learn to communicate about the pain while it is happening. She may also be more adept at communicating what will relieve the pain than to talk about the specific pain itself, so as is age-appropriate, talk about the treatments and medications she receives in connection with her discomforts. At age 14 now, our daughter has a high degree of participation in relieving her miseries and she is right about it every time! Keep in mind we only offer things that could not hurt her if she misjudges (an air venting air, an orthotics check, a heating pad, Advil, Tylenol), not prescription meds.

The more we demonstrate trust that our children are communicating meaning to us, the more trust they will have that we are worthwhile listeners. Can you imagine how overwhelmingly frustrating it must be to muster all your energy into responding to a question, only to have your answer overlooked or dismissed? If that happens too often, anyone would withdraw their trust. If we want honest, reciprocal communication, we have to trust our children...so they can trust us.

--Rose-Marie


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Additional information like this can be found here:

Eye Gaze Techniques

Getting Ready for Non-Verbal Communication

Materials for Non-Verbal Communication, Part One

Materials for Non-Verbal Communication, Part Two