This post originally appeared in the November 2008 edition of the print version of Motivations.
One of the advantages of applied behavior analysis (ABA) as a teaching strategy for our children with autism is that it is neutral regarding a child’s method of communication. If your child is not vocal, ABA programs can teach effectively using sign language, text, pictures or other communication devices. Many parents are not aware that the popular Picture Exchange Communication System (PECS) was developed by behavior analysts, who used B.F. Skinner’s analysis of verbal behavior to shape the system.
When our daughter Anneliese remained non-vocal at age three, we were convinced by the logic and research developed by Mark Sundberg. He argues that sign language is most likely to lead to increased speech1. We began teaching her ASL signs and she eventually learned to request and label with over 100 signs. While ASL has been a doorway to speech for many children, in our case Anneliese’s signs did not transfer to vocal language. Additionally, maintaining her signs took constant effort. Her consistent vocabulary hovered around 30 signs, with new signs just replacing old ones as her motivation changed.
As her sixth birthday approached, we finally conceded she would not become a fluent signer and likely might not speak either. We began to research text-based communication using an augmentative or alternative communication (AAC) device. We knew we had been using AAC for years, since AAC refers to any alternate method of communication – signs, gestures, pictures are all AAC. But it was time to add assistive technology to our strategy.
The distinction that AAC is a method and not just a word for assistive devices was underscored by a recent workshop at the AT:LAST Maryland Assistive Technology Co-op (http://www.matcoop.org/). Diana Jurist, assistive tech specialist, presented “What Are the Options When You Can’t Speak?,” a useful overview of AAC methods and the tools to support them. A focus of the presentation was on evaluation and assessment – how to determine the right method for a given child and, if necessary, the right device.
Jurist said that often parents hear of a device that works for another child and come determined to get that device. Or maybe they’ve just heard the name of a common device and come looking for, say, a DynaVox, because they suspect it might be an answer. In place of these ‘shot in the dark’ approaches, Jurist points parents and professionals to a framework called SETT – Student, Environment, Tasks, Tools. Notice that Tools come last – individual consideration of the student’s needs and abilities, where and in what ways they need to communicate all precede even thinking about a particular device.
In our case we know our daughter has no physical limitations that would restrict our choices. We know she has the cognitive ability to use text-only because she has learned sight words in ABA intensive teaching sessions. Those same sessions have proven her excellent scanning skills. So we knew we could use a tool with a complex, word-based display.
She would need to use the device to request desired objects and activities around our home, to interact with neighbors in the community and to communicate with teachers at school. The tasks would be varied even within those environments. For instance. at school she transitions from natural environment teaching to intensive teaching at a desk, with different vocabulary applying to goals in each setting. So we needed a tool with multiple levels of display, so she could select differing words at home, school and around the block.
In our case, this SETT framework analysis led us to arrange for a loan from AT:LAST of a Go Talk 20 device. It has a display of 20 touch-cells that can be programmed to speak a word or phrase. It supports 5 different levels, so we can dedicate varying 20 cell levels to home, community and different school tasks. This framework clarified my thinking about this choice and will guide my continued re-evaluation of the choice. For more detail on SETT, take a look at:
http://sweb.uky.edu/~jszaba0/JoySETT.html.
At this point, if you have good autism-parent instincts, you are asking: “Sounds peachy, but prove it--where is the research that supports the assumption that these assistive technology devices can help teach kids with autism?” Fortunately, two excellent reviews of the research were published over the last year in speech pathology journals. I’ll share the key points from those reviews in the next issue of Motivations.
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