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Linda J. Burkhart
Special Educator, Technology Integration Specialist
6201 Candle Ct., Eldersburg, MD 21784
Typical children learn language by being immersed in language. They spend the first year of life just listening to others speak, before they make their first attempts to speak themselves. They don't learn by simply repeating what they hear, but rather they construct their thoughts into novel utterances from experiences they have had with language.
For children who are unable to use speech effectively for communication, augmentative communication strategies may be helpful to provide a means of communication. Goossens', Crain and Elder introduced the concept of aided language stimulation in 1992 in their book: Engineering the Classroom Environment for Interactive Symbolic Communication - An Emphasis on the Developmental Period, 18 Months to Five Years. In this strategy, others who talk to the child use the same system that the child will be expected to use. For example, pointing to picture symbols as they talk.
Learning to use an augmentative communication system, may be likened to learning a foreign language. Difference of speed, vocabulary selection, conversational flow and use of multiple systems, are some of the more subtle strategies that become natural when modeled by others. In second language learning, the language immersion method often leads to much richer and functional use of the language than does an isolated drill and practice approach. Receptive use of a child's communication system, can lead to better and more functional expressive use of that system.
Children who face severe multiple challenges, in addition to visual challenges, may have limited options for the type of augmentative communication they will be able to access. Auditory scanning may be one of the few options available to them. Modeling language through aided language stimulation for these children becomes even more challenging. Some of the problems include increased amount of time for generating an utterance, limited or lack of visual and multi-modality cues, increased need for attention to and memory of auditory sequences, and extremely limited natural experiences to observe others using this strategy to communicate thoughts and ideas.
Visual acuity may or may not be a significant problem for these children, however, use of vision may be a concern. Due to motor problems and primitive reflex patterns, some of these children may have difficulty coordinating movement with vision. This may mean that they have difficulty following a visual scan and activating a switch simultaneously. Other children may have difficulty coordinating the muscles in their eyes for smooth tracking. Still others may face cortical visual concerns, where they have difficulty interpreting visual information, especially at a fast enough rate for communication.
A Multi-Modality Approach to Receptive Language:
Even though a child may need to use auditory scanning as a means of expression, a multi-modality approach to receptive language may be very beneficial. Presentation of visual and/or tactile symbols, along with verbal language, in functional situations, can help the child build a richer understanding of language concepts. Symbols need to be selected for the sensory and processing abilities of the child, and then presented to the child in a manner that will increase the child's ability to see or feel them. This may mean holding symbols up close to the child at an angle and position that is best for their current visual field preference. It may be helping children achieve a relaxed position of the hand when presenting tactile symbols and then assisting them in the tactile inspection. For children who have cortical visual impairment, it may mean shaking the visual symbol peripherally and then bringing it into a central visual field for closer inspection, once the child has located it. The use of highlighting with flashlights, mounting on a black background, reducing complexity and presenting visual information silently, followed by the language are other possible strategies. Slowing down, pausing, intonation changes, and placing emphasis on certain vocabulary, may also be useful. Combining auditory scanning with these other strategies, provides rich, multi-modal receptive language experiences for the child.
An important skill needed for auditory scanning is self-talk. Self-talk develops slowly over time and provides the child with a means to "think out loud" and organize his/her thoughts. Since these children will not have a means to use verbal self-talk, we can expand their understanding of it by verbalizing self talk for them as we interact with them. This takes a little extra thought process for us, but can be easily integrated into daily conversation. This is best done by modeling talking to yourself as if you are thinking about your list of choices and then selecting one. For example, when setting up lunch, "Let's see, I have some soup, I see that we have .... a fork, a spoon, and a knife..... I need the spoon for my soup." or when getting dressed: "Hmmm, I have pants, a shirt, shoes and socks, I think I'll put my shirt on first, next my pants, then my socks and lastly my shoes." Another example might be when you hear a noise, "I hear something.... it sounds like foot steps.... I wonder who it might be.... it could be Jamie, it could be the dog, or it might be Daddy..... hmmmm, I think it sounds like Daddy, lets wait and see!"
When presenting choices to the child, present all the possibilities, including, none of those, or something else, before beginning to list the choices individually for the child to choose. This helps him/her self-talk the options before going on to make a choice. For example: "today we have vanilla, chocolate and banana pudding, or nothing, that is all of our choices today.... Let's see... what would you like? vanilla.... chocolate...... banana...... nothing...... Pause after each item and wait for a negative or positive response. At first the child will probably use a smile for yes. This is great to reinforce. Over time, model clearer strategies for yes and no - depending on the abilities of the child. For example: head nod and shake, sounds, word approximations, looking or reaching toward a yes/no symbol, looking away or to the side, looking up for yes, or raising an eye-brow for yes and looking down for no. Whichever means selected, others should use the same means with the addition of the verbal yes or no when modeling self-talk and partner-assisted auditory scanning. Consider your position when modeling yes/no in order to give the child the best opportunity to observe you. Explain to them what you are doing as well. (Note, other means for making choices, for example eye-gaze or a reach may also be used, to give the child a sense of the power of choices.)
"Thinking out loud" is also helpful in developing cognitive skills and a broad knowledge base. For children who have visual impairments, describing situations to them, explaining what is going on, pointing out comparisons and relationships, helps compensate for information that other children pick up incidentally through vision. This is most effective with a communication partner who is sensitive to non-verbal cues from the child, as to what she may be attending to -- even if that is a sound in another room.
Modeling Auditory Scanning:
Modeling auditory scanning may be done through a light tech or high tech means. This can be formal or informal. The use of an auditory scanning system for everything that you say to the child is quite daunting and gives us a glimpse at the complexity with which the child will be dealing. It is probably most appropriate to use a combination approach, where language is presented sometimes through multi-modal supports and also presented through an auditory scan as much as practical.
For the beginning scanner, simple activity specific arrays with vocabulary selected for a specific activity, can be useful in providing a concentrated set of opportunities for successful communication. The selection of vocabulary should include a wide variety of communicative functions, similar to activity specific communications board used by a direct selector. Arrangement of vocabulary may be slightly different, placing more frequently used items near the beginning of the array, or using a series of simple arrays with natural branching.
"Light-Tech" partner-assisted scanning, allows for modeling as well as graduated support for success. Unlike high-tech devices, partner assistance allows for a skilled partner to read non-verbal cues, and other forms of communication, from the child as well as, pace the interaction according to the child's responses. It also allows the child to focus on the communication process without having to deal with a difficult motor task. Motor skills for independent access can be worked on, in parallel, during other activities, as described below in "Modeling Access Through Computer Play."
"Light Tech" dynamic displays or multi-page communication books (Gayle Porter) can be used to organize larger sets of vocabulary. These books are designed to save time, and set the context, by beginning with the pragmatic intent of the message. For example: "something's wrong" or "I want something," and progressing to the specific content of the message. Quick words may also be accessed from the beginning pages. Since the vocabulary is arranged in a pre-determined format, it can be modeled and used to talk to the child in a consistent manner, through aided language stimulation, helping the child to develop a sense of where vocabulary is located in the book. Then, when the child wants to say something, she can actively seek out a message, instead of just hoping that she will be given the right message as one of her listed choices.
Aided language stimulation can also be used with high-tech communication devices that are accessed via auditory scanning. The use of the child's switches and careful positioning of yourself, the child, and the device are important considerations for the child to be able to successfully observe the process.
Modeling Access Through Computer Play:
Learning to coordinate motor skills for switch access can be a challenging task for some children. It may be difficult to work on language and cognitive skills at the same time the child is learning sensori-motor skills. Therefore, parallel programming is often used, so the child can focus on one manageable task at a given time, while not putting other skills on hold.
The use of two switch step scanning or automatic scanning is a process that may be learned and refined through play and then later used for communication. Computer play is powerful, because it gives clear feedback for selections and provides excellent practice for learning to use switches and understanding the scanning process. Activities can be customized for a wide range of topics and play experiences and used interactively. While playing on the computer, access can be modeled as others take a turn, using the same switches, as the child.
Learning language and also how to use auditory scanning as an access strategy for communication is complex and difficult. The use of aided language stimulation, in the form of auditory scanning, may be challenging, but definitely worth the effort. In addition, a variety of multi-modality strategies can be used to support and supplement the auditory scanning process. Verbalizing self-talk for the child helps her understand the process and develop skills needed for auditory scanning and cognitive processing. Parallel programming enables the child to make progress in language, communication, cognitive, and motor skills, while experiencing successes in all of those areas individually.
Goossens', Carol, Crain, Sharon, and Elder, Pam. (1992). Engineering the Classroom Environment for Interactive Symbolic Communication - An Emphasis on the Developmental Period, 18 Months to Five Years. Southeast Augmentative Communication Conference 2430 11th Ave. North Birmingham, AL 35234
Gayle Porter's information can be found in: Students with Physical dImpairment: Augmentative and Alternative Communication Module (Interactive CD, written material and also a video - in PAL format) Learning & Development Foundation Education Queensland, Floor 19 Education House PO Box 33, Brisbane, Qld 4002, Australia Telephone: (07) 3237 0659 Access the order forms online: http://education.qld.gov.au/learning_ent/ldf/html/multipackage.html
Linda J. Burkhart
Linda J. Burkhart
6201 Candle Ct.
Eldersburg, MD 21784
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