Dynamic Therapy Associates, Inc.

HOME                                        

Services

Forms & Directions

Our Team          

Training & Workshops

Contact Us

Employment Opportunities

 

 

 

Dynamic Kids: A Look at Dynamic Screen Learning in Children Labeled

Moderately-Severely Mentally Handicapped.

Presenters: Vicki K. Clarke, M.S. CCC-SLP and Stephanie Williams, M.S. CCC-SLP

Closing the Gap, 23rd Annual Conference

Saturday, October 22, 2005 12:30-1:30

Relevant Characteristics of Children’ with Moderate-Severe Mental Handicaps:

Problems and Solutions

Attention Span and Focus Difficulties:

Definition: Decreased ability to attend to relevant environmental stimuli for sufficient periods to be

successful. Difficulty filtering out irrelevant information to the task at hand. Decreased focus on

relevant input.

Problem: Child is distracted by the operational buttons on the device

Solution: Hide the programming/modify buttons if possible. (Full screen Mode on

Dynavox Series 4 devices)

Solution: Eliminate external switches as possible.

Solution: Set a delay on the activation of the programming buttons so that the child

has to hold the button down for an extended period of time. Most children won’t wait

out the response and will ignore the button since it doesn’t produce a response.

Problem: Child has difficulty filtering out irrelevant information (ex: clicking noises on

devices, extra “dead space” in recordings of digitized devices) on the device.

Solution: Change output of button activation- no “click” or add “click” or “enhanced

click” to help child focus on successful activation

Problem: Child has difficulty attending to/locating specific symbols on a page with

multiple symbols.

Solution: Color-coding symbols by parts of speech and in syntactically correct order

(Goosens & Crain, Engineering Dynamic Display and Joan Bruno, Gateway to

Language & Learning programming). This helps to decrease the number of items in the

visual scan. The child learns to predict what color symbol and only has to scan items in

that color grouping. Having the buttons ordered syntactically “leads” the child from

left to right across his device making it easier to predict from which color group his

next word is included in.

Solution: Consistent placement of symbols on a page so that the child learns to

anticipate the placement of a targeted symbol even before a page loads. Set the search

engine to alphabetical sort so that the placement of symbols doesn’t change as the

frequency counts continuously adjust.

Solution: Gray out background symbols when a popup loads.

Solution: Consider maintaining a symbol set with which the child is already familiar

from past AAC use. If a child has only been exposed to Picture Communication

Symbols, use these symbols primarily on his device. As vocabulary and

comprehension increases, add in other symbols as desired. (something old, something

new)

Problem: Child has difficulty retaining a message intention while pairing words across

pages on dynamic screen device.

Solution: Target either word pairing (sentence building) OR navigation goals mutually

exclusively at first. If concentrating on word pairing then decrease the navigation

demands by adding key words from different parts of speech to pages. For example, on

the food page, include a few relevant verbs (eat, drink) and descriptive words (gross,

hot/cold) so that the child can sentence build without the added challenge of navigation.

If concentrating on navigation, accept single button activation without requiring word

pairing.

Solution: Make sure that you use a consistent page organization to decrease the

cognitive load of communication. Pages that are organized in a consistent manner

promote efficient (automatic) access to vocabulary.

Solution: Provide quick and efficient access to frequently used vocabulary. This can

be achieved by replicating certain vocabulary items on multiple pages or single hit

access to important messages.

Sensory Integration Issues:

Definition: An maladaptive reaction to sensory information perceived through vision, hearing,

touch, taste or smell

Tactile Input

Problem: Child avoids activating buttons because of the pressure required

Solution: Select a device that is very sensitive to touch such as a dynamic display

touch window.

Problem: Child exhibits excessive force when activating buttons on device (not usually

truly sensory in nature)

Solution: May be caused by the child not recognizing the function of the device for

communication and using the device for pressure input to hands. Increase functionality

of symbols to increase desire for accuracy. Provide child with alternative means of

receiving pressure sensation to hands. See OT regarding a “sensory diet.”

Solution: May be caused by child’s motoric system “overshooting” the target (ataxic

movement). Consult with PT/OT, consider offering shoulder/elbow support to increase

stability and control of arm/hand movements

Solution: Explore alternative methods for accessing the device (joystick, mouse, etc.).

Problem: Child seeks sensory input from manipulating a variety of media such as

crinkling/tearing paper or ripping Velcro symbols off pages (can be a PECS learned

behaviors instead of truly sensory)

Solution: No paper overlays or increase the thickness of paper to decrease

crinkling/tearing value (lamination)

Auditory Input

Problem: Excessive non-communicative activation of voice output to hear ancillary

sounds of device (clicking, Velcro release, tapping, recorded “dead space,” hearing the

same message repeated)

Solution: Adjust the button hold down and release times on the device. If a child is in

a compulsive repetitive movement of tapping the symbol, interrupting the rate of

activation can stop the stimulation received from the repetitive movement/sound.

Solution: Change the Behavior of a button. For example, turn off “speak on entry” on

Dynavox Series 4 devices) until the message window is activated (breaks the behavior

patterns as noted above); remove the “click” output; set Message Window Settings to

“clear after speaking” so the child won’t perseverate on pressing a message window

that contains numerous previously activated messages.

Problem: Child is sensitive to the loudness of the device OR requires the device to be

very loud (can be fluctuating).

Solution: Use the Change Volume behavior on a button. This would allow you to preset

a “loud” and “soft” volume on the device for individual messages. This requires no

action on the part of the user.

Solution: Place a button for volume adjustment on one of the main pages of a user’s

page set so that the volume can be easily adjusted by the user or a partner depending on

the circumstances and the child’s ability to handle auditory input at a given time.

Visual Input:

Problem: Child enjoys switching screens on dynamic display devices but not always

functionally.

Solution: Allow the user unstructured exploration time to familiarize themselves with

vocabulary locations.

Solution: Partner assisted linking to help the child stay on appropriate pages. This is

only used if the nonfunctional linking is detrimental to the child’s participation and

learning.

Solution: Increase the interest level and functional outcome of use of the symbols to

encourage child to stay focused and on task. because there are tangible rewards for not

switching pages.

Solution: Turning animation on or off depending on visual need. Animation can be

used to direct the student’s attention to a key concept being taught.

Solution: For scanners, you can deselect “scannable” in the Modify button menu for

navigation buttons. This allows only the communication partner to have access to

navigation buttons via touch. This should be used cautiously so that users don’t miss

out on the independence of accessing their own pages.

Learned Helplessness:

Definition: A psychological state of being when a person no longer attempts to affect his fate given

a history of failure and pessimistic view his own ability to change his situation. This theory is part

of the Attribution Therapy that looks at how our belief of the causes of our successes and/or failures

determines our response. People with learned helplessness believe that their successes and failures

are determined by external uncontrollable factors which leads them to exhibit withdrawal,

unwillingness to approach new tasks and a lack of persistence (pessimism).

Problem: A child looks to a familiar partner to more efficiently relate information for

him- a “Human VOCA.”

Solution: Have the communication partner develop amnesia- purposeful ignorance.

Partner can ask questions to guide the child in the direction of the answer/information.

Solution: Involve the AAC user to the fullest extent possible when completing a

vocabulary gathering task for page creation. This can be integrated into everyday

educational and therapy activities. When looking for words and messages to include on

a communication page, allow the AAC user to choose words or symbols that will be

placed on their page. For example, if making a page for “places to go” present all

options (ex. symbol finder on device, books, magazines, picture cards, etc.) and allow

the individual to choose the items that are most relevant to them. This give ownership

and a sense of control.

Problem: The child exhibits passive aggressive behaviors such as feigned ignorance and

refusal to participate. This often looks like the child doesn’t understand what he is

supposed to do because there are no outward obvious refusals, simply a lack of action,

often accompanied with a decidedly pleasant demeanor (“He’s so cute!”).

Solution: HIGH levels of expectation for communication. Speak to the child as you

would any other child his age and WAIT for a response. If no response comes (after at

least 15 seconds), begin going through the Prompt Hierarchy until some response

occurs. ALWAYS expect a response. NEVER assume ignorance.

Solution: Increase the likelihood of successful, errorless communication by setting up

single hit conversations/interactions.

Solution: Increase the positive social rewards of successful communication by setting

up easy motivating communication activities where errors are ignored and successes are

enthusiastically responded to with natural consequences.

Solution: Improve the availability of motivating specific vocabulary so the child can

have extremely positive interactions. Set up errorless joke pages and new pages.

Solution: Set the child up in a leadership role in his environment (school, classroom)

where she is able to lead others using her communication device (ex: leading the

school pledge, giving the class the steps to complete a recipe or other class project)

Solution: Team up with the child to accomplish any task at which he hesitates, “Let’s

do this together.” Try to avoid offering to “help” the poor little fellow- this only further

increases the feelings of helplessness. Once you are both successful in accomplishing

even a part of the goal celebrate yourselves! “We ROCK!” Always respond

enthusiastically to any individual accomplishment, “You’re the QUEEN!” Enthusiasm

is your best weapon in these scenarios.

Solution: Offer to do the activity for the child while she watches. No demands. Many

of these children are very stressed and scared of new activities/demands. Watching you

work helps ease their fears. Most children will step in and try fairly quickly. Be on the

lookout for indications that she is ready to try even a little of what you’re doing. Ask

the child for help in any small part of the activity (turning a page, getting something for

you). Allow her to refuse. WAIT! No child likes to be bored when the opportunity is

ripe to try something interesting. She simply has to overcome her fear. Be aware that

this fear has very real physical symptoms: increased heart rate, sweating, shivering,

tunnel-vision and nausea.

Solution: Physical contact, touching a shoulder, letting the child hold your hand while

you press buttons, turn pages, touch the touch window etcetera. This makes the action

belong to both of you, thereby decreasing the child’s perception of sole responsibility if

it goes badly.

Recognize that even choice-making for toys, leisure and food items can be scary if the

child has NEVER had these opportunities. It’s best described in the literature, by one

author with autism, as an overwhelming, debilitating fear of baring ones soul.

Behavioral Manipulators- Optimists:

Definition: This is the optimistic brother of the Learned Helpless. These children have a history of

failure that they consider a temporary situation caused by other people and their demands. They

will aggressively attempt to manipulate the environment for their success. They will vehemently

oppose any direction/instruction. They are persistent when motivated. They have a very strong need

to be able to successfully initiate and change topics of conversation independently.

Problem: The child proactively avoids tasks including any instruction using his

communication device.

Solution: Teach the child task completion with visual symbols available. Offer

simple, easily accomplished tasks that have definitive beginnings and endings. Use

visual schedules, “finished” boxes, “first…then” explanations, and activities with a

certain number of items that have to be dealt with before the task is complete. Maintain

a POSITIVE attitude. Take yourself OUT of the equation. Use a timer or other visual

cue that the task is over. The therapist/teacher and child are a team following the cue of

the timer/activity/picture schedule. Use intermittent reinforcement of hard/boring

activities followed by highly motivating activities.

Solution: Visual schedules, moveable popup for choices and on-screen motivation

charts can be used on the dynamic screen device. This serves two purposes: the child

has the visual reminders of the task at hand and the child has successful use of his

device. The more successful interactions with the device, the more motivated the child

is to use the device for other purposes (communication!).

Solution: Entice the child with activities/partners/environments that you know are

highly interesting and motivating to them. Many professionals respond to this idea by

saying “He needs to learn to do his work.” “This is life! He needs to learn to

cooperate!” “He isn’t going to always get his way.” Etcetera, etcetera, etcetera.

WRONG, WRONG, WRONG! He needs to have internal motivation to accomplish

tasks and communicate. Our job is to help him develop that desire. Once a positive

relationship is established with the child, he will work to maintain that relationship and

therefore do the tasks you are asking simply to make you happy. Once he is successful

enough in doing teacher-directed activities he will be less reluctant to try them on his

own even if you are not around to cheer him on (internal motivation!).

NEVER get in a battle of wills with these children in which you are the “bad guy.” Have external

factors control the situation as much as possible- timers, visual schedules and inescapable

(comfortable) locations for working. Work to maintain the positive relationship at all times!

Enthusiastically reward ALL cooperation!

Problem: The child has a history of failure using his communication device so he resorts

to less advanced forms of communication (the “Human Voca”) or behaviors.

Solution: Make the device MORE successful than the other forms of communication.

Replace behaviors with communication by putting easily accessible symbols on the

main page of the device to allow the child to escape a situation such as “I need a

break.” or “I need to leave.” Give the child a way to come back with easily accessible

symbols on the main page such as “I’m ready!” After a small break, ask them if they

are ready to return modeling the use of the “I’m ready!” button. Professionals are often

concerned that if they offer a break the child won’t ever choose to return. Usually this

isn’t the case. There is significant stress in not being able to escape an unpleasant

situation that can be significantly reduced if the child has control over the amount of

exposure he has (think claustrophobia). The stress for this child is no different than for

the child with Learned Helplessness with the same physical symptoms. This child is

just more vocal and physical about avoiding the sensations.

Problem: The child walks away from activities; has her own agenda and won’t

participate.

Solution: Tempt the child with favored activities. Change the order of activities to

draw her back into the setting. Offer tantalizing choices and enthusiastically welcome

her back. Try VERY hard not to physically move her back into the situation. The

natural response to being pushed is to push back. The natural response to being pulled

is to pull back. Consider where children learn to control things with their bodies!

(modeling, perhaps?). Encourage her verbally and through gestures to come back

(pleasantly, please); smile and WAIT. Don’t even make a move toward her because her

natural response will be to move away. Only interfere if they are going to hurt

themselves or others or, destroy property. Try to manipulate the environment so that

they never escape in the first place including making the activity so interesting that

they don’t want to escape. If you have to physically help the child, subtly move behind

her and gently encourage her to come help you out. Explain the upcoming order of

events (ex: “first…then…”). Show her the picture schedule of events so she can

anticipate the end of the activity. Decrease demands when she returns and ease her

back into the activity.

Solution: Consider why the child is walking away. Is the child sick, having stomach

pains (especially in our autistic children!), too stressed, BORED, afraid of failure??

Problem solve and accommodate.

Solution: Back off. At times everyone needs a break. Just as the Learned Helpless

communicator needs to be able to ask for a break, the Behavioral Manipulator needs to

have an “I need a break button” on her main page as well. Set this up in the same

fashion described for the Learned Helpless child.

Decreased Partner Expectations for Typical Communication:

Definition: Due to a history of communicative failure, the child’s partners do not expect effective,

novel and/or intelligent responses from the child. Communication patterns include asking only

yes/no questions, leading questions (in which they already know the answer) and imperatives

(directives- as in “show me the…”).

Problem: The child does not initiate communication.

Solution: It has been well documented in the literature that the communication

partner often dominates interactions with individuals with significant communication

disabilities. Social scripting is a strategy that can be used to encourage interactive

communication. Scripts teach individuals to move beyond basic needs to

communication for purely conversational purposes. Social scripts assist with learning

to initiate and maintain turns in conversation. For more information on social scripting

visit www.aacintervention.com and www.Lburkhart.com.

Problem: The child is not motivated to participate in social conversation given the limited

response he has access to on his communication system.

Solution: A “random” speaking feature on some devices allows multiple vocabulary

items to be assigned to one button. When the button is selected, device will choose one

of the items at random and speak it. Selecting the button again will cause the device to

choose and speak a different item. This feature is beneficial for individuals who have a

limited number of buttons per page but want a variety of rich and communicative

messages. It could also be beneficial for scanners because it would reduce the number

of vocabulary items to scan through.

Solution: Buttons can be programmed to sequence through a series of

anticipated comments so the child can participate in errorless conversations

with single activations.

Solution: Use of a dictionary feature on some dynamic display devices allows the user

independent access to the majority of the vocabulary available on the device. This

allows the child to successfully communicate using a rich vocabulary to describe

experiences that have not been anticipated by his partner. (Ex: Daddy cut down a tree

with a chain saw and hit the car!).

Solution: Help the child select photographs, both personal and ones accessed

professionally, to enrich his story-telling and increase motivation. Some dynamic

display devices afford the ability to import pictures onto buttons and backgrounds of

pages. Photograph backgrounds can also be used in light-tech displays to add interest

for the user.

Decreased Receptive/Expressive Language Skills

Definition: A delay in a child’s basic language comprehension and use including his augmented

language caused by lack of exposure, natural modeling and effective teaching. The child has limited

experience organizing their thoughts, manipulating word order and morphology (meaningful word

endings such as “-ed”) and then understanding the navigation and functional operations of their

communication device. The techniques used to introduce communication symbols may be a key

factor in identifying why some augmented communicators become very successful symbolic

communicators while others are very poor symbolic communicators. The actual process of

introducing symbols becomes more important when working with individuals who have language

disorders in addition to the inability to speak (Carlson, 1997).

Problem: During evaluation, the child shows limited skills in spontaneous use of the

communication system to request, respond and comment.

Solution: Give the child long-term exposure to the system with very specific goals and

modeling of augmented communication in very functional, highly motivating activities.

Solution: Assess the child’s understanding and use of in-context symbolic

communication VERY carefully. Look carefully at the kind of symbol he appears to

readily understand (photographs, picture symbols, words..). Consider the functions

he’s already communicating (even behaviorally) such as requesting action,

commenting, responding. Determine what vocabulary he appears to understand both

symbolically and verbally such as nouns, verbs and adjectives. Once you have a firm

understanding of where the child is “today,” target vocabulary for functional,

independent communication AT THAT LEVEL. Set goals for the child’s “today”

based on these initial findings. Target and model vocabulary and language functions

one step higher for the child’s “tomorrow” (Beukelman and Mirenda, 1992). For

example, if the child appears to readily understand using single words to request, target

expansion of the number of single words he understands for functional, independent

communication right now. Model and scaffold attempts to communicate using 2 word

phrases and functions such as commenting and conversational interchanges.

Solution: Teach the child a very limited number of communications potentially

targeting only one piece of vocabulary at a time with modeling for all others initially.

This piece of vocabulary should be HIGHLY motivating. Modeling just one step above

this level should be used for all other vocabulary so the child can be “immersed” in

augmented language. As the child becomes successful at the first communication,

gradually add in more expectations. Once the child integrates the concept of successful

communication using his new system, new vocabulary can be added more quickly and

in combination. Continuously monitor the child’s understanding to provide additional

vocabulary so he does not get bored.

Problem: The child does not spontaneously use his device functionally, preferring to

resort to less sophisticated forms of communication using gestures and partner-assisted

scanning (20-questions).

Solution: The child may not understand enough rich vocabulary to effectively “tell a

story.” Provide access to new words and encourage the exploration and use new words.

Access to words can be provided through to use “dictionary pages”. Dictionary pages

can be arranged categorically and alphabetically. The dictionary pages should be used

as a reference set for accessing more vocabulary. Many professionals may find that

these pages are a good place for young children to explore new vocabulary. For more

experienced AAC users, words that may not be on their immediate communication

pages can be accessed through the dictionary pages.

Problem: Although the child understands language at a sentence/conversational level, he

expresses himself in only single word utterances.

Solution: Provide opportunity for highly structured word pairing. Use the AAC

system to provide access to written communication activities. Many AAC systems

provide symbol prediction, word processing, and printing. Allow the child to use their

spoken language to create written language. This slows down the expected rate of

communication as the child is creating language for a partner to see later. Writing

allows the child to put create, edit and revise their work without time pressure.

Problem: The child appears to understand language at a single word level only.

Solution: Promote language learning by providing access to single word vocabularies.

A critical consideration in choosing how to display symbols on an AAC display is the

potential of the design to promote language learning. The flexibility by which single

words and symbols can be combined encourages the AAC user to generate novel

language. All AAC users, regardless of chronological or developmental age

characteristics, will benefit from a communication system or display that allows for

novel language generation.

Problem: Child does not appear to spontaneously comprehend picture symbols.

Solution: Use digital images for individuals who require a concrete representation of

objects and activities than a standard symbol set (ex. DynaSyms or PCS) can provide.

Dynamic display devices, In particular preprogrammed vocabulary sets, allow us to model

and teach language for the child’s future. The non-speaking child’s partners are able to

model, scaffold and prompt; all the techniques traditionally used in speech/language

therapy. The assumption is not made that the child, given a voice, is going to know how to

use it (see Cafeiro, 1998). Aided Language Stimulation is an exceptional tool in teaching

augmented communication users (Goosens, C. Crain, S., and Elder, P. (1992)

References, Resources and Web Sites

Attwood, Tony (1998) Asperger’s Syndrome, A Guide for Parents and

Professionals. Jessica Kingsley Publishers, London, England.

Arnold, Nicki G. (1996/1997) Learned Helplessness and Attribution for

Success and Failure in LD Students. LD Online, July 28-August 3, 2002.

http://www.ldonline.org/

Beukelman, David R. and Mirenda, Pat (1992) Augmentative and Alternative

Communication, Management of Severe Communication Disorders in

Children and Adults. Paul H. Brookes Publishing, Baltimore, MD.

Bondy, Andrew and Frost, Lori A. (1994) PECS: The Picture Exchange

Communication System, Training Manual. Pyramid Educational

Consultants, Inc. Cherry Hill, NJ.

Bruno, Joan

Burkhart, Linda J. (1993) Total Augmentative Communication in the Early

Childhood Classroom. Linda J. Burkhart, Eldersbury, MD.

Cafeiro, Joanne (1998). “Communication Power for Individuals with Autism,”

Focus on Autism and Other Developmental Disabilities, Vol. 13, Number 2,

Summer 1998. Pgs. 113-121.

Church, Gregory and Glennen, Sharon (1992). The Handbook of Assistive

Technology. Singular Publishing Group, Inc. San Diego, California.

Dalrymple, Nancy J. (1995). Environmental Supports To Develop Flexibility

and Independence. In K. Quill (ed.) Teaching Children with Autism:

Strategies to Enhance Communication and Socialization, Delmar Publishers

Inc. Albany, N.Y.

Goosens’, Carol and Crain, Sharon Sapp (1992) Utilizing Switch Interfaces

With Children Who Are Severely Challenged. Pro-Ed, Austin, Texas.

Goosens, C. Crain, S., and Elder, P. (1992) Engineering the Preschool

Environment of Interactive Symbolic Communication- 18 Months to 5 Years

Developmentally. Birmingham, AL: Southeast Augmentative

Communication Conference Publications.

Gordon, Robert & Myrna (2003).“Learned Helplessness and School Failure,”

The Gram, Learning Disabilities Association of California newsletter. July

30, 2003. http://www.ldaca.org/.

Grandin, Temple and Scariano, Margaret M. (1986). Emergence: Labeled

Autistic. Warner Books, New York, NY for Arena Press, Novato, CA

Gillette, Yvonne (2003) Achieving Communication Independence, A

Comprehensive Guide to Assessment and Intervention. Thinking

Publications, Eau Claire, WI.

Grandin, Temple (1995). The Learning Style of People With Autism: An

Autobiography. In K. Quill (Ed.) Teaching Children with Autism: Strategies

to Enhance Communication and Socialization, Delmar publishers Inc.

Albany, N.Y.

Musselwhite, Caroline Ramsey and Burkhart, Linda J. (2001). Can We Chat?

Co-Planned Sequenced Social Scripts, A Make It/Take It Book Ideas and

Adaptations. Special Communications and Linda J. Burkhart

Musselwhite, Caroline R. and St. Louis, Karen W. (1998). Communication

Programming for Personas with Severe Handicaps: Vocal and

Augmentative Strategies. College Hill Press division of Little, Brown and

Co. Inc. Boston, Massachusetts.

Seligman, Martin E.P. (1990) Learned Optimism, Pocket Book, New York,

N.Y.

Silvernail, Nannette Beyea (2002). Dancing In Cornmeal, Life With Autism.

Writer’s Club Press, Lincoln, NE.

 

 

Copyright © 2006 Dynamic Therapy Associates                                     Hit Counter
Last modified: November 09, 2008