Thursday, November 13, 2014

A Thought Experiment

Let's do a thought experiment. You'll come along for this journey with me won't you?

Imagine that your classroom receives a new student. She's 7 and has been home-schooled until now, no formal education at all.  Her parents report that she developed normally until around 20 months. At which time she became very ill and developed multiple disabilities. The audiologist reports that she has no hearing (based on an evoked auditory potential test done under sedation) and the neurologist has provided a report saying she will not recover vision and that she is untestable using standard measures. Additionally, she has significant behavioral challenges and she appears to have a cognitive or intellectual disability.

When a home visit is completed the child is noted to move throughout the house destroying property and at times having behavioral meltdowns where she is aggressive.  She is unable to participate in class at all when she comes to school and does not appear to attend to adapted materials when you present them.  It's fallen to you to develop an IEP.  You bring in the team to complete assessments and make recommendations.

The behaviorist at your school completes a functional behavior analysis and determined that the child is acting out to receive tangible items and to avoid demands. She's completed a preference assessment and determined a few sensory experiences that will be rewarding. She lays out a plan to increase sitting at the table with her peers and to decrease aggressive outbursts.

The occupational therapist notes her upper extremity use is within functional limits and does not
recommend OT. However, she suggests a sensory diet and frequent sensory breaks. The physical therapist finds no need for PT services.

The teacher of the visually impaired has brought in a number of sensory items to trial with your new student. She is also suggested using a calendar box/object schedule.  She wants you to begin introducing object symbols. The speech therapist agrees with the TVI and wants you to begin to work on exchanging object symbols
for actual items.  The TVI also suggests you make a modified "little room" with plenty of tactile and olfactory stimuli.

The teacher of the hearing impaired comes in and teaches you and your staff two dozen keyword signs and shows you how to do hand under hand signing. You learn the signs to go with the object symbols that you will be working on. You all work together with the behaviorist so that you can cue transitions using these keywords signs and the object simple cards.

The assistive technology specialist helps you set up switches to control things like fans. You also set
up other sensory experiences to be run by switch.   You have a foot bath and a special aroma fan.  The behaviorist is working these things into her positive behavior support plan.

Your paraprofessionals are feeling ill prepared to deal with your new student. They're worried about her aggressive behavior. You have requested a one-to-one aide and one is brought in and trained and certified in de-escalation and restraints.  She will be with your new student all day.      

You are a little worried about the number of adults in your classroom now. You do have six other students who have wheelchairs and equipment and there is a lot of feeding and changing to do. You were worried you will not be able to address the core curriculum as demanded by the state with so much to do and so many people to manage.

Can you imagine all of this? Can you picture it happening in your classroom or your school? Do you know who the student is?


The student is Helen Keller. Can you imagine what would happen if Helen Keller arrived in one of our classrooms today? Can you imagine what the world would be without Helen Keller because that is what you need to imagine when you think of this scenario.

Our thought experiment leads us to understand that if any child with the capacity of Helen Keller and the disabilities that Helen Keller had were arrive in nearly any special education setting in the United States and possibly abroad her intellect and talent would be wasted.  If Helen Keller was a student today what would happen when we took the behavioral and sensory approach that we nearly always take?  What would happen if we failed to presume competence and fell back on our hierarchies and prerequisites?


Luckily, Helen Keller was not educated using behavioral and sensory interventions. She was educated using a presumption of competence; a belief that she could and would learn and was provided with intensive aided language stimulation. That is not what it was called then, but that is what we would call it now.  Annie Sullivan spoke to Helen Keller in the language that Helen Keller would then learn to use for the rest of her life. Think about that.  She spoke to Helen USING the language she expected Helen to learn to use.

We know, for a fact, that Helen Keller succeeded because Annie Sullivan presumed competence and dedicated every waking minute to teaching Helen a robust language system. Helen Keller wasn't given a choice between two objects. She wasn't forced to touch an object symbol that was supposed to mean "more" for every bite of food. She wasn't pushed through a (false) hierarchy of symbolic representation. No one ever said that sign language wasn't transparent enough or that she had to prove herself with three signs before she could be exposed to 16 signs. Helen Keller succeeded precisely because  Annie Sullivan did not do what we do now.  Helen Keller succeeded because Annie Sullivan believed in her and gave her the gift of language without testing to find out if she was capable of learning that language first.  What do you make of our thought experiment?

What I make of it is that we cannot judge our student's future accomplishments based on first impressions.  We must, MUST, presume competence and believe that our students can learn.  We must treat every "untestable" child as if she has the intellect of Helen Keller.  We really have no other choice.

Saturday, November 8, 2014

How Samantha Learned to Read

Samantha, a sixteen year old who has Rett Syndrome is not the first teenager with significant special needs I have worked with who has accomplished basic literacy, and I know she will not be the last.  I believe that literacy is a life skill and a human right.  I've featured Samantha as she has learned to read on this blog twice.  Recently I have been asked how it was she learned to read and if we followed any curriculum.

This is my attempt to explain how Samantha came to be a reader.  In short, we did not follow any curriculum.  I did take much guidance from the Non-Verbal Reading Approach.  Also, luckily I had an amazing Reading Methodology course when I was in teacher school that gave me the background to be create a developmentally appropriate curriculum based on Samantha's needs and I was able to pull from many sources to keep her interested and engaged.  How Samantha learned (and continues to learn) to read is a journey she lead me on and not the other way around.  It was child-lead to the extreme, pursuing what she found enthralling and trying to find more interesting ways to help her learn when the first try (or tries) were lacking.  Here are some of the things that worked:

Believing She Could
This goes without saying, but presuming competence and believing that Samantha could and would learn to communicate and read was the first step.  She needed to be reminded constantly that though she battled Rett Syndrome taking away use of her hands, dystonia forcing her eyes up and head back and seizures that interrupted everything she was smart and could learn to read.

Print Rich Enviroment
Being a augmentative communication user with a robust communication system has the added benefit of automatically creating a print rich environment.  Once Samantha moved to a robust system of language on her Tobii (a combination of custom boards and Sonoflex) she had print in front of her nearly every waking moment.  She has access to letters through typing pages on her device.  As her family and school committed to constant aided language input on her AAC system they frequently modeled how to go to the typing page and sound out words that could not be easily found in her system.  Samantha has also always loved books.  She loves picture books and age respectful books (she is currently reading Divergent using Bookshare and the Voice Dream Reader App projected to her TV with Apple TV).  She loves being read to and reading along.  She also loves the Reading A-Z app.  This life long exposure to and engagement with the printed word set the stage for learning to read. 

Letters and Their Sounds
For Samantha the journey started with her interest in letters and their sounds, and more specifically, her interest in how the mouth makes sounds.  She was fascinated by how mouths would move to make sounds, happily watching my mouth, video clips and trying to move her own mouth into the shape of a sound.  Though she rarely was able to reproduce the sound of a phoneme she often got close to making the right shape with her mouth.  Samantha's interest in watching how mouths made sounds lead us to the free Small Talk Phonemes (and later the Small Talk Blends) app on her iPad.  We spent many months matching letters printed on cards, letter manipulatives and letters written on a white board to the sounds that they make.  Samantha played with letter sounds using manipulatives and playing games.  She did some "scribbling" with letters using the LiterAACy software program on her Tobii Communication Device. We also used a lot of music videos.  You can find a music video for just about any phonics concept on YouTube.  We used the Niki Play app to give us easy access to our favorite phonics and literacy music videos.  Like most learners with apraxia, Samantha does not do well with on demand assessment so we surreptitiously assessed for the knowledge of one to two letter sounds per session.  Mastery was assumed when she correctly matched the letter to the sound and vice versa just twice, allowing us to move forward and not cause boredom or anxiety with repeated testing.  

Segmenting and Blending
Once Samantha had mastered the letters and their sounds we began work on segmenting and blending words.  Samantha's favorite way to do this was using a drawing of a slide for blending CVC words.  This became a preferred activity and we worked through all the CVC word families on our letter slide.  We also worked on tapping out words.  This was somewhat more difficult as it was hard to find motivating ways to do a task that is usually so kinesthetic. 

Digraphs, Diphthongs, Double Vowels and More
Now that Samantha had a grasp of all the basic phonemes and how to spell and read most CVC words, we began work on blends, double vowels and a variety of phonics rules.  This continues to be a slow process.  We work on these concepts as they present themselves. For instance, when Samantha spelled the word "blu" using an alternative pencil we began a journey learning about double vowels and specifically "ue".  We watched music videos and an instructional video on YouTube.  We looked at other words.  I keep a list of phonics rules, digraphs, diphthongs and other information to check off as we work through these things at Samantha's pace based on her interest.

Reading for Meaning
It was Samantha who forced my hand on this.  I didn't think she was ready.  I was wrong.  We had long been in a habit of me reading aloud text and discussing it or, if I needed data and Samantha was in the mood, having her answer questions.  One day I prepared to do such an activity.  She became irritated with me as I choose the harder flashcards designed to work on reading for main idea out of the box.  Using facial expressions and banging her fist on her tray she made it clear she wanted to use the easier cards.  I gave in.  Then she told me with her Tobii, "Let me do it."  So I took a chance, I held up the card and waited while she read.  In the end she read three of those cards and answered the main idea question correctly each time.  You can see the video on the post "Sam is Reading." She has done this numerous times since and we have started to offer her more and more chances to read text on her own.  We have been setting up books on Bookshare with the Voice Dream Reader app set to a slower playback speed so she can read on her own.  She has been known to swipe the iPad to her Bookshare book when someone comes along and switches her to a picture book instead!  We are experimenting with new ways for her to use technology to access text to read on her own, for meaning.  I think the sky may be the limit.

Note: Obviously I am not the only one who has been on this journey with Samantha.  Her parents, siblings, PCAs, nurses, teachers and therapists have also been part of this adventure.  This is just my view of the story.  Many people played a role.


Saturday, November 1, 2014

Halloween and AAC

"Make a choice, Make it your voice!"
Over the past five years there has been a huge upsurge in postings about awesome Halloween costumes for children and teens (and adults) who use wheelchairs.  On Pinterest and other social media you can find hundreds of example of amazing and clever costumes that see the wheelchair as just part of who the child is. 

Yet as I looked through my feeds yesterday on Twitter, Facebook, Pinterest and other social sharing sites yesterday and today I saw almost NO pictures of children who's AAC systems or devices were even in use, forget included as part of custom design.

I do, definitely, want to applaud those pictures I did see of children and adults using AAC in costume.  Here are a few of them (thanks to the parents who gave permission).  Nice job! 

I know some families may have moved systems out of the way for pictures.  I know other families struggle with the challenge of high tech devices being too cumbersome or heavy to bring trick or treating.  Which is, of course, why all our high tech AAC users should have back up low tech systems!  And just to be clear, it is on us, as professionals, to find a way to help families in making sure AAC is always available. 

As teachers we can start to make that happen for next Halloween right now!  Let's dedicate ourselves to 1) full time AAC for all our non-speaking/low intelligibility students 2) back up low tech systems for all our high tech users 3) training families on how to integrate AAC into daily life and special events!  We alone, as those who teach and love AAC users, are able to support AAC all the time!  Even on Halloween.  We need to start now to make sure next year pictures of AAC users in amazing AAC incorporating Halloween costumes flood the internet!

Bee Ready to Communicate
And so I announce the 2015 Communicators Costume Contest!  Write it in your calendars!  On November 1st, 2015, at Noon, I will be posting the picture and giving away and amazing prize to AAC user with the best costume that incorporates AAC into the costume!  Make your device the control panel of your airplane!  Disguise your PODD book as a shield!  Carry your iPad with Proloquo2Go as Snow White's mirror!  Be creative!  Let's get AAC out there!


Spooky Switches!












The Yes/No Series and 10 Steps to Teach a Head Nod and Shake

The Yes/No was a series of blog entries written in 2012.  The six part series works through ways to indicate yes and no and then many ways to teach and reinforce yes and no responses.  Of course, there is much more to life and to communication than yes and no!  Yet yes and no can be vital in an emergency and is a skill all communicators should have.  Here are links to the series (which I have been asked to collect in one place).

The Yes/No Series Links

And below you can find the text of a hand out designed to help schools and day habiliations facilities teach a head nod and shake as a yes/no response for individuals with complex communication needs.


Teaching Method for Yes and No with a Head Nod and Shake
                                                                                                        

This method of teaching the universal head gestures in English speaking country is commonly taught by Linda Burkhart and Gayle Porter in PODD training courses (http://www.lburkhart.com/podd.htm)


Candidates for learning to indicate yes and no with a head nod and shake are all learners, young and older, who are developing a yes/no response including children with cerebral palsy, Rett Syndrome, Angelman Syndrome and other genetic disabilities affecting communication. 



Steps

1) Model an enthusiastic head nod and shake for yes and no frequently and consistently throughout the day.  Have others model it as well.  Peers and siblings make great models! 


2) Directly teach the child what the head nod and shake mean using multi-sensory teaching methods and motivating interactions.


3) Remember that there are different levels of yes and no responses beginning with yes and no to accept and reject.  Start with accept and reject before moving on to more complex yes and no questions.


4) Provide a target for the child to aim their head movement towards by placing your fingers at his or her cheek and chin about a ¾ of an inch to 1 inch away.  The child touching your fingers with his or her chin and cheek should be accepted and rewarded as a yes or no response.  


5) Some child may need more feedback when they touch the target.  For those children you can use a voice output communication aid such as a talking switch.  You can add picture symbols to the switch if this will help increase understanding for the child.  Again, hold the switch ¾ of an inch to 1 inch from the child’s chin and cheek as a target.  


6) In general you should not be touching the child’s face except a gentle and brief tap as a touch cue if the child is NOT tactile defensive and the child needs such a cue to increase understanding or motor planning.  Your fingers or the switches are a target and can’t function as such if you are touching the face.  (Note picture shows switches during the tap - they were then moved away to be targets.)


7) Continue with enthusiastic modeling of yes and no throughout this process


8) Fade out the targets, whether using your fingers or a switch, as soon as the child has demonstrated some understanding of what is expected in terms of a head nod and shake


9) Continue to provide informative feedback (I see you dropped your head for yes.  Nice job!) as you shape the yes and no response.  


10) Once using yes and no to accept and reject is consistent you can add more complex forms of yes and no 

Switch Options for Targets for This Method:

Thanks to Linda Burkhart for chatting with me and guiding me as I developed the hand out I posted as a blog entry!
 

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