Pre-conference workshop presented at the AGOSCI Conference 2013

1. Apps for AAC
Adding iPads to your AAC Toolkit
Jane Farrall, Janelle Sampson and Kelly Moore

2. Outline – ‘til morning tea….
— What we know
◦ Evidence base in AAC
◦ Key Frameworks
◦ Relevant research to consider
— Benefits and Limitations of the iPad
— Types of Apps
— A process for selecting and setting up apps
— Review – the good, the bad and the ugly.

3. What do you love about your
favourite app?

4. What frustrates you about any
apps you have used.

5. What we know (AAC)…..
— Evidence base
◦ Approximately 40 year history
◦ Significant body of evidence on which we base
our practice (incl. published systematic
reviews)

6. • Non-electronic forms are also important
• Communication is multi-modal
• Important considerations for vocabulary selection and arrangement
• Core and fringe
• Pragmatic functions
• Visual considerations
• Scanning v’s direct access
• Attitudes, skills and knowledge of communication partners is
important.
• Voice output supports speech development
What we know about supporting
communication…

7. • A system needs to be for today and tomorrow. (Beukelman & Mirenda,
2005)
• Nothing is perfect before you use it
• Not limited to face to face communication (Raghavendra et. al., 2012)
• Needs vary depending on partner and situation (Blackstone and Hunt-Berg,
2003)
• MODEL MODEL MODEL – Aided Language Stimulation (Goossens’,
Crain & Elder, 1992)
• MAKE IT REAL!!!! (Participation focus)
What we know about supporting
communication…

8. Key Frameworks
— Participation Model – Beukelman and Mirenda (2005) along with
COPM (Law et.Al., 2000) or other discussion of preferences for
activities and interests
— Janice Light’s definition of communicative competence (1989) –
operational, linguistic, social, strategic - (AAC Profile. Kovach,
2009)
— Social Networks assessment (Blackstone and Hunt-Berg, 2003)
— Pragmatic Profile – (Dewart and Summers, 1995).

9. • The aim of any communication system is for the person to meet his/her varied communication
requirements as
• Intelligibly – easy for communication partners to understand and listen..
• Specifically – to make the exact message clear (near enough is not always good enough)
• Efficiently – time, ease of access, likelihood that others will take listen
• Independently
• In as socially valued manner as possible – being part of the group, regarded by others .
• To understand others and to be understood. -
• Porter, G, (1997).
Key Frameworks

10. Research: Success versus
Abandonment of AAC
Factors impacting long-term success
— Person who uses AAC system experiences success 91.76%
— Degree to which the system is valued by the user and partners
as a means of communication 90.58%
— System serves a variety of communicative functions 89.85%
— System is used for communication, not just as a toy or therapy
tool (Real communication) 87.20%
— Other areas:
◦ Appropriate device selected
◦ Support for system
Johnson, et al. (2006). Perspective of Speech Language Pathologists Regarding Success versus Abandonment of AAC

11. Research: Success versus Abandonment of AAC
Factors leading to inappropriate abandonment.
— Communication partners believe they can understand message
without AAC (not solving anything) - 77.75%
— Insufficient opportunities - 76.80%
— User prefers a simpler means of communication (effort higher than
outcome) 70.02%
— Vocabulary does not meet individualized daily living needs 67.70%
— Other areas
◦ Lack of support – training, time for programming, knowledgeable
professionals,
◦ Time!!!!
◦ Motivation
Johnson, et al. (2006). Perspective of Speech Language Pathologists Regarding Success versus Abandonment of AAC

12. Communication challenges?
— If technology (or any kind of AAC) is not being used to meet a
communication challenge, it is not going to be used.
— Don’t solve a problem that doesn’t exist. Who really needs Picnic
Pants????

13. Research: ‘‘When I First Got It, IWanted toThrow It
Off a Cliff’’: (reflections from adults who use AAC)
— Discusses the importance of:
◦ Autonomy
◦ Real life experiences
◦ Not just requesting!!!
◦ Communication Partners
◦ Practice, learning and opportunities
◦ Role models/modelling
Rackensperger, et. al. (2005). ‘‘When I First Got It, IWanted toThrow It Off a Cliff’’:The Challenges and Benefits of
Learning AACTechnologies as Described by Adults who use AAC

14. Opinion Papers: Mobile Devices
— RERC White Paper:
◦ “partnering will serve the AAC professional
better than resistance”
◦ “There is a real danger of succumbing to the
media’s interest in smaller, faster, more
powerful devices, and ignoring the other
features (customizability, learnability, durability,
supports for training) that are critical to
successful use of AAC”
Mobile Devices and Communication Apps. (2011).White Paper. Gosnell, J., Costello, J. & Shane, H. (2011). Using a
Clinical ApproachTo Answer “What Communication Apps ShouldWe Use?.

15. Assistiveware survey - Taking the Pulse of Augmentative
and Alternative Communication on iOS
— Showed that AAC apps for iPad led to improvements in
communication but with the following challenges:
Niemeijer, Donnellan & Robledo, (2012)..Taking the Pulse of Augmentative and Alternative Communication on iOS
http://www.assistiveware.com/taking-pulse-augmentative-and-alternative-communication-ios
• Professional support (availability and
knowledge/skills).
• Limited use of pragmatic functions –eg.
starting and changing a conversation.

16. Bottom line…….
— We know what we are doing in AAC but not all
developers look at this when creating apps.
— There is a need for better implementation of
AAC apps to ensure positive outcomes.

17. APPles and Oranges..
— Example 1
◦ We know that category based AAC organisation slows down communication
and impedes the development of language and communication skills
◦ We have known this since the 80s
◦ Despite this, around 60 of the AAC Apps on the App store (at the time of
writing) are straight category based apps
— Example 2
◦ We know that voice output encourages speech development
◦ Some app developers don't include speech in their AAC Apps claiming that
this is because speech output will impede speech development
— Example 3
◦ We know that providing an AAC system at all times and modelling use of the
system throughout the day in multiple situations leads to maximum language
development and best outcomes
◦ In the instructions for several AAC Apps users are advised to allow access to
the user only a couple of times a week until they become more competent

18. So, don’t let the APPle fall too far
from the tree!
— Although apps are cheap, we are not just wasting money with the
wrong apps.
◦ Time…Valuable time!
◦ Opportunities
◦ Attitude – user and communication partners

19. Benefits of mobile devices…
• Cool factor and general acceptance
• “There’s an app for that!!” – over 290 apps for AAC
• Real life models of use – much more than other devices
• Always with you – for other uses
• Portable
• Battery life
• Other uses
• Relatively cheap
• No Gatekeepers

20. Limitations and disadvantages
• Distractions
• Speakers
• Apps don’t ‘link’……yet.
• Durability
• Some limits in accessibility features
• Ongoing change
• Attractiveness to other kids (good and bad)
• No gate-keepers (good and bad)
• Less documentation and R&D behind them

21. Types of Apps
Comprehensive AAC Apps
◦ Symbol based only
◦ Symbol and text based.
◦ Text only
Specific situations or activities
◦ Eg. Phone calls, games, etc.
Pre-planned or sequenced messages
– Eg. Reciting, counting, social scripts
Initiating or encouraging interaction
◦ Eg. Intro strategy, getting attention, partner focussed questions, conversation starters
Fringe vocabulary
◦ Movies, friends, maps
Sharing information and chat books
◦ Specific for this purpose or mainstream eg. iMovie
As the activity itself
Comprehensive apps can usually do most of these
functions too

22. A Process for Selecting Apps
Created 12/09/2012 : Janelle Sampson - Janelle@twowaystreet.net.au
CHOOSING APPS FOR COMMUNICATION
What do you want to
do? (goal or
communication
challenge)
What communication
is required and with
who?
How do you envisage
your (or your child's)
participation?
What can you/they
already do?
What do you/they
need to add?
Priorities and
compromises.
(See attached list)
Is the iPad the best
way to acheive this?
I need an app that
does .........
List possible apps and
pros and cons. Use
feature comparison
charts.
Select app for trial.
Set up preferred app and
prepare for situation. MODEL, ROLE PLAY AND
PRACTICE
USE , Modify, update, USE
Consider preferences, issues,
breakdowns, compare with others,
etc
Is the iPad the best option? What
other modes might be used for
participation in this setting.

23. Summary of key points and how
they relate to selecting apps.
—
◦
— Consider social networks
— Consider practicalities and other realities
— Multi-modal
— Meet communication challenges
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL
— Learn in natural contexts - practice and modify

25. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic functions
—
— Consider practicalities and other realities
— Multi-modal
— Meet communication challenges
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL
— Learn in natural contexts

27. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
—
— Multi-modal
— Meet communication challenges
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL
— Learn in natural contexts

29. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
— Consider practicalities and other realities
—
— Meet communication challenges
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL
— Learn in natural contexts - practice and modify

31. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
— Consider practicalities and other realities
— Multi-modal
—
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL
— Learn in natural contexts

33. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
— Consider practicalities and other realities
— Multi-modal
— Meet communication challenges
—
— Vocabulary considerations
— MODEL MODEL MODEL
— Learn in natural contexts

35. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
— Consider practicalities and other realities
— Multi-modal
— Meet communication challenges
— Feature matching
—
— MODEL MODEL MODEL
— Learn in natural contexts

37. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
— Consider practicalities and other realities
— Multi-modal
— Meet communication challenges
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL – Aided Language Stimulation
— Learn in natural contexts

39. Summary of key points and how
they relate to selecting apps.
— Need to address participation needs and pragmatic
functions
— Consider social networks
— Consider practicalities and other realities
— Multi-modal
— Meet communication challenges
— Feature matching
— Vocabulary considerations
— MODEL MODEL MODEL
—

41. User preferences
— Voice
— Symbol set
— Learning style and vocabulary organisation
— Preconceived notions and experience
— Importance of user buy-in
— Opportunities to trial

42. “How do you like them APPles….”
— Select a couple of apps
— Have chat or simulate a common activity for an individual you know
— Review the ‘What to look for’ list and Flowchart and rate the app
depending on the needs of that person.

43. References
— Beukelman, D., & Mirenda, P (2005).AAC: Supporting children and adults with complex communication needs, 3rd Edition, Paul H.Brookes.
— Blackstone, S., & Hunt Berg, M. (2003). Social networks:A communication inventory for individuals with complex communication needs and their communication partners-manual
& Inventory Booklet. Monterey, CA:Augmentative Communication, Inc
— Dewart, H & Summers, S (1995) The Pragmatics Profile of Everyday Communication Skills in Children. wwwedit.wmin.ac.uk/psychology/pp/children.htm
— Gosnell, J., Costello, J. & Shane, H. (2011). Using a Clinical ApproachTo Answer “What Communication Apps ShouldWe Use?. Perspectives on Augmentative and Alternative
Communication.Vol. 20(3). 87-96
— Johnson, J.M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspective of Speech Language Pathologists Regarding Success versus Abandonment of AAC,
Augmentative & Alternative Communication, 22:2, 85-99.
— Law, M., Baptise, S., Carswell,A., McColl, M.A., Polatajko, H., & Pollock, N. (2000). Canadian Occupational Performance Measure. CAOT Publications,ACE
— Kovach,T.M.(2009). Augmentative and Alternative Communication Profile:A Continuum of Learning. LinguiSystems. Inc.

44. References
— Mobile Devices and Communication Apps. (2011). Retrieved from
http://aac-rerc.psu.edu/documents/RERC_mobiledevices_whitepaper_final.pdf
— Musselwhite, C.R., & Burkhart, L.J. (2001). Can we chat? Co-Planned sequenced social scripts,A make it/Take it book of ideas
and adaptations. Eldersburg, MD.
— Niemeijer, Donnellan & Robledo, (2012).Taking the Pulse of Augmentative and Alternative Communication on iOS
http://www.assistiveware.com/taking-pulse-augmentative-and-alternative-communication-ios
— Porter, G, (1997). Integrating AAC into programs applying the principles of conductive education. Conductive Education News,
12 (3), 2-8.
— Rackensperger,T., Krezman, C., McNaughton, D., Williams, M.B., & D’Silva, K. (2005). ‘‘When I First Got It, IWanted toThrow It
Off a Cliff’’:The Challenges and Benefits of Learning AACTechnologies as Described by Adults who use AAC. Augmentative and
Alternative Communication,VOL.21 (3), 165-186.
— Raghavendra, P., Olsson, C., Sampson, J.,McInerney, R., & Connell,T (2012). School Participation and Social Networks of Children
with Complex Communication Needs, Physical Disabilities, and Typically Developing Peers. Augmentative and Alternative
Communication, 2012; 28(1): 33–43
— Raghavendra, P.,Wood, D., Newman, L., Grace, E., & Connell,T. (2012). Strategies for supporting Internet use to increase social
participation of adolescents with complex communication needs. Proceedings of the 15th Biennial Conference of the
International Society for Augmentative and Alternative Communication, Pittsburgh, USA.
— Tatenhove, G.M. (1994) What is Minspeak? Prentke Romich Company, Wooster, USA
— http://www.janefarrall.com/html/ipad.html