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ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
ATI 2014 Assessment to Outcomes G. Meier
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ATI 2014 Assessment to Outcomes G. Meier

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Individuals with autism are unique! And so are their progressions with AAC. These very different, nonverbal students with ASD are followed along their path with AAC from assessment to the present; …

Individuals with autism are unique! And so are their progressions with AAC. These very different, nonverbal students with ASD are followed along their path with AAC from assessment to the present; assessment, therapy and progress.
- Gwendolyn Meier, SLP, MT
www.VillaEsperanzaServices.org

Published in: Education, Technology, Business
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  • 1. AAC in ASD: Three Journeys from Assessment to Outcomes Gwendolyn Meier, SLP, MT Speech Pathologist, Music Therapist gmeier@villaesperanzaservices.org Wednesday, February 5, 14
  • 2. Find the companion AAC Goal Bank and timeline handout at www.scaacn.blogspot.com ATI 2014 page Wednesday, February 5, 14
  • 3. Gigi Nicolas Student photos removed for posting online in the interest of privacy Wednesday, February 5, 14
  • 4. 3 Students with ASD • Assessment • Goals • AAC Therapy • Progress • Outcomes Wednesday, February 5, 14
  • 5. Gigi Wednesday, February 5, 14
  • 6. Communication Goals 2010-2011 1. Respond using picture communication book with phrases “I have ___”, “I see ___”, “I want ___”, “I am ___” 2. Indicate a need/want by constructing a phrase strip “I want ___ please” with attributes (color, numbers 1-5), concepts (big/little), travel, deliver message 3. Given the question “Is this a ___,” answer yes/no using her picture book 4. Identify emotions in a field of four pictures Wednesday, February 5, 14 60 min individual/ week
  • 7. 1st order of business: Picture Communication Book Wednesday, February 5, 14
  • 8. 30-day IEP, 5/2011 1. “I have ___”, “I see ___”, “I want ___”, “I am ___” 1. Given questions (What do you/ the girl/ character names/etc. have? want? doing?) respond using her picture book with phrases (agent +action) (action+object) (agent+object) with gesture prompts, 80% as measured by data/observation. 2. Indicate a need/want by constructing a phrase strip “I want ___ please” with attributes (color, numbers 1-5), concepts (big/little), travel, deliver message 3. Given the question “Is this a ___,” answer yes/no using her picture book 4. Identify emotions in a field of four pictures 4. Exchange or indicate a single symbol to direct the actions of others using 10 core vocabulary (e.g., open, in, out, what, go, stop, more, put, that, on, off, done, take, want) 5. Increase number of manual signs by adding 5 to her baseline for communicating wants & needs to control her environment Wednesday, February 5, 14
  • 9. SLP Recommendations - 5/2011 • 60 minutes individual/week • 60 minutes consult/month (for picturebased communication) Wednesday, February 5, 14
  • 10. *District-approved trial* Requesting, Locating Vocab Wednesday, February 5, 14
  • 11. 10/2011 - Progress 1. 2-word phrases (agent+action) (action +object) (agent+object) 2. “I want ___ please” for wants/needs and point to pictures as she delivers the message 3. Answer yes/no to “Is this a __” 4. Direct actions w/one symbol 5. 5 new signs for wants/needs Wednesday, February 5, 14
  • 12. Proposed -10/11 1. Given prompting ? 3-component descriptive phrases (e.g., agent+action+object) using her picture book 2. Replace symbols in her communication book according to category 3. Search the pages of her book to find a named symbol card and complete a sentence started for her 4. Answer YES/NO to confirm or deny requests (Do you want this?) and label objects related to familiar vocational tasks 5. Create 2- and 3-word phrases to request or direct actions using 10 core vocabulary phrases (e.g., put in, put on, take off, open it, I do, you do, etc.) 6. 10 signs to her baseline for communicating wants & needs to control her environment Wednesday, February 5, 14
  • 13. Annual IEP, 10/11 • • • Wednesday, February 5, 14 AAC Evaluation requested by parent Assessment plan signed Conducted by an SLP in the assistive technology department of her district of residence
  • 14. AAC Assessment - 2/12 Statement of Need Gigi’s Gigi • Hearing,Vision, Motor skills within functional limits • Behavior - some history of repetitive movements, some mild self-injurious Wednesday, February 5, 14
  • 15. Wednesday, February 5, 14
  • 16. Symbol ID Nouns in F:4-128 Categorization Symbol ID Actions, Locations F:8 Syntactic Performance- Wednesday, February 5, 14 Sequence symbol phrases
  • 17. AAC Evaluation Genie - $9.99 Wednesday, February 5, 14
  • 18. Symbol ID Nouns 6/6 from F:66 4/6 in F:128 Categorization 16/16 Simple (transportation, food, clothes, animals) 0/16 Complex (people, verbs, things, places) Symbol ID 7/8 actions F:8 4/8 adjectives & nouns 0/4 (little, big, more, in) Wednesday, February 5, 14 Sequence Symbols into Phrases (given a direct model) 4/4, 2-word phrases 0/4 3-word phrases
  • 19. Literacy Skills Teacher report: • Matches letters • Copies words • Some spelling during typing activities Wednesday, February 5, 14
  • 20. Device Trials • Tobii S32 Touch/Scan • Springboard Lite 32 • iPad 2 with Proloquo2Go app • iPad 2 with TouchChat with WordPower app Wednesday, February 5, 14
  • 21. Tobii S32 Touch/Scan • Features: lightweight, 32 locations, 192 overlays, digitized voice output, keyguard, scan accessible Wednesday, February 5, 14
  • 22. Tobii S32 Touch/Scan • Not a match for her ability to scan 66+ locations, emerging literacy and categorization skills Wednesday, February 5, 14
  • 23. Springboard Lite 32 • Features: lightweight, 36 locations, dynamic display, pre-stored vocabulary, Unity Language System, focus on core vocabulary, digitized and synthesized voice output Wednesday, February 5, 14
  • 24. Springboard Lite 32 • Not a match. Some difficulty with touch pressure, did not appear to understand Unity symbols and activity rows Wednesday, February 5, 14
  • 25. Boardmaker PCS eat drink sleep Unity Language System Wednesday, February 5, 14
  • 26. Proloquo2Go • Version 1.7 (released Nov 2011) • Features: lightweight; customization options for number of locations per page, message window size, space between cells, border color; 7000 SymbolStix symbol library; 16category locations with page links trialed Wednesday, February 5, 14
  • 27. Proloquo2Go • A match! • Able to access screen through touch • Produce requesting sequences (I want more) and sharing opinions (awesome! I like it) after a brief model Wednesday, February 5, 14
  • 28. TouchChat with WordPower • Features: Similar to PLQ2G 1.7 plus Customization options, SymbolStix, Vocabulary packages (MultiChat 15, WordPower 24 & 42), color coded cell backgrounds, cell location control, intuitive navigation, next word prediction • Not actually trialed Wednesday, February 5, 14
  • 29. AAC Recommendation Gigi Gigi Gigi Wednesday, February 5, 14
  • 30. Signs Tracking Sheet Wednesday, February 5, 14
  • 31. Sign Tracking Key S  =  Spontaneous (initiation  of  the  sign  to  request  action  or  item  with  no   prompt  or  following  an  open-­‐ended  question,  “What  do  you   want  to  do?”) I  =  Independent     (shown  a  visual  of  someone  eating,  learner  INDEPENDENTLY   signs  EAT  without  a  direct  verbal  prompt  “eat”) V  =  Verbal  Prompt     (shown  a  visual  of  someone  eating,  learner  only  enacts  the   sign  EAT  when  given  a  direct  verbal  prompt  “she’s  eating”   etc.) M  =  Model   (learner  only  enacts  the  sign  EAT  after  you  perform  the  sign) H  =  Hand-­‐over-­‐hand   (learner  requires  your  touch  in  order  to  enact  the  sign) Wednesday, February 5, 14
  • 32. Wednesday, February 5, 14
  • 33. VIDEO: Indep Multi-word Request Listen to music Wednesday, February 5, 14
  • 34. VIDEO: Augmented Input uh oh...stop...I don’t like it Wednesday, February 5, 14
  • 35. 10/2012 - Progress 1. 3-component phrases (agent+action+object) MET 2. Replace symbols in communication book EXCEEDED 3. Search to find a named symbol card EXCEEDED 4. Answer YES/NO to confirm or deny requests NOT MET 5. Create 2- and 3-word phrases - MET given MOD cues 6. 10 signs given minimal cues - NOT MET Wednesday, February 5, 14
  • 36. Proposed - 10/12 “Using her communication system...” 1. Appropriate greeting (i.e., Hi vs. Bye) with familiar persons including their name and facing the communication partner 2. 2- and 3-component phrases each in 2 different contexts (e.g., open it to refer to the cupboard and also the microwave) to direct the actions of others and/or describe actions 3. Functional communication statements or questions appropriate to the scenario (e.g., listen to music, something else, want water, need bathroom, take a break, etc.) 4. Given 3 rehearsal trials, navigate two screens to comment; including making an announcement (e.g., “time to go on a walk” or “I have a note for the teacher”), a single-button interjection (e.g., be careful, sorry, oh man!), or sharing an opinion (e.g., I like that, that’s funny, that’s gross) 5. ID 4 pieces of personal bio information Wednesday, February 5, 14 !
  • 37. VIDEO: Core Words to Request Put on pink Wednesday, February 5, 14
  • 38. VIDEOL: Desribe to Request Look funny dance Wednesday, February 5, 14
  • 39. 10/2013 - Progress 1. Greet using names - MET 2. Direct/describe actions - NOT MET 3. 8 functional phrases - NOT MET (only 3) 4. Making announcements & commenting NOT MET (MOD cues needed) 5. Answering 4 bio questions - MET Wednesday, February 5, 14
  • 40. Proposed - 10/2013 1. When asked “What do you want/ need?”...retrieve her communication system and make a request 2. (continued) 2- and 3-component phrases: close it, put it away, turn it on, turn it off to direct the actions of others and/or describe actions 3. (continued) functional communication statements 4. Comment or answer questions about activities performed in the classroom setting (academics, cooking activities, vocational training, etc.) Wednesday, February 5, 14
  • 41. SLP Recommendation • • Wednesday, February 5, 14 90 min/week indiv 540 min consult/year (9 hours)
  • 42. All students at Villa Esperanza School on identical 42location vocabulary with hidden buttons 2013 Hide Mode Wednesday, February 5, 14
  • 43. Today AAC System:Vocalization, gestures, sign, Sequencer, TouchChat 42 Phase 1 Prompting: Independent for greeting, requesting, verbal prompt to retrieve device, visual picture-phrase cards for core vocabulary Wednesday, February 5, 14
  • 44. VIDEO: Cooking with core vocab Open it, take it out, more Wednesday, February 5, 14
  • 45. Nicolas Wednesday, February 5, 14
  • 46. Summer 2011 • Age 6:4, Kindergarten • 20 Compensatory hours of NPA speech therapy • AAC Assessment and Independent Speech & Language Assessment agreed upon in mediation with school district Wednesday, February 5, 14
  • 47. Present Level - Communication • • • • Verbal approximations for yes/ no Primarily uses vowel sounds in his attempts to speak words Communicates by pulling or pointing 50 sight words, matches letters, some numeral ID Imitates (approx) of two word phrases Wednesday, February 5, 14
  • 48. Behaviors that Impede Learning • • • • • • • • Wednesday, February 5, 14 Task avoidance Non-compliance Dropping to the floor Touching/moving items not related to lesson Squeezing others’ hands Running away from work areas Eloping attempts (leaving classroom) Tantrum behaviors Taking off shoes
  • 49. Communication Goals (2010-2011) 1. Imitate/spontaneously produce the /m/, /t/, /k/, and /p/ sounds at the end of CV, CVC words with 50% accuracy (tactile/verbal cueing provided). 2. Sustain joint attention for a period of 5-7 minutes during a clinician directed task 3. Receptively ID common objects and actions (w/ objects or pics - no more than 3 choices) 4. Use/imitate head nod/shake or verbal approximations for YES/NO when asked questions regarding personal preference (e.g., Do you want the balloon?) with 70% accuracy with mild verbal/gestural/tactile prompting provided Wednesday, February 5, 14
  • 50. Barriers to Progress in Therapy: Off-task behaviors are exhibited in transitions and without close attention (when parent and clinician are talking) including: • touch the clinicians’ face, run away, close and lock doors, climb onto tables, drop to the floor or under chairs or tables, pull at or tear the clinician’s shirt, and remove his own clothing Functions: • negative attention seeking • escape Wednesday, February 5, 14
  • 51. Behavior Support Plan (Informal) • Respond to maladaptive behaviors by asking • • • • “Do you need help?” If ‘yes’ (“ess”) provide assistance If ‘no’ (“oh”) and behavior persists, inform that “I’m going to help you” and physically assist him in keeping his hand in his lap Direct him “quiet hands” and ”tell me when you’re ready” while giving no eye contact or attention other than physical cue. Nicolas will indicate that he is ready and will again participate in the presented task. Wednesday, February 5, 14
  • 52. AAC Assessment • Conducted by district independent contractor (trusted colleague) • Observed: • • • Wednesday, February 5, 14 • Classroom, clinic-based speech, home ABA Extremely little productive work in classroom Attention seeking and escaping behaviors in all environments History of attempts at PECS in home ABA (played with Velcro) and speech (hit cards on his chin)
  • 53. AAC Assessment • Fleeting attention and no engagement with examiner • • No direct assessment due to non-compliance • • • Used both hands to access iPad screen (games) Wednesday, February 5, 14 Ambulatory with adequate motor skills to access technology. Exited apps often, no sustained attention Reported computer skills (Bailey’s Bookhouse)
  • 54. AAC Recommendation • Maximize oral speech through intensive instruction • Strong behavioral program • Visual Supports (Visual Schedules, Work Systems, addition of picture supports to language input) • Links to Language program • No augmentative communication system ! Wednesday, February 5, 14
  • 55. Proposed Goals - 10/2011 1. Imitate 6 early developing consonant sounds (m, b, w, d, p, h) in CV and CVC syllables for a set of functional vocabulary words (e.g., mine, bye, want, don’t, please, hi, etc.) tactualkinesthetic-proprioceptive cueing for oral motor placement 2. Anticipate and continue 3 of 3 steps within a predictable, motivating sequence or routine by producing a word or action spontaneously for 5 routines 3. Spontaneous requests, object or action label & visual gaze toward his communicative partner when the desired object or context for the action is visible in the environment 4. Respond verbally to confirm (i.e., speak ‘yes’) 5. Refuse (e.g., “no” or “all done”), protest (e.g., “mine”), or request an alternate activity (e.g., “ball” while working on a puzzle) total communication 6. Point to pictures in books to answer concrete WHO and WHAT questions Wednesday, February 5, 14
  • 56. IEP Outcome • Independent Speech Assessor NOT in agreement with AAC recommendation • Recommendation for NPS placement (Villa Esperanza) • Agreement that AAC systems will continue to be trialed in the NPS classroom and services • 150-min/week individual (30 min daily sessions) to address articulation ! Wednesday, February 5, 14
  • 57. AAC Trials @ Villa • • • GoTalk 9+ GoTalk 20+ iPad with TouchChat Independent: • 2- and 3-button messages (2-3 screens) to request items and activities Emerging: • • Wednesday, February 5, 14 Describe what he sees Give bio info in response to questions
  • 58. TC - Initial vocab set, totally custom Wednesday, February 5, 14
  • 59. Wednesday, February 5, 14
  • 60. AAC Trials (cont.) • Passive communicator in any mode (sounds, gestures, iPad) • Resistant to prompting/assistance (escape or lose interest) Wednesday, February 5, 14
  • 61. Wednesday, February 5, 14
  • 62. 5/2012, 6-mo Progress 1. ARTIC - 50-70% 2. Sequence actions in routines - 2/3 steps MOD cues 3. Requesting w/ eye gaze - INDEP in iPad phrase composition, cues for eye gaze 4. Confirm w/approx. “yes” - MET In sessions 5. Protest, req. alternative - MET 6. Rec WH-questions (Who What) in books MET Wednesday, February 5, 14
  • 63. Impressions - 5/2012 “Since his admission at Villa Esperanza Services’ Non-Public School...behavior and participation in the curriculum has improved dramatically, and has allowed him access to provided augmentative aids that incorporate visual and voice-output support for his communicative intent.” Wednesday, February 5, 14
  • 64. Proposed Goals - 5/2012 1. ARTIC - goal continued 2. Gain attention and greet others, using names 3. 2- and 3-word phrases to make requests within daily classroom activities (e.g., I need pencil, where chair, do again) 4. Rec ID person in response to “Who” questions (e.g., Who do you want to work with?, Who did you work with? Who is sitting with you? Who do you see?) 5. ID 5 items of personal/biographical information 6. ID10 common actions 7. ID appropriate modifier (e.g., color, size, action, adjective) and noun to describe pictures 8. * Follow a verbal instruction delivered to the class as a group (e.g., everybody line up, it’s time for music, etc.) 9. ** 3 new oral motor movements Wednesday, February 5, 14
  • 65. SLP Recommendation - 5/2012 • • • • iPad 2 with the TouchChat HD app Protective case Across all daily environments (school-home) Continue150 minutes of individual/week (30 per day) Add 720 minutes of speech and language consultation/year • Programming, training (classroom, home), implementation support Wednesday, February 5, 14
  • 66. Answering “Who?” Wednesday, February 5, 14
  • 67. Moved up to WP24-ish Wednesday, February 5, 14
  • 68. VIDEO: 2/13 Intro to Social Scripts Wednesday, February 5, 14
  • 69. 5/2013 Progress 1. ARTIC - MET for /p,b,m,h/ NOT MET for /w,d/ 2. Greeting using names - MET Independent 3. Request needed items - MET given prompting question “What do you need?” 4. Answer “Who” questions about familiar persons - PROGRESSING needs MOD 5. Bio questions - EXCEEDED, mixes “...brother” and “...father” 6. Labeling actions - EXCEEDED in pics 7. Rec ID modifier - MET for colors, big, little, open,close; PROGRESSING for good, bad, yummy, gross, cool, clean, dirty, hot, cold, pretty 8. * Follow group instruction - MET 9. ** Non-speech oral motor movements - MET added suck, blow for 2-3 seconds, close lips on tongue depressor Wednesday, February 5, 14
  • 70. Triennial Testing - 5/2013 • Expressive, pragmatic, and articulation skills were assessed informally Wednesday, February 5, 14
  • 71. Triennial Testing - 5/2013 • Uses eye gaze alone when needing help • Requires verbal prompt “What do you need?” to initiate requests • Agent + action sentences • Uses he/she accurately • Picked up plural -s • Recently started scripts for errands • Cues for pragmatics in interaction Wednesday, February 5, 14
  • 72. Proposed Goals - 5/2013 1. ARTIC - mastered sounds in CVCV reduplicated syllables 2. Sentences using he, she, they and present tense is verb-ing 3. Answer simple WH type questions (“What is it?” “Who is eating?” “Where are they?”) regarding books and/or his activities 4. Use 3 social scripts, 3 turns in length in interactions around campus, including non-verbal skills 5. GROUP - Use name, direct turns, label and comment 6. 5 new location prepositions (under/over, top/bottom, in between) Wednesday, February 5, 14
  • 73. SLP Recommendation - 5/2013 • 120 min/week individual • 30 min/week group • 360 min/year consult (denied) Wednesday, February 5, 14
  • 74. VIDEO: Group! Wednesday, February 5, 14
  • 75. VIDEO: Social Scripts Today Wednesday, February 5, 14
  • 76. Today AAC System: Gestures, eye gaze, simple 1syllable words (buh), TouchChat WordPower 42 Prompting: Model required for greetings, very responsible with device, independent with phrase-based scripted interactions (jobs on campus), verbal prompt to use device to request, very independent with navigation, some self-taught morphology Wednesday, February 5, 14
  • 77. Different roads Wednesday, February 5, 14
  • 78. Destination: Communication! Wednesday, February 5, 14

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