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  • Following the child’s lead instead of a lesson plan or specific routine produces the kind of communication that generalizes and grows naturally. In the beginning, it does not matter what the child is doing, whether he/she is picking up or dropping objects, running back and forth, or playing with a toy. It is essential to follow the child’s lead and make it interactive.Through your own affect and actions, court the child into letting you engage with him/her. Watch for a signal that suggests that he/she is interested in what you are going to do. Don’t interrupt the interactive process as long as the child is continuing to participate.
  • During the initial stages of motor learning, the AAC device needs to be in the same location relative to the position of the child. For example, if the AAC device is placed at midline and the child is using his/her right hand to execute the motor pattern to say “go,” the child would be moving his/her hand slightly to the right of midline to the location of the frog icon. The next time you work with the child, you do not want to put the device way off to his/her left, which would then require him/her to move his hand across midline. During the early stages of learning, the device needs to stay in approximately the same position relative to the child’s position in order to maintain consistency in the motor plan. Think about moving your devices to a different position. What do you have to do differently with your body? Visually? Auditorily?
  • Random selection & mis-hits are okay! They offer a learning opportunity if met with natural consequences. How does a child learn a video game? Now, I would read the manual, but they don’t. They try over and over until they learn the strategies they need to succeed. It is a motor plan. Kids learn things happen at certain points of the game – gain lives – treasures etc. I read the manual – they see how it works and respond to what happens. Our non-verbal kids with ASD are just the same! Carolyn Musselwhite says “a child’s occupation is to play.” Self stimulation (perseveration) is OKAY until it affects learning and valuing the device. Some children are distracted or overly challenged by the many pictures and choices presented on an AAC device. Others may perseverate on a key, with perseveration possibly serving a communication function for the child. Before you try to control the perseveration, determine whether or not it is serving a useful function. Work through whatever may be triggering the perseveration, such as sensory overload. If it is a roadblock in the learning process, the key on the AAC device can be temporarily hidden. Many children may be more successful if the number of keys available to them is limited. In some cases, hiding most of the keys may be necessary, but other children may be able to handle having a full display. Language that is not needed during the activity can be hidden on dynamic devices such as the Vantage. Hiding unused keys reduces random selections, promotes learning of the motor pattern, and provides opportunity for greater success. Since activities need to be child-directed, hide keys as needed in the activity, modifying and adjusting the vocabulary available based on the needs of the child and the activity.Remember the Hide/show keys option we looked at before?It is appropriate to show some words to evaluate the child’s emerging motor automaticity. It is also valuable to show some keys to allow the child opportunity to learn something new from hitting an incorrect key. An error in key selection is a powerful lesson when the communication partner reacts with natural consequences or even surprising and exaggerated reactions. When adding more keys, you may need to change the key color just to give an additional cue as the client practices the motor movement.
  • The child’s selection of words must be rapid and without conscious thought to ensure that real language processing is taking place. This type of rapid, automatic use of words develops through repetition of consistent motor patterns and repeated manipulation. We talked earlier about types of activities that have become automatic – for example……Automaticity is developing for our students when movement to the key is fast with little to no visual scanning and with limited physical assistance. Some children, because of their motor planning problems, continue to need some type of physical assistance, such as a tap on the shoulder, in order to initiate movement of any kind. The movement must be one continuous movement. It cannot be hit – wait –hit or the motor plan is lost. Why? Then it is no longer motor planning. Think of reading comprehension – if we struggle to read each word, we encounter, we forget what we have already done. It does not become automatic decoding. What would you do if the child is hitting waiting hitting? If it appears to be difficult to make a transition to a 2 hit movement, look at readiness. Perhaps it will be better to come back later.
  • There is a moment when you know you’ve “got ‘em.” When the child looks at you as a communication partner to see what your reaction is going to be.
  • Glacier example from Ken.
  • A device user from the UK who is advocating for people with communication impairments and specifically for the inclusion of core vocabulary in therapy and in school.
  • Back: “back” of; touch your back; back off; back upUp: Plane up in the sky, pick me up, clean up, squirrel ran up the tree; what’s up; wake up; get up; speak up; it’s up to you; turn it up; open up; are you up to it; look it up; dress up, warm up, line up….
  • Transcript

    • 1. AAC & Autism: Teaching Communication Through Motor Planning
    • 2. Thank you… Michigan Integrated Technology Supports
    • 3. The Mission of LAMP To improve public awareness of the unique qualities of the power of AAC to change the lives of non-verbal individuals with autism and other developmental disabilities by: – Providing specialized clinical training to health care professionals, teachers, and parents – Supporting Clinical Research – Supporting clients and families with education, resources and information
    • 4. By the end of this session you will be able to: 1. Briefly describe the five key elements of LAMP 2. Identify the relationship between motor planning and communication using AAC 3. Identify the benefits of using core words to teach communication using AAC
    • 5. What is LAMP? Language Acquisition Through Motor Planning A therapeutic approach
    • 6. What is LAMP? Language Acquisition Through Motor Planning A therapeutic approach Built on principles of motor-learning
    • 7. A Case for Motor Consistency
    • 8. "In the practiced automatic movements of daily life attention is directed to the sense impression and not to the movement. So, in piano playing, the beginner may attend to his fingers but the practiced player attends only to the notes or to the melody. In speaking, writing and reading aloud, and in games and manual work, attention is always directed to the goal, never to the movement. Cattell, J.M. 1893
    • 9. Ming, Brimacombe, Wagner 2007 154 Children with ASD found that 41% of 2–6 year olds and 27% 7-18 year olds showed clear evidence of oral motor and/or hand muscle apraxia Mirenda, P. (2008) A back door approach to autism and AAC; Augmentative and Alternative Communication, 24, 220-234
    • 10. Motor Planning Indicators and ASD High prevalence of motor planning difficulties in ASD  Speech requires high degree of motor planning  Automaticity facilitates motor action
    • 11. We can take advantage of motor planning when: •Each word has its own motor pattern due to consistent icon locations •Motor patterns don’t change •Patterns build upon themselves as language grows
    • 12. We cannot take advantage of Motor Planning when: –Significant navigation of the system is required –Requires continuous visual refocus and visual reorientation –Large bank of icons to learn –Same motor plan has different language outcome –Too many or inconsistent rules for generating language
    • 13. What is LAMP? Language Acquisition Through Motor Planning A therapeutic approach Built on principles of motor-learning Emphasizes independent access across environments
    • 14. Communication Goal Same as for all AAC users… S: Spontaneous N: Novel U: Utterance G: Generation i.e. expressive, generative communication
    • 15. What is LAMP? Language Acquisition Through Motor Planning A therapeutic approach Built on principles of motor-learning Emphasizes independent access across environments Multi-sensory
    • 16. LAMP approach
    • 17. Good Poor Low Moderate High Performance Arousal Level Zone of Optimal Arousal The Inverted U-Principle (Duffy, 1962)
    • 18. Considerations for Treatment –Enhance or minimize sensory input –Manipulate sensory input to maintain a “zone of optimal arousal: • Client must be able to orient, discriminate, attend, explore, interact, and learn • Match activity to level of arousal • Incorporate sensory strategies throughout the day to help maintain appropriate arousal level
    • 19. LAMP approach
    • 20. Child-Focused
    • 21. As suggested by Stanley Greenspan, enter the child's activities and follow the child's lead. If the child wants to line up cars in a row or twirl a top, the parents will join the child in his or her preferred activity (with the intent of developing this action into an affective interaction) rather than demanding that the child join them in their preferred activity (a process which, at best, will produce no more than rote action and reaction). From Autism National Committee http://www.autcom.org/behaviorism.html
    • 22. Follow the child’s lead: Watch for what interests the child and use that interest to create a meaningful language learning experience. Join in with the child: Shared focus develops through interaction.
    • 23. Purposeful and Intentional Use Movement Surprising and Novel
    • 24. LAMP approach
    • 25. LAMP LAW…
    • 26. LAMP LAW… Initiating a unique motor plan Hearing the word produced by that movement Experiencing another’s reaction to the word
    • 27. Things to remember:  Device Position
    • 28. And… Random Selection and Perseveration
    • 29. Why?? Stable key location enables the development of automaticity When using AAC, teach location, NOT metaphor
    • 30. Each consistent pattern of one, two or three hits on the AAC device must always result in production of a unique word.
    • 31. Automaticity
    • 32. Automaticity • EMG brain : new vs. automatic tasks • Repeated movements become subcortical • Cortical areas can then be put to “better use”
    • 33. Avoid temptation to “check comprehension” by shifting locations of pictures because …?
    • 34. LAMP approach
    • 35. The auditory output stimulates the child’s auditory system, providing auditory feedback with the motor response, …
    • 36. … which may later stimulate the child’s natural attempts to imitate the auditory output he/she gets from the AAC device and the auditory feedback from his/her communication partner.
    • 37. Auditory Signals “Input from the vestibular, proprioceptive, and auditory systems is critical for the development of speech and language (1989, Windeck & Laurel) Children need to experience words, not just repeat them In LAMP each unique motor pattern = specific auditory signal……a specific word SGD provides critical auditory information
    • 38. LAMP approach
    • 39. Any attempts to communicate should have natural auditory/verbal, visual, and social consequences.
    • 40. Social Exchange
    • 41. No Mistakes: No matter what the child selects on the AAC device, the rule for the communication partner is RESPOND RESPOND RESPOND
    • 42. LAMP Language Consideration: Single Words “Communication is based on the use of the individual words of our language. True communication is spontaneous and novel. Therefore, communication systems cannot be based significantly on pre-stored sentences. Communication requires access to a vocabulary of individual words suitable to our needs that are multiple and subject to change. These words must be selected to form the sentences that we wish to say.” ASHA’s AAC
    • 43. Focus on “core” vocabulary
    • 44. Words Percentage 1. I 9.5 2. No 8.5 3. Yes/yea 7.6 4. my 5.8 5. the 5.2 6. want 5.0 7. is 4.9 8. it 4.9 9. that 4.9 10. a 4.6 11. go 4.4 12. mine 3.8 13. you 3.2 14. what 3.1 15. on 2.8 16. in 2.7 17. here 2.7 18. more 2.6 19. out 2.4 20. off 2.3 21. some 2.3 22. help 2.1 23. all done/finished 1.0 96.3% Toddler Vocabulary Arranged by Frequency These 26 core words comprise 96.3 percent of the total words used by toddlers in this study Banajee,M., DiCarlo, C, & Buras-Stricklin, S. (2003). Core Vocabulary Determination for Toddlers, Augmentative and Alternative Communication, 2, 67-73.
    • 45. 1. again 2. all done 3. all gone 4. away 5. big 6. go 7. help 8. here 9. I 10. it 11. like 12. mine 13. more 14. not/don’t 15. stop 16. that 17. want 18. what 19. you 20. my 21. do 22. down 23. get 24. in 25. little 26. off 27. on 28. put 29. some 30. out First 30 Words ©Van Tatenhove, 2005, Revised October 2007
    • 46. Michael Brian Reed (2009) Is “campaigning for people with communication impairments to be given a way to say the same 100-400 words that speaking people say most each day…” Questions for, teachers, SLPs, decision makers and makers of communication aids: 1. What is your plan to introduce core vocabulary to students with communication disabilities? 2. Can teachers and SLPs be sure that during preschool years specific core vocabulary and all language functions be introduced. 3. Can teachers and SLPs be sure that students have access to core vocabulary in education?
    • 47. The “Core” of Language Representation  Picture producing words RARELY provide communication power  Early vocabulary samples have very few, if any, picture producing words  Any representation method requires learning  DO NOT create the AAC displays based upon what can be easily represented
    • 48. Word List I Stop Go Not Eat Drink More
    • 49. Vocabulary Expansion –Pronouns: I, you, it: “I go; You stop. More it” –Colors: “Get red; Need blue.” –Foods: “Eat soup.” –Toys: “More bubbles; Need truck” –Drinks: “Drink juice; Want water.” –Adjectives: “Good work;” “Not bad.”
    • 50.  Unexpected in the expected  Fulfilling Needs Opportunities for Communication
    • 51. Rapid Generalization
    • 52. Core words have many meanings Back Up Meanings of these words are continually revised by children as they are used in different contexts.
    • 53. To match or harmonize The shirt goes with the pants. To fit: The belt won’t go around my waist. To circulate: The rumor goes around the school. To make a sound: The dog goes “bow wow”. To function: The engine is going. To come into a condition: Time to go to sleep. go
    • 54. Move around an axis or a center: To reverse the sides or surfaces : Other ideas? To affect or alter function: Bend or change the course: turn
    • 55. Don’t over-train in one activity Look for social exchange Move quickly to next level; may be next word, may be combined words, may be next level (sequenced) May not need to “train” each word
    • 56. References • American Speech-Language Hearing Association (2009). Augmentative Communication: A Glossary. Retrieved from http://www.asha.org/public/speech/disorders/accPrimer.htm. • Angermeier, K., Scholosser, R., Luiselli, J., Harrington, C. & Carter, B. (2008). Effects of iconicity on requesting with the Picture Exchange Communication System in children with autism spectrum disorder. Research in Autism Spectrum Disorders, (3), 430-446. • Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62(5), 564-573. • Banajee, M., Dicarlo, C., & Stricklin, S. (2003). Core vocabulary determination for toddlers. AAC: Augmentative & Alternative Communication, 19(2), 67. • Bruinsma, Y., Koegel, R., & Koegel, L. (2004). Joint attention and children with autism: A review of the literature. Mental Retardation & Developmental Disabilities Research Reviews, 10(3), 169- 175. • Bruneau, N., Bonnet-Brilhault, F., Gomot, M., Adrien, J., & Barthélémy, C. (2003). Cortical auditory processing and communication in children with autism: electrophysiological/behavioral relations. International Journal of Psychophysiology, 51(1), 17. • Buffington, D., Krantz, P., McClannahan, L., & Poulson, C. (1998). Procedures for Teaching Appropriate Gestural Communication Skills to Children with Autism. Journal of Autism & Developmental Disorders, 28(6), 535.
    • 57. References, cont. • Cafiero, J. (2007). Challenging our belief systems regarding people with autism and AAC: Making the least harmful assumptions. Closing the Gap, 26 (1) 7-9. • Cattell, J.M. (1893). Aufmerksamkeit und reaction. Philosophische Studien, 8, 403- 406. English translation: in R.S. Woodworth (1947). Psychological research (vol.1, pp 252-255). Lancaster, PA: Science Press. • D’Ausilio, A., Pulvermuller, F., Salmas, P., Bufalari, I., Begliomini, C., Fadiga, L. (2009). The motor somatotopy of speech perception. Current Biology 19 1-5. • DeThorne, L., Johnson, C., Walder, L., & Mahurin-Smith, J. (2009). When "Simon Says" doesn't work: alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18(2), 133-145. • Duffy, E. (1962). Activation and Behavior. Oxford, England: Wiley. • Durand, V. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis, 32(3), 247. • Elder, P.(1992). Phone conversation as cited in Unity: Language for Life Training Manual. Wooster, OH: Prentke-Romich Company. • Fey, M. (2008). The (mis-)use of telegraphic input in child language intervention. Revista de Logopedia, Foniatria y Audiologia, 28(4), 218-230. • Fitts, P. & Posner, M. (1967). Human Performance. Belmont, CA: Brooks/Cole. • Gernsbacher, M., Sauer, E., Geye, H., Schweigert, E., & Goldsmith, H. (2008). Infant and toddler oral- and manual-motor skills predict later speech fluency in autism. Journal of Child Psychology & Psychiatry, 49(1), 43-50.
    • 58. References, cont. • Koneya, M. & Barbour, A. (1976). Louder Than Words… Nonverbal Communication. Columbus, OH: Merrill. • Light, J., Roberts, B., DiMarco, R. & Greiner, N. (1998). Augmentative and alternative communication to support receptive and expressive communication for people with autism. Journal of Communication Disorders. 31, 153-180. • Ming, X., Brimacombe, M., & Wagner, G. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain & Development, 29(9), 565-570. • Mirenda, P., Wilk, D. & Carson, P. (2000). A retrospective analysis of technology use patterns in students with autism over a five-year period. Journal of Special Education Technology, 15 (3) 5-16. • Olive, M., de la Cruz, B., Davis, T., Chan, J., Lang, R., O'Reilly, M., et al. (2007). The Effects of Enhanced Milieu Teaching and a Voice Output Communication Aid on the Requesting of Three Children with Autism. Journal of Autism & Developmental Disorders, 37(8), 1505- 1513. • Provost, B., Lopez, B., & Heimerl, S. (2007). A Comparison of Motor Delays in Young Children: Autism Spectrum Disorder, Developmental Delay, and Developmental Concerns. Journal of Autism & Developmental Disorders, 37(2), 321-328. • Reed, M. B. (2009, July 28). AAC campaign questions [video file]. Retrieved from http://www.youtube.com/watch?v=B-qFcPpeNu8
    • 59. References, cont. • Rogers, S., Hepburn, S., & Wehner, E. (2003). Parent Reports of Sensory Symptoms in Toddlers with Autism and Those with Other Developmental Disorders. Journal of Autism & Developmental Disorders, 33(6), 631-642. • Schepis, M., & Reid, D. (1998). Increasing communicative interactions of young children with autism using a voice output.. Journal of Applied Behavior Analysis, 31(4), 561. • Schlosser, R., & Blischak, D. (2004). Effects of Speech and Print Feedback on Spelling by Children With Autism. Journal of Speech, Language & Hearing Research, 47(4), 848-862. • Siegal, M., & Blades, M. (2003). Language and auditory processing in autism. Trends in Cognitive Sciences, 7(9), 378. doi:10.1016/S1364-6613(03)00194-3. • Thunberg, G., Ahlsén, E., & Sandberg, A. (2007). Children with autistic spectrum disorders and speech-generating devices: Communication in different activities at home. Clinical Linguistics & Phonetics, 21(6), 457-479. • Windeck, S. & Laurel, M. (1989). A theoretical framework combining speech-language therapy with sensory integration treatment. Sensory Integration Special Interest Section Quarterly / American Occupational Therapy Association, 12 (1) 44-48. • Wynn, J. & Smith, T. (2003) Generalization between receptive and expressive language in children with autism. Behavioral Interventions, 18(4), 245-266. • Xu,J., Gannon, P.J., Emmorey, K., Smith, J., Braun, A. (2009). Symbolic gestures and spoken language are processed by a common neural system. Proceedings of the National Academy of Sciences, 106 (49); 20664-69.
    • 60. www.aacandautism.com
    • 61. Mailing Address: P.O. Box 1317 Wooster, OH 44691 Telephone: 330-202-5800 (local or international toll line) 866-998-1726 (toll free US) Email: lamp@aacandautism.com Follow us on Facebook & Twitter to receive the latest news and updates

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