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Facilitating Communication with Adults who are Nonverbal
- 1. Gwendolyn Meier, SLP, MT Speech-Language Pathologist Music Therapist April 30, 2014 Facilitating Communication - Part I -
- 2. AGENDA • What is Communication? • AAC - Augmentative and Alternative Communication • Why Do We Communicate? • Visual Supports for Communication • Communication and Behavior • 10 minute break at 10:30
- 5. What is Communication? • The exchanging of information
- 6. What is Communication? • The exchanging of information • The act or process of using words, sounds, signs, or behaviors to express or exchange information or to express your ideas, thoughts, feelings, etc., to someone else
- 7. What is Communication? • The exchanging of information • Means of connection between people
- 9. Everyone Communicates • How do the clients in your program communicate?
- 10. Everyone Communicates • Sounds • Words • Phrases • Sentences
- 11. Everyone Communicates • Crying • Reaching • Pointing • Gestures • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences
- 12. Everyone Communicates • Crying • Reaching • Pointing • Gestures • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences • Silence • Screaming • Pulling hair • Falling asleep • Aggression
- 13. Everyone Communicates • Crying • Reaching • Pointing • Gestures • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences
- 14. Alternative Communication • Crying • Reaching • Pointing • Gestures - Signs • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences
- 15. Alternative Communication • Crying • Reaching • Pointing • Gestures - Signs • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences
- 16. Alternative Communication • Crying • Reaching • Pointing • Gestures - Signs • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences I need a breakI need a break
- 17. Alternative Communication • Crying • Reaching • Pointing • Gestures - Signs • Facial expression • Body language • Tone of voice • Sounds • Words • Phrases • Sentences I need a breakI need a break
- 18. Enter the iPad • 4 short years ago… • Currently over 100 iPad apps designed to be communication tools
- 19. 60 Minutes – October 2011
- 21. Why do we communicate?
- 22. Why we communicate • Express Wants and Needs • Social Interaction, Etiquette • Sharing Information
- 23. Why we communicate • Express Wants and Needs • Brief exchanges - end quickly • Social Interaction, Etiquette • Sharing Information
- 24. Why we communicate • Express Wants and Needs • Brief exchanges - end quickly • Social Interaction, Etiquette • Greeting, starting, ending, manners • Sharing Information
- 25. Why we communicate • Express Wants and Needs • Brief exchanges - end quickly • Social Interaction, Etiquette • Greeting, starting, ending, manners • Sharing Information • Pointing as toddlers • Topics and vocabulary grow from there
- 31. In NON-VERBAL Autism? WANT S & NEED S Social Sharing information can we What give clients?
- 34. Come to the sink
- 37. Add visuals for understanding Come to the sink !
- 38. Come to the sink Tell me and I will forget Show me and I will remember Involve me and I will understand
- 39. Visual Supports for Understanding / Expression • Anything visual that enables the learner to understand what is said, what is expected, time, sequences, changes in routines • Visuals to share about: • Wants • Needs • Choices • To Escape • Feelings • Protest/Refuse
- 40. Visual Supports for Understanding / Expression • Anything visual that enables the learner to understand what is said, what is expected, time, sequences, changes in routines • Visuals to share about: • Wants • Needs • Choices • To Escape • Feelings • Protest/Refuse
- 41. Visual Supports for Understanding / Expression Can include: •Pictures •Objects •Sign language •Text •Arrangement of the environment •Picture sequences •Schedules Can include: •Vocalization •Pointing, reaching •Gestures •Signs •Choosing a picture •Picture phrases •Spelling •Typing
- 42. Sign Language • For Understanding • For Expression
- 43. When YOU use Sign Language • Add visual to your words • Helps focus attention • Can increase comprehension • No special equipment or materials! STOP
- 44. Sign Language for Expression Requires: •No special equipment or materials! •Fine motor skills •Others know sign language •Memory for the gesture •Memory for the meaning
- 46. Boardmaker Software, v. 6 PC/Mac ($399) • Software for creating visual displays • Library of 4,500 symbols • 44 languages
- 47. Boardmaker Software Choice Board & Sentence Strip
- 48. • Printable templates in the program • • Free online file-sharing forum Boardmaker Software
- 49. Choice Boards • Provide images specific to an area or activity to choose from in order to request
- 50. Choice Boards • Provide images specific to an area or activity to choose from in order to request Breakfast choices
- 51. Choice Boards • Provide images specific to an area or activity to choose from in order to request Movie choices Breakfast choices
- 52. Choice Boards • Provide images specific to an area or activity to choose from in order to request Movie choices Breakfast choices
- 53. Choice Boards
- 54. Choice Boards • Give choices in non-preferred settings • Affords the client control • Can reduce anxiety & avoid behavior challenges
- 55. Choice Boards • iPad app – Sounding Board (Free) • 1 - 16 buttons per page
- 56. Choice Boards • Pics in the app • Save pics from Google Images
- 57. Let’s Try It!
- 58. Speech
- 59. Speech Speech
- 60. Speech Pictures
- 62. Choice Boards • Use pictures as you talk
- 63. Choice Boards • Use pictures as you talk before expecting pictures to express
- 64. Picture-Supported Input InputInput with Pictureswith Pictures OutputOutput with Pictureswith Pictures
- 65. Last but not least…
- 66. How can I use the board to increase my clients understanding?
- 67. First Then • Simple, visual representation of expectation • Can help aid understanding On paper iPad app – First Then (9.99 by Good Karma Apps)
- 68. Visual Schedules • Decrease anxiety about what’s coming • Increase independence
- 70. Visual Schedule • “Check” off each step as it is completed
- 71. Visual Schedules • Monthly Calendar • To anticipate preferred & non-preferred upcoming events
- 72. Token Systems Tokens earned toward a rewarding item or activity. More generic than a visual schedule or task analysis.
- 73. Token Systems Token earned for: 1.A period of time that passes • Reinforce # of minutes: having a calm body refraining from profanity staying with the group, etc. 1.A specific behavior • Keep track of completion of repetitive tasks: laps around the park packing a number of parcels
- 74. Token Systems Require tolerance for delayed gratification Puzzle tokens – to earn the pictured item Token strip
- 75. Apps for Token Systems • iReward ($4.99) • iEarned That ($1.99)
- 76. PECS ™ • Picture Exchange Communication System • Photos, drawings, or cartoons represent real-life objects or activities that can be exchanged for the desired object/activity • Taught through meaningful activities • Goal: Initiation • Requesting for high interest items or activities
- 77. PECS ™ • Requirements for Teaching: • 1:1 instruction • Immediate reward until the behavior is learned • Visuals (picture cards) for items/activities
- 78. Visual Support and Evidence Based Practice
- 79. Problem Behavior
- 80. Given no better system: Problem Behavior Lack of functional speech Frustration Challenging behavior
- 81. Given no better system: Problem Behavior ...may be the individuals best attempt to convey a message or communicate a need
- 82. Give a better system: Positive Behavior Support Lack of functional speech Frustration Challenging behavior Visual Supports Functional Communicatio n Training
- 83. Functional Communication Training • Replacing inappropriate or ineffective behaviors with wanted behaviors that serve the same function • Create or strengthen alternative communication behaviors • That results in the same outcome for the client • Replacement behavior must be efficient and effective (in order to be successful)
- 84. Given no better system: Problem Behavior CommunicationCommunication BehaviorBehavior
- 85. Given no better system: Problem Behavior ...may be the individuals best attempt to convey a message or communicate a need ...are not responses to be reduced or eliminated but shaped, made more functional
Editor's Notes
- With technology, the possibilities have exploded!