Pennsylvania School for the Deaf, Speech Language Pathologist, and Assistive Technology

Written by Amanda Franklin

Augmentative and Alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. AAC goes hand in hand with assistive technology (AT). I visited the Pennsylvania School for the Deaf (PSD) to meet with one of their speech language pathologists on what AT they used for communication needs. It was extremely fascinating to learn about the different types of technology, how they get access to the technology, and what strategies and resources they use to help students who need assistance in accessing communication. Deafness is not equitable to signing as some students are not able to establish formal language, may be echolalic, or may have a disability that makes using sign language difficult or not a physically plausible option.

In the classroom, they use a handful of different AT devices and methods. Naturally, sign language is used as much as possible, because it is the students’ predominant language. To facilitate communication for students who struggle with additional disabilities, assistive technology is used to allow them to communicate and participate with their peers and others. It is important to note that AT and AAC is not used as a replacement but is used to augment communication and support the student in the event of a communication break down.

Low-tech Versus High-tech

At PSD, they use both low-tech and high-tech solutions. At PSD, they use picture exchange books, apps on iPads for text to speech, NOVA chat, Proloquo2Go, Accent 1000, Minspeak, and picture cards. The technology most frequently used is the iPad and NOVA chat. NOVA chat was a personal favorite of the speech language pathologist I spoke with as she preferred the predictive quality that it has from the input given by the user. She also prefers devices or products that are connected to a larger company, such as Setillo, Prentke Romich Company, or DynaVox because you can contact them for support or assistance, whereas applications usually do not have that.

I asked if low-tech or high-tech solutions are more commonly used. She said that low-tech AT can be extremely limiting. For students who need to communicate anything more than simple statements, higher-tech solutions are required. However, low-tech can be good for teaching specific concepts or for specific activities, such as guided reading.

Access

Getting access to the technology that she needs for her students can be a struggle. Most of it is often covered by insurance. Lending libraries can be helpful, but the waiting list can often be too long to be worth the wait. Getting in contact with a representative in the area can be your best bet of obtaining the technology that is needed. PATAN’s lending library and PIATT, from Temple University, is how they can obtain some of the technology they need, but by getting devices through insurance, they can be more easily reset or replaced and the student can keep them when they move on from the school into adulthood.

Accessibility

Many SLPs will work in tandem with occupational therapists or physical therapists to build ways to make AT as accessible as possible. For some students, hearing aids can sometimes give the ability to hear at certain frequencies. This can sometimes assist a speech language pathologist. Knowing what a child can and cannot hear according to the “speech banana” (shown below) can inform the SLP what the student may hear or what feedback they might get from a device. The depression or feedback from pressing buttons can also help the student to know whether or not information is conveyed upon touching a screen.

Evaluation and Assessment

Dynamic assessment and scaffolding are the base of evaluation and assessment for an SLP. Specially designed instruction (SDI) is used along the way. She said that checklists are often used, including developmental checklists for social, emotional, and expressive data. When evaluating the use of an AT device, they trial 3 different devices and must provide data and information for why or why not the devices work for the child and whether they meet with the strengths and needs of the student.

In the process of obtaining devices for students it is often important to stress the means in which the devices could be required for medical needs. As SLPs and others who apply to obtain AT for their students/children, it helps to communicate health issues or the need to communicate medical needs. Insurance companies often see value in this over educational value, so conveying needs of the child to communicate medical information is important to recognize in these situations.

Self-Education and Resources

Lauren Enders created an AAC Boot Camp information diagram with content by Lauren Enders, Pat Mervine, Melissa Skocypec, and Cathie VanAlstine (shown below). It is available to print here. It is a great reference for any person who works with someone who uses an AAC device.

Image result for lauren Enders AAC boot camp

Conferences for SLPs are extremely informative as they display the newest technologies and methods for assisting students with communication needs. Prentke Romich Company has a free 3 day training confrence. In Pittsburgh, htere is an AAC Language Seminar Series by the creator of Minspeak, Bruce Baker. ATIA and PATTAN have helpful resources. These resources can be found here. She said Pinterest can also be a very helpful resource for SLPs and parents. She also rattled off some names of some people who are informative or important in the realm of AT and speech language pathology including: Lauren Enders, Gail VanTatenhove, Debbie McBride, and Tracy Kovach.

Overall, there are many resources that can be found locally and online. Speaking with a local speech language pathologist can help you find the resources you need and better understand what resources are needed and available.

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Review of Studies Related to Sign Language and use of AAC in Early Intervention

Written by Amanda Franklin

Amongst five studies I compiled for review, there are a few things to compare; use of augmentative and alternative communication (AAC) versus non-use of AAC, results from use of AAC in children that are neurotypical verses use of AAC in children with intellectual disabilities (ID), and the impact of social-environmental factors in children using AAC. These factors are some of the most integral parts of these studies and contribute to the most significant outcomes.

Relationship with Hearing, Disability, and Communication

In children who learn to use AAC, they develop ways to communicate in multiple ways, by signing, gesturing, using facial expressions, eye gaze, etc., and it gives them the ability to communicate in situations where they once may not have been able to. In control groups of some studies, in which infants did not learn sign language, they scored lower than their signing trained counterparts on language outcomes, however, the differences were not statistically significant. This is seen across the board in many studies for children that are hearing and neurotypical, where there are slight differences in scores and skills, but the differences are not statistically significant and therefore show that there is no strong evidence that supports or disproves the benefits of using sign language.

There is a stark difference between the results of the studies that analyze the use of sign language in early childhood in children that are neurotypical as opposed to using sign language with children with special needs. The predominant result of studies that focus on the use of sign language in children that are neurotypical is that there is no evidence that supports the idea that the use of sign language has long-term positive benefits in cognitive and linguistic development. There is also no notable evidence that supports the idea that the use of sign language detracts from a child’s verbal language development. Contrary to the results of the studies for neurotypical children are the studies that focus on the use of sign language in children who have intellectual disabilities. In those studies, the children grow in their language development, while also improving other parts of their lives through the ability to communicate. The main difference being that in one situation the child is fully capable of developing a means of communication, whereas the child who has an ID may rely on the alternative form of communication. However, in both cases it is shown that signing does not defer verbal language development, and in some cases it allows the child to develop some verbal language skills.

Impact of Social-Environmental Characteristics

In many of the studies used for this review, social-environmental factors greatly impact the outcomes of the studies as interactions in the home and in other natural environments in which the child would typically be, with or without the presence of a disability. Interactions with the parents are mentioned most frequently, as parent’s drive to interact with their child makes the interactions meaningful or purposeful matters. It is common for parents who have a child with a speech delay to have less frequent interactions, regardless of the child’s need for an enriching language environment. The frequency of interactions and opportunities to utilize communication methods are very important to the development of language and language skills. In giving parents specific language strategies, it gives them structure, purpose, and direction with which positively affects vocabulary growth. This doesn’t show in situations where the child is neurotypical and receives the typical amount of interaction with parents because the child does not need additional support like the child who is already delayed and receiving less linguistic input. Knowledge, attitude, frequency, and ability of usage of sign language impact the parent’s interactions with their child and therefore impacts their child’s ability to learn and use language.

Limitations of the Studies

Overall, the studies call for more research into the benefits or drawbacks to the usage of sign language in young children that are hearing with hearing parents. The fact of the matter is that these studies are often too small and the data is not statistically significant. The study that is the most comprehensive shows its results in narrative form, giving context for each of its participants. Context matters in the individual cases as progress may not be as great for one child as it is for another and skew the data. With context, the child, their social-environment, and their ability levels factor into the results. For children who are neurotypical, the effects of learning baby sign as an infant has short lived effects as language development progresses, but for children who have an intellectual disability sign language can give them a method of communication that they did not have access to.

Conclusion

Throughout the studies there is a theme of weighing the benefits of signing verses not signing with a young child. Overall, the studies show that there are no adverse effects to using sign with a child. For children who have an intellectual disability, the studies show development in different areas for different children. There is no evidence to support the proposed theory that using sign language with young children delays spoken language. There is still a need for more studies related to the use of signing with young children who have intellectual disabilities or speech delays, and more research is needed specific to the impact of certain variables related to social-environmental factors and language development. The outcome of these studies are that there are some temporary benefits to using sign language and gesturing with young children that are neurotypical. There are also some benefits for children who have an intellectual disability or a speech delay. However, there are different levels of intervention required for each case. The use of sign is not a one-size-fits-all model and children with more severe needs will have a drastically different experience than a child with a moderate speech delay. The use of sign also really has to be something that the parents want to invest time and effort into using with their child as those interactions make an impact on whether or not the child picks up the method of communication. Regardless, children have the will to communicate needs, wants, and ideas. It comes down to the resources, ability, attitude, and circumstances of each child whether or not this is a good option for them. The studies in this review show that participants are affected in many different ways and that the frequency and purpose of interactions with children who have communication difficulties have value in the overall cognitive and linguistic development.

 

References

Brady, N. C., Thiemann-Bourque, K., Fleming, K., & Matthews, K. (2013). Predicting language outcomes for children learning augmentative and alternative communication: child and environmental factors. Journal of Speech, Language, and Hearing Research, 56(5), 1595-1612 .

Fitzpatrick, E. M., Thibert, J., Grandpierre, V., & Johnston, J. C. (2014). How handy are baby signs? a systematic review of the impact of gestural communication on typically developing, hearing infants under the age of 36 months. First Language, 34(6), 486-509.

Seal, B. C., & DePaolis, R. A. (2014). Manual activity and onset of first words in babies exposed and not exposed to baby signing. Sign Language Studies, 14(4), 444-465.

Toth, A. (2009). Bridge of signs: can sign language empower non-deaf children to triumph over their communication disabilities? American Annals of the Deaf, 154(2), 85-95.

Vandereet, J., Maes, B., Lembrechts, D., & Zink, I. (2011). Expressive vocabulary acquisition in children with intellectual disability: speech or manual signs? Journal of Intellectual & Developmental Disability, 36(2), 91-104.

Sign Language and Augmentative and Alternative Communication in Early Intervention

Written by Amanda Franklin

Use of Baby Signing

Baby sign language is a strategy that has become particularly popular within recent years as hearing parents have used sign to communicate with their hearing children who have yet to learn to speak. There is plenty of discussion within the educational world that begs the question of whether or not baby sign is beneficial or harmful for typically developing hearing infants. There are three positions that people generally fall into in these beliefs; those who advocate for the benefits in linguistic and cognitive development, those who advocate for the purpose of early bilingual language learning, and those who believe it competes for attention with spoken language and that it delays spoken language acquisition (Seal & DePaolis, 2014). The impact of sign language intervention on development and interaction with others will be explored throughout this article.

A review done by Fitzpatrick, Thibert, Grandpierre, and Johnston in 2014 focused on outcomes with interest in receptive and expressive, or understanding and expressing, language. The study focused on communication in typically developing hearing infants. “Three studies suggest that using baby sign language does not interfere with parent-child interaction and may, in fact, contribute to positive interactions” (Fitzpatrick, Thibert, Grandpierre, & Johnston, 2014). Overall, the research shows that there is not a strong compilation of evidence that would support the benefits in language acquisition for typically developing children, but allows for certain interactions that are not possible until later in development. For typically developing children, there is a short window in which sign language can enhance early communication, but there has been no evidence that would support the notion of lasting benefits in spoken language or cognitive development. Overall, the authors concluded that while there is no evidence that supports long-lasting benefits for typically developing children, there is also no evidence that shows adverse effects to typical language development or parent-child interaction. There is no reason to advocate for or discourage the use of symbolic gestures or sign language in early communication with young, typically developing children (Fitzpatrick et al., 2014). The research and studies simply do not provide statistically significant evidence that can support or disprove that the use of signing helps or harms linguistic development.

Expression of Vocabulary Acquisition in Children with Intellectual Disabilities

In Seal and DePaolis’ study (2014), they focus on the relationship between vocal, as in verbal, and manual, as in using of the hands or gestural, activity. Their study shows a clear link between both verbal and nonverbal means of expressive communication. The study also places emphasis on the parent and whether they emphasize only a certain number of signs, which can restrict, or limit, a child’s manual-vocal development trajectory. This is important, as the study shows that parents who use American Sign Language, British Sign Language, or another sign language better support manual-vocal activity which leads to increased manual-vocal activity in interactions and more meaningful gestures, signs, and first words. The results of this study conclude that there are no language based deficits derived from the use of baby sign. They also fail to support the concerns of those who warn against the use of baby sign due to the belief that it interferes with the learning of spoken language (Seal & DePaolis, 2014). Baby signing is not shown to advance or delay spoken language acquisition in infants.

In typically developing children, it is clear that there is no evidence that supports the use of baby signing for the purpose of long-term benefits. However, when the child is atypical, we see different results. For children with intellectual disabilities, language acquisition can be limited or delayed. Vandereet and others in 2011 attempted to identify factors that contributed to the development of language in children with intellectual disabilities. Specifically, their aim was to “explore whether point of view, sign, child, and social environmental characteristics, as factors, are sufficient to explain the degree to which children with ID depend on manual signs during the longitudinal process of their expressive vocabulary acquisition” (Vandereet, Maes, Lembrechts, & Zink, 2011). Factors related to vocabulary acquisition include child characteristics, cognitive skills, communication skills, initial vocabulary comprehension, social-environmental characteristics, and home environment. The conclusion of the study shows that exposure to manual signs does not guarantee that the child will use them or develop adequate symbolic skills. Linguistic, cognitive, and communicative factors that are fundamental to the development of speech are also notably fundamental in the development of manual sign use (Vandereet et al., 2011).

Social-environmental factors have a vital role in language acquisition within the studies. Making sure that parents are able to support the use of signing in the home was an emphasized point in Vandereet and others’ study. It is also an important factor in “Predicting Language Outcomes for Children Learning Augmentative and Alternative Communication: Child and Environmental Factors” (2013), as their findings showed that in children with a speech delay, without intervention, the children will typically receive less language input from parents and peers. Increasing input at home and stressed importance of an enriched home language environment can positively affect growth of vocabulary. The findings of the study “support the importance of enriching social communication input across home and school environments during this sensitive period of symbolic word learning, as well as assessments of and interventions aimed at improving comprehension, play, visual discrimination, and communication complexity” (Brady, Thiemann-Bourque, Fleming, & Matthews, 2013). This factor was one of a few that was found to significantly be able to predict word production in early intervention.

Use of Sign Language and Augmentative and Alternative Communication

The use of sign language and augmentative and alternative communication(AAC) in hearing children with the presence of disorders such as Autism Spectrum Disorder and Down Syndrome has become commonplace as over 50,000 children between the ages of 4 and 6 years are learning to communicate with forms of AAC (Brady et al., 2013). Augmentative and alternative communication includes any form of communication other than oral speech that is used to express ideas, needs, or wants. For children with intellectual disabilities, this allows them to communicate in ways other than communicating verbally. In Toth’s study in 2009, it was affirmed that children seek to communicate, regardless of ability. Given the chance and education to use a different form or method of communication, via a visual or gestural language, such as American Sign Language, or a text or symbol to speech method, children respond. The will to communicate shows through physical, developmental, and cognitive impairment (Toth, 2009). Children exposed to sign language can have very different results. In Toth’s study, the results were shown in narrative form to give better context of results. In multiple cases, correlated with small developments in vocalization, modification of maladaptive behavior, and improved communication with others.

In Toth’s study (2009), the narrative results of the Bridge of Signs program show many improvements to the lives of the children involved as one of the children in the study who was nonverbal with autism had reduced some frustration and gave the family hope for the possibility of their son developing language. This was not the only case in the study where a participant in the program responded to a caregiver’s attempt to interact by pausing maladaptive behavior to make eye contact and view the signs. At a minimum, the children in the program who had severe difficulties came away from the program with the ability to anticipate a transition from one activity to another, a greeting, and a nutrition or bathroom break. Some others who were a part of the study developed their spoken language as well as their signing.

 

References

Brady, N. C., Thiemann-Bourque, K., Fleming, K., & Matthews, K. (2013). Predicting language outcomes for children learning augmentative and alternative communication: child and environmental factors. Journal of Speech, Language, and Hearing Research, 56(5), 1595-1612 .

Fitzpatrick, E. M., Thibert, J., Grandpierre, V., & Johnston, J. C. (2014). How handy are baby signs? a systematic review of the impact of gestural communication on typically developing, hearing infants under the age of 36 months. First Language, 34(6), 486-509.

Seal, B. C., & DePaolis, R. A. (2014). Manual activity and onset of first words in babies exposed and not exposed to baby signing. Sign Language Studies, 14(4), 444-465.

Toth, A. (2009). Bridge of signs: can sign language empower non-deaf children to triumph over their communication disabilities? American Annals of the Deaf, 154(2), 85-95.

Vandereet, J., Maes, B., Lembrechts, D., & Zink, I. (2011). Expressive vocabulary acquisition in children with intellectual disability: speech or manual signs? Journal of Intellectual & Developmental Disability, 36(2), 91-104.

Early Intervention Experience with Augmentative and Assistive Technology From a Parent Perspective

Written by Amanda Franklin

This past week I interviewed the mother of a child who had a speech delay in the hope of gaining insight into a family’s experience with the early intervention process and the use of assistive technology. Needless to say, it was fascinating to hear their experience as I had known the child growing up and saw his progress, but, until this point, I did not know what they had to do to get their child to where he is today.

To begin the story of their experience, I asked what the process was like for them. First, they went to the pediatrician to rule out any physical reasons for her son’s lack of speech. Her son was 2 1/2 years old at the time and it was determined after evaluation that two days a week, her son would receive speech therapy and occupational therapy until he turned 3 years old and started preschool. When they started early intervention in the home, they used some sign language, flash cards, and certain games based on his needs. The use of signing and the games were the most used as signing was used when he needed to communicate something he couldn’t verbalize, while the games gave him practice in a way that got him interested and invested.

I asked what the easiest and hardest part of the process was, and she said that the easiest part may have also been one of the hardest parts. For the evaluation, the interdisciplinary team did all the work and they saw what he was like without mom around. The hardest part in that was being sent out of the room. She also said that one of the hardest things she had to do was explain over and over to others why her child wasn’t at the same level as his peers. It was also very hard to deal with the idea that there is “something wrong with my kid.” Fortunately, the team was able to let her know that her child could understand and process everything that was being spoken or shown to him, he just couldn’t say what he wanted to say.

They started basic communication with early intervention in the home, but when it came time for her child to start preschool, the preschool said they didn’t want him to sign. The preschool had discouraged the signing, but she pushed for them to continue the use of signing in order to maintain consistency in the ability to communicate. There was no evidence to support their claim that the signing would deter him from speaking. She said, “As soon as he could say [the word], he replaced the sign with the word.” With signing, he was able to communicate with his siblings and it avoided a lot of confusion. So, they continued the use of signing in preschool until he no longer needed it.

She also said that it was a bit of a difficult transition going from weekly reports of how her son was doing and the goals/future expectations they were working on, to very basic updates from the preschool. The preschool interactions were harder because they didn’t share as much about what they were learning and how he was growing day to day as opposed to early intervention when it was like a conference after every session.

Overall, early intervention seemed to be a positive experience for her and her family, and the outcomes for her child were beyond what they had hoped. By the time he was getting ready to go into kindergarten, he was already ahead of his peers. One thing that was mentioned while we were talking is that while her family felt that they took something away from their experience, her friend’s experience with intervention was different from theirs. They didn’t use signing with their child and so the process was more frustrating and felt “lacking,” as they didn’t feel that they took anything away from the experience.

In my personal experience with her son, when he was little, there was a lot of frustration when somebody couldn’t understand what he wanted, but signing gave a bridge that allowed us to understand what he couldn’t verbalize. Once he was able to verbalize a word, he completely dropped the use of the sign. These days, as a child in elementary school, he speaks fluently and he doesn’t remember the signs he once relied on to communicate. The only sign he and his family still use is the sign for “no,” which they apparently use subconsciously when they speak to each other.

All-in-all, the interview gave me insight into their experience in early intervention and their interaction with the use of augmentative and assistive technology. Signing seemed to be the most helpful for them among the other techniques and technology they were using. Just having the support from the individual family service plan team and the individual education plan team allowed them to make the necessary strides to get their child up to his peers by the time he entered kindergarten. While this may not be everybody’s experience with early intervention, it was definitely fascinating to learn about their experience.