DecisionMaking About Assistive Technology with Infants and Toddlers

1
Decision-Making About Assistive Technology with
Infants and Toddlers

• Lauren Dugan, M.S.
• Philippa Campbell, Ph.D.
• Thomas Jefferson University
• Jeanne Wilcox, Ph.D.
• Arizona State University

This work was completed through the Tots n Tech
Research Institute which is supported by U.S.
Department of Education, Office of Special.
Education Grant H327X010003
2
Overview of Presentation

• What is Assistive Technology (AT)?
• Tots-N-Tech
• Introduction to investigations and data sources
• Provider decisions about assistive technology in
  practice
• New follow-up T-n-T survey for professionals

3
What is Assistive Technology (AT)

• AT includes a range of supports that help young
  children with disabilities to increase, maintain
  or improve their functional capacities
  (Mistrett, 2004)
• Range from simple (e.g., adapted spoons and
  switches) to complex (e.g., computers,
  augmentative communication systems, electric
  wheelchairs)
• Devices and services promote a childs ability to
  move, communicate, and interact while
  participating in everyday activities and routines
• Helps families support their childrens learning
  and development
• Nationwide, AT may be underutilized with infants
  and toddlers

4
Intro to Tots-N-Tech
The Tots n Tech Research Institute, which is
funded by the U.S. Department of Education,
Office of Special Education Programs, was
established in 2001 as a collaborative effort of
Arizona State University and Thomas Jefferson
University. The mission of TnT is to study
prevalence, policy and resources, individualized
decision making, training and support and other
factors related to use of assistive technology
(AT) devices and services in early intervention.
5

Institute Research Areas

• AT Use by Infants Toddlers
• Policy and Resources
• Decision Making
• Training and Support
• Funding
• Best Practices Implementation

6
Decision-Making about AT

• Providers perceptions about AT can influence
  their decisions about using AT devices in
  practice (Lahm Sizemore, 2002)
• Provider beliefs may be contributing to an
  underutilization of AT in early intervention
  (Cress Marvin, 2003 Judge, 1998 Kemp
  Parette, 2000 Mistrett, 2001 Sullivan Lewis,
  2000 )
• Two T-n-T Studies (see references)
• Wilcox, Guimond, Campbell, Moore (2006)
• Dugan, Campbell, Wilcox (2006)

7
Data Sources

• National EI Practitioner Phone Survey
• 967 multidisciplinary early intervention
  providers (e.g., EI teachers, PTs, OTs)
• Random recruitment from 12 states
• Working with at least 3 children per week
• Demographic information, perceptions and
  definitions of AT, prevalence and use
• Follow-up Practitioner Survey
• 424 providers were re-contacted
• Decision-making about AT in practice
• Training and education experience in AT

8
Practitioner Follow-up Survey Demographic
Information (n 424)

• Gender
• Female 98.3
• Education
• Bachelors 34.7
• Masters 61.6
• Doctorate 2.1
• Ethnicity
• Caucasian 89.9
• Hispanic 2.4
• African American 3.5
• Asian 0.2

• Avg. years experience 13.57 (range 1-45)
• Discipline
• OT 21.5
• PT 17.6
• SLP 22.8
• Child development specialist/teacher 28.8

9
Decision-Making Study

• What decisions do providers make about AT use?
• Childrens skills
• Type of intervention
• Timing of intervention use
• Type of AT (low/high)

10
Decision-Making ScenariosPlaying

• TRUE or FALSE
• You would use an adapted toy or a switch device
  if an 11 month old child could hold, but not
  manipulate, a toy.

11
A child can hold, but not manipulate a toy

• Provide a toy of high interest (Skill
  development)
• Adapt toys to make play easier (e.g., switch)
  (Low Tech)
• Provide activities so the child can improve fine
  motor skills to manipulate toys better (Skill
  development)
• Teach the child how to use a computer (High tech)
• No concern

12
Decision-Making ScenariosA child can hold, but
not manipulate a toy
13
Decision-Making ScenariosDressing

• TRUE or FALSE
• You would use a dressing aid like a buttoning
  device if a child was totally unable to
  participate in dressing at 30 months.

14
A child is totally unable to participate in
dressing

• Select clothing that is easy to get on and off
  (Skill development)
• Adapt clothing to make it easier for the child or
  parent to put on and take off (Low tech)
• Teach the child to use a dressing aid, such as a
  buttoning device (Low tech)
• No concern at this time

15
Decision-Making ScenariosA child is totally
unable to participate in dressing
16
Decision-Making ScenariosMobility

• TRUE or FALSE
• You would use a power wheelchair for a child
  under 3 years that cannot get around by crawling
  or walking.

17
A child cannot get around by crawling or walking

• Teach child to use a powered wheelchair (High
  tech)
• Teach child to crawl, walk, scoot on bottom or
  roll (Skill development)
• Provide child with a motorized ride-on toy
  vehicle (e.g., barbie car) (Low tech)
• Use a stroller, wheelchair, something pushed
  (Low-tech)
• Self-propelled device like tricycle, gait trainer
  walker (Low-tech)
• No concern

18
Decision-Making ScenariosA child cannot get
around by crawling or walking
19
Decision-Making ScenariosBathing

• TRUE or FALSE
• You would feel comfortable using an adapted or
  off-the-shelf bath seat for a child even as young
  as 6 months if he/she were having trouble sitting
  up for bath time.

20
A child is unable to sit up for bathing

• Purchase an off-the-shelf bath seat (Low tech)
• Order a custom bath seat (High tech)
• Sponge insert so the child can have a bath while
  lying down (Low-tech)
• Teach the child to sit up so that he/she can
  participate in bath time (Skill development)
• No concern at this time

21
Decision-Making ScenariosA child is unable to
sit up for bathing
22
Decision-Making ScenariosCommunication

• TRUE or FALSE
• If a child has not yet produced any speech by
  age 2, you would continue to teach that child to
  vocalize until at least 3 years of age.

23
A child has normal hearing, babbles rarely,
struggles to vocalize, and has not yet produced
any speech

• Teach child to vocalize so that he/she can
  communicate (Skill development)
• Teach child sign language (Skill development)
• Use objects, communication board, or picture
  exchange system so child can communicate (Low
  tech)
• Simple voice output device like Big mac, loop
  tape or cheap talk (Low-tech)
• Early communication device like Tech-Speak (High
  tech)

24
Decision-Making ScenariosA child has normal
hearing, babbles rarely, struggles to vocalize,
and has not yet produced any speech
25
Decision-Making ScenariosEating/Drinking

• TRUE or FALSE
• If a child cannot eat or drink without
  assistance, you would not be concerned until the
  child was older than 3 years.

26
A child is able to swallow without a problem but
cannot eat or drink without assistance

• Use physical assistance or hand-over-hand methods
  (Skill development)
• Adapt dishes, cups, utensils so child can use
  them to eat/drink (Low tech)
• Mechanical device that brings the spoon or cup to
  a childs mouth (High-tech)
• No concern at this time

27
Decision-Making ScenariosA child is able to
swallow without a problem but cannot eat or drink
without assistance
28
With this sample of providers..

• For the most part, AT not selected as an
  intervention option until children were older
  than 24 months.
• When AT chosen, high-tech options seldom selected
• Providers tend to choose skill-based
  interventions
• ____________________________________________
• Two convenience groups

29
Other groups and decision-making

• Deaf-Blind Program Coordinators
• 37 state directors/coordinators for programs for
  children who are deaf-blind (representing 31
  states)
• Combo of both provider surveys
• Responded to decision-making scenarios
• State Coordinators
• Providers who were coordinators for the TnT
  implementation study
• 31 providers representing 21 states nearly all
  female
• Completed the provider follow-up survey
• Responded to decision-making scenarios

30
Scenario 1 Child can hold but not manipulate
toys
31
Scenario 2 Child is unable to participate in
dressing
32
Scenario 3 Child can not get around by crawling
or walking
33
Scenario 4 Child unable to sit up for bathing
34
Scenario 5 Child is struggling not talking and
struggling to vocalize
35
Scenario 6 Child can not eat or drink without
assistance
36
Conclusions and Trends

• Generally, the national sample less likely to
  choose AT until child older than 2 years
• Other 2 groups sometimes chose AT sooner than
  national sample
• Low-tech devices chosen more often than high-tech
• In some situations, Deaf-blind coordinators more
  likely than other groups to choose AT when child
  lt12m

37
A New Tool

• Best practices for using AT with infants and
  toddlers
• Includes key areas of the process when using AT
  with young children
• Assessment
• Use and Implementation
• Evaluation of Effectiveness
• System elements
• Self-assessment tool and guide for professionals
  when thinking about their local early
  intervention systems

38

• Feedback?
• Please complete at http//tnt.asu.edu STARTING
  NOVEMBER 1ST!!!!!!!!

39
References

• Cress, C.J. Marvin, C.A. (2003). Common
  questions about AAC services in early
  intervention. Augmentative and Alternative
  Communication, 19, 254-272.
• Dugan, L.M., Campbell, P.H., Wilcox, M.J.
  (2006). Making decisions about assistive
  technology with infants and toddlers, Topics in
  Early Childhood Special Education, 26(1), 25-32.
• Judge, S. (1998). Providing access to assistive
  technology for young children and families. In
  S.L. Judge H.P. Parette (Eds.), Assistive
  technology for young children with disabilities
  (pp 1-15). Cambridge, MA Brookline Books.
• Kemp, C.E., Parette, H.P. (1998).
  Family-centered assistive technology
  decision-making. Infant-Toddler Intervention, 8,
  185-206.
• Lahm, E.A., Sizemore, L. (2002). Factors that
  influence assistive technology decision-making.
  Journal of Special Education Technology, 17,
  15-26.
• Mistrett, S. (2001). Synthesis on the use of
  assistive technology with infants and toddlers
  (birth through age two) (Contract No. HS97017002,
  Task Order No. 14). Washington, DC U.S.
  Department of Education, Office of Special
  Education Programs, Division of Research to
  Practice.
• Mistrett, S. (2004). Assistive technology helps
  young children with disabilities participate in
  daily activities. Technology in Action, 1, 1-8.
• Wilcox, M.J., Guimond, A., Campbell, P.H.,
  Moore, H. (2006). Provider perspectives on the
  use of Assistive Technology for infants and
  toddlers with disabilities, Topics in Early
  Childhood Special Education, 26(1), 33-49.

40
For more information about TnT

• Visit the Tots-N-Tech website
• http//www.asu.edu/clas/tnt/