Assistive Technology at Childrens Community Early Intervention At Childrens Hospital Boston

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Assistive Technology at Childrens Community
Early InterventionAt Childrens Hospital Boston

• Holly Cavender-Wood, M.A., CCC-SLP, Lend Fellow
• Iris Lee, M.S., CF-SLP
• Vicki Haddix, M.S., CCC-SLP, Doctoral Student,
• Special Education, Boston University

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Early InterventionPresentation Objectives

• Who we are? What we do?
• Underpinnings of Communication
• Relevant Research
• AT supports across 3 children
• What goals do we work on in Early Intervention?
• How do we use AT to enhance them?
• How do we promote family buy-in?
• Key Lessons Learned/Future Initiatives

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Who we are What we Do
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Mission Statement

• Childrens Community Early Intervention Program
  provides family centered services to children,
  ages 0-3 years, who have or are at significant
  risk for developmental delays.
• The central mission of the program promotes the
  family in caring for some of the most vulnerable
  and medically fragile infants and toddlers living
  in the communities of Boston and Brookline.
• Services are provided through Individualized
  Family Service Plans (IFSP).

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Childrens Community Early Intervention Program

• A voluntary program administered by DPH to
  provide family centered services to eligible
  children
• Children ages 0 - 3 years old are eligible for 6
  months of services, if there is
• A 30 delay in one or more areas of development
• A minimum of 4 significant risk factors
• Clinical Judgment to justify services
• Children with an established diagnosis (per DPH)
• are eligible for 12 months of services.

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Childrens Community Early Intervention Program

• Services are provided by an interdisciplinary
  team, which may consist of
• Developmental Specialist
• Physical Therapist
• Occupational Therapist
• Mental Health Worker
• Social Worker
• Speech-Language Pathologist
• Feeding and Swallowing

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Underpinnings of communication
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Prelinguistic Underpinnings of Communication

• What is Prelinguistic Communication?
• Behaviors body movement, vocalization, eye gaze
• Functions requesting, commenting
• Why is Teaching Parents about Prelinguistic
  Communication Important?
• Can be difficult to recognize
• Behaviors have meaning
• Highly responsive parenting styles promote
  communication and language skills

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Assign Meaning to Behavior

• Meanings
• Protest
• Request
• Recurrence
• Gain attention
• Maintain attention
• Confirm/deny
• Label
• Comment

• Behaviors
• Movements
• Vocalizations
• Approximations
• Words
• Phrases
• Sentences
• Stories

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Jane Korstens Math

• A typically developing child has 4,380 hours of
  exposure to oral language before starting to
  speak around 18 months.

• A child using an alternate symbol set with an SLP
  twice a week for 20-30 minute sessions will need
  84 years to get the same amount of exposure.

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Jane Korstens Math

• A typically developing child reaches language
  competence between 9-12 years, while immersed in
  the language and having practiced 36,500 hours.

• A child using an alternate symbol set with an SLP
  twice a week for 20-30 minute sessions will need
  701 years to accumulate that amount of practice.

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Relevant research
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Relevant Research

• Cress and Marvin (2003) Common Questions about
  AAC Services in Early Intervention
• Millar, Light Schlosser (2006) The Impact of
  Augmentative and Alternative Communication
  Intervention on the Speech Production of
  Individuals with Developmental Disabilities A
  Research Review
• DeThorne, Johnson, Walder Mahurin-Smith (2009)
  When Simon Says Doesnt Work Alternatives to
  Imitation for Facilitating Early Speech
  Development

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CASe Study 1 late talkers
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AT with Late Talkers

• Photograph to Object Matching
• Single message voice output switches
• Computer based songs (PowerPoint or iPod Touch)
• Low-tech song choice boards
• Pictures for organization
• Simple Signs for survival words
• All about the motivation and engagement

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Case study 2 using social stories
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Social Stories Background

• Developed by Carol Gray in 1991 to teach children
  with autism to perspective take, follow social
  protocol, and improve understanding of social
  events

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Social Stories What are they?

• Short and simple stories
• Basic Social Story Ratio (Gray 2000)
• 0-1 directive sentence
• 2-5 descriptive, perspective and/or affirmative
  sentences
• Emerging research suggests this ratio is
  important
• Based on theory that improving a childs
  understanding of events, expectations and
  consequences will improve their behavior

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Social Stories Implementation

• Assess comprehension
• Present the story prior to a specific task or
  situation
• Consistent schedule
• Monitor effectiveness
• Fade by increasing the time between readings
• After mastery continue to store in an easily
  accessible area and review when needed

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Social Stories Increasing understanding

• Research reports positive changes in
• Tantrum behaviors
• Social interactions
• Anxiety levels
• Aggression
• Initiating requests
• Classroom behaviors
• Response to directions
• Frequency of social communication
• Scattone, Wilczynski Edwards (2002), Reynhout
  Carter (2006)

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Social Stories Outcomes

• Teaching Theory of Mind
• Building schemas
• Play on visual strengths

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Social Stories Case Study

• Child male, 33 months old

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Case study 3 AAC and a child with
physical disabilities
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AAC for a child with Cerebral Palsy

• Childs Active Role
• Initiation
• Responsiveness
• Range of Words and Functions
• Present and Absent objects, actions and emotions
• Pace of conversation
• Transactional theory of development
• Adaptation behaviors, opportunities

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AAC for a child with Cerebral Palsy

• Partner Training
• AAC use
• Physical environment
• Responsiveness
• Balance in communication
• Cues, prompts and targets
• positive feedback

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AAC for a child with Cerebral Palsy

• Video Observation
• Child Behaviors
• Symbolic
• Access
• Complexity control, comments, responsiveness
• Parent Behaviors
• Recognition AAC, idiosyncratic communication
  behaviors
• Understanding
• Reduced Directed Communication
• Warmth in interaction

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AAC for a child with Cerebral Palsy

• Next Steps Opportunities to practice
• range of communication functions
• variety of language concepts
• language structure
• early literacy
• control

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AAC for a child with Cerebral Palsy
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Key Lessons Learned future initiatives
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Key Lessons Learned Future Initiatives

• Integrate AAC
• Remove familys barriers to access
• Model
• Interdisciplinary teams
• Coordinated services
• Outcomes
• Communication
• Ratings
• Skill level transitioning from Early Intervention

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References

• Cress and Marvin (2003) Common Questions about
  AAC Services in Early Intervention Augmentative
  and Alternative Communication Vol 19(4), pp
  254-272.
• DeThorne, Johnson, Walder Mahurin-Smith (2009)
  When Simon Says Doesnt Work Alternatives to
  Imitation for Facilitating Early Speech
  Development, American Journal of Speech Language
  Pathology, Vol 18, pp 133-145.
• Gray, C. (2003). My Social Stories Book.
  Philadelphia, PA Jessica Kingsley Publishers.
• Idaho Training Clearinghouse (2007). Fact sheet
  1 assessing communication skills Webpage.
  Retrieved from http//itcnew.idahotc.com/dnn/learn
  ing-communities/parent-and-school-success/video-fa
  ct-sheet-1.aspx.
• Millar, Light Schlosser (2006) The Impact of
  Augmentative and Alternative Communication
  Intervention on the Speech Production of
  Individuals with Developmental Disabilities A
  Research Review, Journal of Speech, Language and
  Hearing Research, Vol 49, pp 248-264.

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References

• Pennington, L., Thomson, K., James, P., Martin,
  L., McNally, R. (2009). Effects of it takes two
  to talkthe Hanen program for parents of
  preschool children with cerebral palsy findings
  from an exploratory study. Journal of Speech,
  Language, and Hearing Research. 52 (5),
  1121-1138.
• Reynhout, G. Carter, M. (2006). Social Stories
  for children with disabilities. Journal of Autism
  and Developmental Disorders, 36, 445-469.
• Scattone, Wilczynski Edwards (2002)
• Tarnai , B. (in preparation). Establishing the
  relative importance of applying Grays sentence
  ratio as a component in a 10-step Social Stories
  intervention model, teaching social skills to
  students with ASD.
• Warren, S.F. (2000). The future of early
  communication and language intervention. Topics
  in Early Childhood Special Education. 20 (1),
  33-37.

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Questions

• Contact Information
• Childrens Community Early Intervention Program
• A program of Childrens Hospital Boston
• Phone [phone]
• Email
• holly.cavender-wood_at_childrens.harvard.edu
• vicki.haddix_at_childrens.harvard.edu
• iris.lee_at_childrens.harvard.edu

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