CD 5672 Week 3

1
CD 5672Week 3

• Augmentative and Alternative Communication
  Interventions for Individuals with Developmental
  Disabilities
• Summary of Chapters 12, 13 and 14
• In Beukelman, , Miranda, (2005). Augmentative
  and alternative communication Supporting
  children adults with complex communication
  needs (3rd Ed.) Baltimore, MD Brookes
  Publishing.

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CHAPTER 12 - LANGUAGE LEARNING AND DEVELOPMENT
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WHAT WE KNOW ABOUT LANGUAGE DEVELOPMENT IN AAC
USERS

• Regardless of the cultural, cognitive, social,
  and other factors that influence language
  development, all languages are composed of 5
  domains
• Pragmatics
• Phonology
• Semantics
• Morphology
• Syntax

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Pragmatics

• It is not unusual to find reports that AAC users
  have impaired pragmatic skills, especially in
  conversational interactions
• During interactions with speaking partners,
  people who use AAC tend to occupy a respondent
  role
• they seldom initiate conversations
• respond primarily when obliged to do so
• produce utterances that are only as long as they
  need to be to get a message across
• However, when two people who use AAC interact
  with one another, their conversations are much
  more equal than when they interact with natural
  speakers
• The phenomenon of conversational asymmetry
  appears to be a function of an imbalance in
  conversational power rather than of pragmatic
  deficits per se in people who use AAC

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Phonology

• Although some individuals with SSPI (severe
  speech and physical impairments e.g., cerebral
  pals) are able to analyze and manipulate
  phonologic information successfully, they score
  well below control participants on research
  tasks, regardless of whether other language
  problems are present
• At least some potential AAC users are at risk for
  delays in the area of phonology, in the absence
  of intervention

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Semantics

• Young AAC users often experience delays in
  semantics because
• They cannot select their own lexicon for their
  AAC displays and rely on adults to make those
  selections, thus, a childs external lexicon
  (i.e., the words on his or her communication
  display) may not reflect his or her internal
  lexicon (i.e., the words in his or her head)
• They may be talked to less than children who do
  not have disabilities, for a variety of reasons
• There is an asymmetry between language input and
  output such that children receive and process
  words in one modality (i.e., speech) but
  communicate through another (e.g., manual signs
  or graphic symbols)
• As they select words from their communication
  displays, they do not receive symbol feedback
  from their partners, particularly if they
  overextend words (e.g., if they use the symbol
  COW to refer to a dog, they might be told the
  correct word verbally No, thats not a cow,
  thats a dog but they are unlikely to be shown
  the correct symbol on their display, even if it
  is there)
• There may be less convergence between semantic
  and conceptual organization in come graphic
  symbol sets (Blissymbolics) and systems than
  others (e.g., Picture Communication Symbols)
• The challenge for AAC teams in building semantic
  knowledge is primarily one of providing
  individuals with sufficient access to new
  vocabulary via some type of symbol system and
  then providing ongoing input to build semantic
  knowledge through the use of that system
• Some individuals who use AAC are able to fast
  map, despite moderate to severe cognitive
  impairments

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Morphology

• Individuals who use AAC experience marked
  difficulties with grammatical morphology.
• It is not clear why people who use AAC regularly
  experience problems with morphology, five
  explanations are possible
• No experience using them, the symbols the AAC
  user need to indicate (e.g., plural, possessive,
  or past tense) are not available on his or her
  communication display
• Chooses efficiency over accuracy as a strategy
  for enhancing the speed of communication
• Not yet learned the morphological rules that
  apply to the situation
• AAC modality itself influences output and
  precludes the need for conventional English
  morphemes.

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Syntax

• Syntactic difficulties of individuals who
  communicate with graphic symbols
• A predominance of one- or two-word messages, both
  in spontaneous and elicited conditions
• Use of constituent orders that differ from the
  individuals spoken language background,
  regardless of the AAC modality used
• Omission of words that appear frequently in the
  individuals language, such as verbs and
  articles, even when available on the
  communication display
• A prevalence of simple clauses, with limited use
  of complex structures such as questions,
  commands, negatives, and auxiliary verbs
• Extensive use of multimodal combinations (e.g.,
  gesture symbol, vocalization symbol), word
  overextensions (e.g., dog instead of cow), and
  other linguistic strategies that compensate for a
  lack of necessary symbols
• Three primary explanations
• Deficit hypothesis most individuals who use AAC
  systems have underlying deficits, a notion that
  has since been disabused
• Compensation hypothesis the atypical graphic
  symbol utterance structures reflect constraints
  involved in aided communication
• Modality-specific hypothesis between what
  individuals who use AAC hear (i.e. spoken
  language) and how they communicate, and are a
  function of the differences between the two
• It is probable that both the compensatory and
  modality-specific hypotheses contribute to the
  differences seen in the language patterns of
  persons who use AAC

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In Summary

• We can make several statements about language
  learning and development in individuals who
  communicate through AAC
• Many of these individuals show evidence of both
  receptive and expressive language impairments,
  however, it is important to note that many
  individuals who have never been able to use
  natural speech have written and spoken eloquently
  about their experiences and their lives using
  AAC
• Language difficulties experienced by many
  individuals who use AAC are undoubtedly
  influenced by the fact that their
  language-learning experiences are so very
  different from those of individuals who can speak

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INTERVENTIONS TO SUPPORT LANGUAGE LEARNING
DEVELOPMENT

• Graphic Symbols and Language
• Instructional Strategies and Language Learning
• Message Units From Sentences to Morphemes
• Teaching Strategies

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Graphic Symbols and Language

• One of the challenges in representing any
  language system for persons who use AAC and do
  not (yet) know how to read involves how to
  translate spoken language into a visual form
  without losing specificity and flexibility, the
  answer depends on whom you ask...
• Blissymbolics
• DynaSyms
• Minspeak
• Manual Signing

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• Blissymbolics The use of this pseudolinguistic
  system allows users to learn about the rules of
  morphology, syntax, and message construction
• DynaSyms A symbol set used on some dynamic
  display SGDs, including grammatical markers and
  symbols that allow representation of tense,
  plurals, possessives, and other grammatical forms
• Minspeak AKA semantic compaction, a technique
  to support language which has been debated and
  derived two main questions
• Is Minspeak a language?
• Does Minspeak promote language development?
• Minspeak is not a language. It does not have an
  established rule system, set of icons, or set of
  meanings associated with particular icons,
  rather, its an iconic encoding technique whereby
  symbols are organized so that they can be joined
  together to access a vocabulary with a minimum of
  keystrokes
• Some believe that Minspeak does promote language
  development because of the similarities among
  semantic compaction, language learning, and
  literacy learning and use
• Thus, semantic compaction, language, and
  literacy all share the characteristic of being
  generative in nature. Others argue that the
  question is not a fair one because no symbol or
  encoding system itself promotes (or impedes )
  language developmentit all depends on how it is
  taught and used!

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Manual Signing

• Linguistic in nature
• Individuals with a range of disabilities are
  often able to acquire extensive manual sign
  vocabularies in the course of intervention
• Manual sign learning often stalls at the one-word
  stage of development, especially when individuals
  with cognitive disabilities use it
• Nonetheless, despite some clear theoretical
  advantages in favor of manual signing as a
  technique for language learning, the research
  suggests that there may be no real advantage to
  using this symbol system rather than others for
  AAC users who can hear.

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Instructional Strategies and Language Learning

• By instruction, we mean methods for organizing
  and teaching the use of symbols, in this case, to
  encourage language development
• Not one best way to do this
• Little research exists in this area overall
• Find ways to create links between whichever
  system a person uses for face-to-face
  communication and whichever system he or she uses
  for language and literacy instruction, so that he
  or she is not faced with the daunting task of
  learning completely separate systems for each of
  these domains

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Organizational Strategies

• Have the potential to encourage language
  learning
• Two main categories
• Grid displays, in which the elements depicted are
  the event, persons, objects,
• Related actions that are inherent components of
  the scene

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Organizational Strategies

• Activity Grid Displays
• Semantic-Syntactic Display
• Taxonomic Grid Displays
• Visual Scene Displays
• Other Categorical Arrangements

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• Activity Grid Displays
• One of the most popular grid display strategy
  involving the organization of vocabulary
  according to even schemes, routines, or
  activities
• Many AAC users begin using pictorial or other
  graphic symbol displays that are organized for
  different environments or activities which can
  function as overlays on electronic devices or as
  stand-alone, low-tech communication aids
• Participation is enhanced when multiple activity
  displays are available
• Activity displays can also be designed for use by
  individuals across the age range in community,
  school, and vocational settings
• Advantage facilitators can construct new
  displays relatively quickly using only the
  vocabulary items appropriate to the activity or
  event
• Activity-based displays are preferable to
  semantic-syntactic displays because they latter
  adds to the cognitive demands of the task for
  individuals who might not think in semantic
  categories
• Promote the use of multiword linguistic
  structures and build a strong receptive language
  base

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• Semantic-Syntactic Display
• Encourages the AAC user to learn language by
  mapping the symbols according to spoken word
  order and/or usage (i.e. organizing symbols from
  left to right into categories such as who, doing,
  modifiers, what, where, when and so forth with
  frequently used phrases and letters clustered
  along the top or bottom of the display)
• Taxonomic Grid Displays
• Grouping symbols according to superordinate
  semantic categories such as people, places,
  feelings, food, drinks and action words
• Visual Scene Displays
• Visual scene displays are similar to activity
  displays in that they contain vocabulary words
  associated with specific activities or routines
• The words in a scene display are organized
  schematically rather than semantically
• Most appropriate for use with speech-generating
  devices (SGDs) with dynamic screen displays
• Other Categorical Arrangements
• Some individuals may have skills that facilitate
  the use of unique categorical arrangements.

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Message Units From Sentences to Morphemes

• Message units can range in length from 1 symbol1
  paragraph to 1 symbol1 morpheme marker, in
  between these two extremes are symbols for
  sentences (e.g., a single symbol that means leave
  me alone), phrases (e.g., I want or I dont
  want), and single words

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Longer message units speed up the communication
process, which is usually slow and cumbersome.
Longer message units require fewer
cognitive/linguistic resources and may be good
for individuals who fatigue easily, are minimally
motivated to communicate, and/or are just
learning to use AAC techniques. Finally, longer
message units permit the person to produce
messages that actually exceed his or her
productive language ability.
How does use of different message unit lengths
affect both long- and short-term language
development?
But longer message units may also impede
communication accuracy. Shorter message units
such as words and morpheme markers, allow more
flexibility in communication. Having
opportunities to manipulate word- and
morpheme-length units is also likely to enhance
language development. Finally, shorter message
units reduces the need for the individual to have
to translate the language he or she hears
(input modality) into the language he or she is
able to use (output modality).
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Teaching Strategies

• Structured Approaches
• Milieu Teaching
• Interactive Model
• Aided Language Stimulation and the System for
  Augmenting Language (SAL)

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Structured Approaches

• Characterized by adult- or computer-delivered
  discrete trials that are usually conducted with
  one learner at a time
• Typically, each trial consists of a stimulus
  (e.g., the facilitator holds up a cookie and
  asks, Whats this?), a prompt (e.g. from an
  array of two photographs, a cookie and a shoe,
  the facilitator gestures toward the symbol for
  cookie), a response by the learner (e.g., he or
  she points to the cookie photo) and a reinforcer
  (e.g., the facilitator says good work!)
• Note the use of a structured teaching approach
  to teach labeling may have some advantages over
  other instructional approaches, especially when
  applied in natural contexts
• A two- pronged approach is recommended for
  teaching manual signs, with structured discrete
  trial techniques to teach language forms and
  incidental instructional paradigms to teach the
  use of the forms
• The problem with generalization is one of the
  major disadvantages of structured approaches to
  language intervention

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Milieu Teaching

• A naturalistic strategy for teaching functional
  language skills
• Appears to be more effective than structured
  approaches in promoting early vocabulary
  learning and abstract symbol learning
• Most reports of successful AAC interventions
  using milieu teaching have been confined to
  individuals at the early stages of language
  development who are learning functional, one-word
  communication skills. Few reports have
  documented the efficacy of milieu teaching to
  develop more complex language with AAC
  techniques.

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Interactive Model

• Parent training programs situated within an
  interactive model of language development that
  are designed to teach parents to provide rich
  language input, respond to their childs
  communicative attempts, and encourage the use of
  a variety of language forms and functions
• Parent training programs The Hanen Early
  Language Parent Program and associated offshoots
  such as More than Words and Allow Me the
  Prelinguistic Milieu Teaching
• At least in the short term, parents trained
  within the Interactive Model learn to be more in
  tune with their childs abilities, more
  responsive to the childs focus and communicative
  attempts, and less controlling of the childs
  conversational topics
• Both short- and long-term treatment effects of
  standard Interactive Model interventions are
  usually restricted to increase use of existing
  competencies and do not include acquisition of
  new communication and/or language skills
• Interactive Model programs, which are widely used
  in North America, can be applied to successfully
  to at least increase communication opportunities
  for beginning AAC users.

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Aided Language Stimulation and the System for
Augmenting Language (SAL)

• Both designed specifically for AAC applications
  and based on milieu teaching with several
  additional elements
• Both are total-immersion approaches to teaching
  individuals to understand and use graphic symbols
  with the purpose of providing learners with
  models for combining symbols in a flexible manner
  and opportunities to do so
• Based on the premise that by observing graphic
  symbols being used extensively by others in
  natural interactions, the learner can begin to
  establish a mental template of how symbols can be
  combined and recombined generatively to mediate
  communication during the activity.
• Both are intended to teach the AAC learner to use
  language in a very natural way that eliminates
  the need for more structured training
  interventions, because they mimic the way natural
  speakers learn to comprehend language

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Aided Language Stimulation

• A facilitator highlights symbols on the users
  communication display as he or she interacts and
  communicates verbally with the user, similar to
  the total communication approach used to teach
  manual signs to individuals with hearing or other
  impairments
• Also incorporates a variety of techniques for
  eliciting communication using symbols and other
  AAC modes. Nonverbal juncture cues are nonverbal
  signals (achieved via facial expression, gesture,
  body posture) performed by the facilitator that
  precede the highlighting of a symbol on the
  communication display.
• The cues serve two functions
• They code the target symbol in nonverbal form
• They help the individual to anticipate symbol
  selection by providing a brief time delay during
  which the individual might jump ahead of the
  facilitator and select the symbol spontaneously

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System for Augmenting Language (SAL)

• AKA Augmented Communication Input
• Similar to aided language stimulation, with two
  notable exceptions
• The use of an electronic voice-output
  communication device is considered a critical
  component of the intervention
• SAL techniques are much simpler than the
  elaborate procedures for augmented input and
  elicitation used in aided language stimulation
• Similar to aided language stimulation, with two
  notable exceptions
• The use of an SGD is a critical component of the
  intervention
• SAL techniques are much simpler than the
  elaborate procedures for elicitation used in
  aided language stimulation
• Communication displays using graphic symbols with
  a printed word gloss are constructed for the
  learners SGD, and communication partners learn
  to activate symbols on the device to augment
  their speech input in naturally occurring
  communication interactions.
• A 2 year longitudinal study of SAL showed
• Generalized use of their communication devices
  with both familiar and unfamiliar adults and
  peers without disabilities in a variety of
  environments
• Students learned to use arbitrary symbols in
  combination with gestures and vocalizations to
  request items, assistance, and information to
  make comments and to answer questions, among
  other functions
• Meaningful and functional symbol combinations
  spontaneously emerged in the repertoires of 10 of
  the 13 participants

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CHAPTER 13 - LITERACY DEVELOPMENT OF CHILDREN WHO
USE AAC
29

• Most individuals consider reading and writing
  skills to be a valued component for successful
  participation in society. These skills allow them
  to use literacy as a tool for communication,
  critical thinking, and the attainment of social
  and cultural power.

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Primary Motor Impairments/Severe Speech and
Physical Impairments (SSPIs)

• Includes individuals with congenital impairments
  such as cerebral palsy and arthrogryposis, as
  well as people with acquired impairments (e.g.,
  spinal cord injuries)
• The greatest barrier to literacy learning may be
  reduced opportunities to engage in authentic
  reading and writing opportunities and erroneous
  beliefs that individuals with SSPIs are not
  capable of learning to read and write
• Lack of knowledge about literacy curricula and
  supports to literacy learning has been one of the
  critical challenges in supporting the literacy
  learning of students who use AAC

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Handwriting/Fine Motor Impairments

• Dysgraphia inhibit the mechanics of producing
  words on paper
• This difficulty with handwriting may be related
  to underlying fine motor control or eye-hand
  coordination problems, visuospatial impairments,
  or attention deficits
• Many students with fine motor impairments also
  experience learning disabilities, specific
  language impairments, and/or cognitive impairments

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Specific Language Impairment

• Is considered to be a primary, rather than a
  secondary, disorder in that it is not the result
  of mental retardation, autism, or other
  etiologies
• Considerable attention has focused on describing
  a heterogeneous group of children who have
  considerable difficulty with spoken receptive and
  expressive language
• Specific language impairment, childhood aphasia,
  developmental aphasia, dysphasia, and language
  disability, among others, have been used
  interchangeably to refer to the problems that
  children experience

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Learning Disabilities

• A variety of names used, including
  language-learning disabilities, dyslexia, minimal
  brain dysfunction, and specific reading
  disabilities, among others.
• The national Joint Committee on Learning
  Disabilities uses the following definition
• Learning disabilities is a general term that
  refers to a heterogenous group of disorders
  manifested by significant difficulties in the
  acquisition and use of listening, speaking,
  reading, writing, reasoning, or mathematical
  abilities.
• These disorders are intrinsic to the individual,
  presumed to be due to a central nervous system
  dysfunction, and may occur across the life span.
  
• Problems in self-regulatory behaviors, social
  perception, and social interaction may exist with
  learning disabilities but do not by themselves
  constitute a learning disability.
• Although learning disabilities may occur
  concomitantly with other handicapping
  conditions...or with extrinsic influences...they
  are not the result of those conditions or
  influences.

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Cognitive Impairments

• People whose intellectual abilities lag behind
  their same-age peers
• The severity may vary widely across individuals
  and is usually established in terms of an
  individuals scores on both norm-referenced
  intelligence tests and adaptive behavior scales
• When making decisions about literacy instruction,
  consider not only the impairment itself but any
  additional learning needs that might be present
• Many children with cognitive impairments can
  develop both emergent and conventional literacy
  skills and should receive access to the same
  instructional opportunities as typically
  developing children

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Visual Impairments

• The vast majority of these individuals are not
  totally blind, it is estimated that 80 of all
  individuals classified as legally blind have
  residual vision that is sufficient for use as a
  primary learning channel for reading, writing,
  and other school activities
• Assessment involves specialized vision tests that
  evaluate a number of components including visual
  acuity, visual field magnitude, oculomotor
  functioning, light and color sensitivity, and
  visual stability
• Approximately 50-60 of school-age individuals
  with VI have additional impairments, with
  physical and/or intellectual abilities occurring
  most often
• Educational adaptations for this population
  should consider use of enlarged text, enlarged
  keyboards, screen magnifiers, speech output text
  readers, or braille

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Autism Spectrum Disorders

• As you know
• As many as 40-60 of children with ASD do not use
  speech as their primary mode of communication
• Some of these individuals have significant
  strengths in word recognition (e.g., hyperlexia)
  and relative deficits in comprehension that are
  evidenced across language and literacy

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Emergent Literacy and Literacy Development
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Early Literacy Experiences of Typically
Developing Children

• The home environment is important in laying the
  foundation for success in literacy
• Literacy learning is thought by many to begin at
  birth, as writing, reading, speaking, and
  listening skills develop simultaneously
• Across both home and school environments, the
  literacy experiences of children who use AAC are
  distinctly different from those of typical
  children
• A large part of becoming literate is learning the
  functions of literacy, simply having exposure to
  favorite books, children learn a host of
  literacy concepts - story schema, plot
  structure, anticipation of events, memories from
  previous readings, and ways in which story
  language creates emotions such as surprise and
  humor

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Early Literacy Experiences of Children with
Severe Communication Impairments and those who
use AAC

• Substantial differences exist between the
  experiences of children who do and do not have
  disabilities in learning to read One survey
  found that although parents of preschoolers
  without disabilities reported that they read to
  their children daily, parents of children with
  SSPIs read to their children, on average, two to
  three times per week
• Factors that influence literacy development in
  children with severe communication impairments
• Many parents of children who use AAC report that
  they primarily focus their priorities on
  communication and meeting the childrens physical
  needs, in contrast, parents of typically
  developing children place the highest priorities
  on communication, making friends, and literary
  activities
• Children who use AAC often have difficulty
  manipulating and playing with literacy materials
  (e.g., selecting books, turning pages of books,
  playing with pencils and crayons) because of
  their motor impairments
• Positioning and seating difficulties, paired
  with vision impairments, may make it difficult
  for these children to see the illustrations while
  their parents and teachers read to them which,
  in turn, influences the quality of the
  interactions during storybook reading activities
• Language and cognitive factors affect the
  development of play skills related to literacy
  (e.g., pretending to read), and parent modeling
  of literacy opportunities may be less frequent
  because the child is less mobile
• Children may also be unable to provide their
  parents with feedback related to their level of
  understanding as well as their preferences
• Classroom literacy learning experiences have also
  been found to be substantially different for
  school-age students who use AAC compared with
  their typically developing peers, instruction
  differs not only in quantity but also in quality
  and amount of time spent engaged in literacy
  tasks.

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RELATIONSHIP BETWEEN LANGUAGE KNOWLEDGE AND
LITERACY LEARNING
41
Early Literacy Support

• Three main principles of child learning should
  guide activities
• activities should be child directed and
  interactive, with the parent following the
  childs lead
• parents should consider learning to be a
  constructive process in which the child
  participates actively and is supported to map
  previous knowledge onto new experiences
• literacy tasks should be meaningful, goal
  directed, and embedded in purposeful activities.

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Reading and Storytelling

• Strategies family members, teachers, and others
  can use to encourage the development of literacy
  skills
• Read age-appropriate stories aloud frequently and
  repeatedly, young children enjoy hearing the same
  story over and over- repetitive reading helps
  children to see that all stories contain a
  predictable structure (pattern)
• Involvement in story times such as those
  sponsored by many libraries, as well as by
  visiting the library with the child to borrow
  books from an early age
• AAC users need integrated communication and
  literacy activities that allow them to engage in
  active, meaningful interactions about texts
• It is essential that AAC users master
  considerable language knowledge before entering
  the elementary grades, the development of
  conventional literacy skills is inextricably
  linked to the potential of their language and
  communication systems

43
Writing and Drawing

• Children also need opportunities to learn
  writing, drawing, and other composition skills
  that involve the use of output tools

44
Augmented Reading and Writing

• Emergent literacy computer programs for young
  children are available to teach language and
  preliteracy skills to young children that provide
  AAC users with access to materials that foster
  critical reading skills, (e.g., grapheme-phoneme
  awareness).
• Emergent reading software offers
• Opportunities to develop skills in visual
  discrimination, letter naming, letter recognition
  and recall, sight word recognition, spelling, and
  phonics (e.g., letter-sound combinations)
• Access to basic decoding and writing functions,
  such as sounding out words inventing word
  spellings, and engaging in early writing that is
  legible, (e.g., writing names of family members,
  writing familiar environmental print such as Stop
  or Exit)
• Access to drawing tools or picture dictionaries
  to produce story illustrations.

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SYMBOLIZATION AND LITERACY LEARNING
!

123


ABCDEFGHIJKLMN
46
Graphic Symbols and Language Development

• Most young children with SSPIs who cannot speak
  are also unable to read and spell in order to
  prepare their messages
• Many of these students must focus on the
  simultaneous acquisition of three modes of
  communication-speech, graphic symbols, and
  orthography
• Instructors should consider overlapping features
  of the three modes and utilize instructional time
  as a means to foster integration of concepts
  across modes
• Through exposure to print children learn
• that print conveys meaning
• that there is directionality to the way we read
• a basic understanding of the concepts of words,
  letters, and sounds
• that the words we speak are mapped onto print and
  there are certain patterns in speech-to-print
  correspondence
• that each letter has a shape and a name
• that letters can represent sounds

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Graphic Symbols Cont.

• There are several important skills related to the
  influence of language abilities on reading
  comprehension. These critical variable include
• phonological processing skills
• word recognition abilities
• problem-solving skills
• lexical processing abilities
• syntactic awareness
• semantic knowledge
• narrative discourse processing skills
• Difficulty with any one of these skills may have
  an impact on the individuals ability to
  comprehend text
• Frequent exposure to graphic symbols and
  orthography may not automatically give students
  who rely on AAC an upper hand in the early
  stages of literacy

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The contributions of graphic symbols to literacy
learning

• When learning AAC symbols, children develop the
  knowledge that symbols convey meaning, and they
  may be able to transfer this concept to
  understand that print also conveys meaning
• When communication displays support left-to-right
  progressions, children may also learn the concept
  of print directionality
• When symbols are paired with traditional
  orthography, children who use AAC are exposed to
  the concept of words
• When facilitators draw attention to the concept
  of letters, and communication displays utilize
  sound symbol mapping rules, knowledge of words,
  letters, and sounds may be fostered
• Symbols are presented at the whole-word level, so
  the ability to recognize words out of context,
  and to discriminate individual letters through
  paired associative learning (i.e., letter-phoneme
  associations and speech-to-print matching) is not
  facilitated
• Because symbols are not orthographic in nature,
  they are unlikely to teach children who use AAC
  that letters have shapes and names and that
  letters can represent sounds

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The relationships between graphic symbols and
reading comprehension

• Phonological awareness skills in students who use
  AAC also play a role in facilitating word
  recognition and thus support their ability to
  understand text
• For students who use AAC, word knowledge relates
  directly to the availability of symbols to
  communicate, the more symbols the student has,
  the more vocabulary words he or she can
  manipulate and use
• Graphic symbols play a role in supporting
  syntactic awareness and competence if
  facilitators or teachers teach the student who
  uses AAC to integrate symbols into sentence
  sequences
• Pragmatic awareness ability to recognize
  relationships between groups of sentences, to
  create on overall representation of the
  sentences, and to use prior knowledge to gain the
  full meaning of a passage. This skill develops
  through experience with written paragraphs, thus
  the influence of graphic symbols on comprehension
  at this level is unclear

50
Graphic Symbols and Reading Acquisition

• Print Conveys Meaning
• When learning AAC symbols, children develop the
  knowledge that symbols convey meaning, and they
  may be able to transfer this concept to
  understand that print also conveys meaning.
• Directionality of Print
• When communication displays support left-to-right
  progressions, children may also learn the concept
  of print directionality.
• Words, Letters, and Sounds
• When symbols are paired with traditional
  orthography, AAC users are exposed to the concept
  of words. In order to emphasize this concept, as
  well as to draw attention to the concept of
  letters, facilitators can teach AAC users to
  relate the words on their communication displays
  with written text.
• Graphic symbols are unlikely to teach AAC users
  that letters have shapes and names and that
  letters can represent sounds because the symbols
  are not orthographic in nature, graphic symbol
  use will teach these concepts only if the AAC
  user communicates with the symbol set in
  combination with traditional orthography and if
  the facilitator directs the users attention
  toward the sound system of language.

51
Graphic Symbols and Reading Comprehension

• Phonologic Processing Skills
• When readers can identify words rapidly, they can
  allocate greater cognitive resources to the
  higher level processes involved in comprehension.
• Word Knowledge
• For AAC users, word knowledge directly relates to
  the availability of symbols to communicate-the
  more symbols an AAC user has, the more vocabulary
  words he or she can manipulate and use.
  Vocabulary is also a critical factor in reading
  comprehension-the more word meanings a person
  knows, the more language he or she can
  understand, either aurally or visually.
• Syntactic Awareness
• Researchers have hypothesized that graphic
  symbols support literacy learning by providing
  learners with information about the structural
  aspects of language.
• Pragmatic Awareness
• Pragmatic awareness is the ability to recognize
  relationships between groups of sentences, create
  an overall representation of the sentences, and
  use prior knowledge to gain the full meaning of a
  passage.
• Because this skill develops through experience
  with written paragraphs, the influence of graphic
  symbols on comprehension at this level is
  unclear. To facilitate pragmatic awareness, the
  AAC system must allow the user to draw
  inferences, use metaphors and similes, and foster
  audience awareness.

52
Augmented Reading and Referencing

• Instructional Techniques
• Educators rely on many instructional approaches
  to teach reading skills to all children. These
  methods include various phonics approaches,
  direct instruction tactics (DISTAR), language
  experience techniques, whole language
  approaches, the Orton-Gillingham method, and
  many, many others.

53
Technology-Supported Writing

• Instructional Techniques
• Strategy Instruction
• Augmented Writing
• Alternative Access

54

• Instructional Techniques
• The current philosophy about writing development
  emphasizes that students learn to write by
  writing
• Strategy Instruction
• Given the slow writing rates of many AAC users,
  it is important to implement strategies to
  support all phases of the writing process. By
  using one method of explicit skill instruction,
  known as strategy instruction, teachers can aid
  beginning writers in developing problem-solving
  skills for approaching academic tasks.
• Students who participate in strategy instruction
  intervention in which teachers convey information
  about good writing and model it, appear to gain
  greater awareness of the writing task, learn
  strategies for approaching writing, and are able
  to generalize these skills to other writing tasks
• Augmented Writing
• Individualized literacy supports, both
  technological and instructional, address
  individual student needs by providing varying
  levels of assistance and graduated independence
• In the next phases of literacy scaffolding, the
  student begins to use alternative modes of
  writing access and/or engage in greater degrees
  of independent writing
• Alternative Access
• School personnel can utilize a backwards
  elimination approach to determine the writing
  adaptations needed by an individual student, the
  teacher simply works backward from the standard
  materials and procedures that students without
  disabilities use. Thus, initial adaptations
  might involve modifications of worksheets or
  textbooks.
• If simple solutions to participation prove
  ineffective, the backwards elimination approach
  requires that the teacher then try low-tech
  adaptive equipment or materials as solutions

55
CHAPTER 14 - EDUCATIONAL INCLUSION OF STUDENTS
WHO USE AAC
56
PREPARING AAC USERS FOR THE CLASSROOM

• Begin providing AAC services to children with
  severe communication disorders during their
  preschool years
• AAC team members involved with preschool students
  must have a solid understanding of the
  participation requirements of elementary school
  programs in order to adequately prepare children
  for these environments

57
Transition to Elementary School

• The ultimate goal of communication and other
  interventions for young children is to facilitate
  their entry into general education environments
• It is important to ensure that by the time the
  child reaches the first grade, he or she has the
  tools necessary for academic participation and
  instruction, tools may include an augmented
  writing system (either electronic or
  nonelectronic) in addition to whichever spoken
  communication system the child uses, computer or
  software technology necessary for formal
  augmented reading instruction
• To facilitate a smooth transition to
  kindergarten, visit the target classroom well
  before the beginning of the school year in order
  to gather information about the participation
  patterns of typical children in that setting
• Interventionists and educators must manage
  transitions between kindergarten and elementary
  school with care and systematic planning
• First, the AAC team should not modify the AAC
  system unnecessarily during the first year of
  school
• Second, the AAC team in the elementary school
  should have the knowledge and skills to
  facilitate communication efforts of young AAC
  users

58
INVOLVING STUDENTS IN THE GENERAL CURRICULUM

• Negative consequences may result if inclusion
  does not occur
• Teachers (often special educators) must develop
  personalized educational plans to meet their
  needs and deliver this instruction either in a
  segregated setting (e.g., a resource room, a
  special education) or in the general classroom
  during activities that are parallel to, but not
  the same as, those for other students
• Reduces available peer pressure and support
• Diminishes opportunities for peer interaction and
  instruction, even if a student with disabilities
  is physically present in a general classroom,
  opportunities for social and academic involvement
  with other students are reduced if he or she has
  a personalized curriculum
• May shape students perceptions of themselves
  negatively and may also foster negative
  impressions of the students in the eyes of their
  classmates, teachers, and family members

59
THE PARTICIPATION MODEL

• We use the Participation Model as a framework for
  making decisions associated with including AAC
  users in general educational programs

60
Identify Participation Patterns

• Academic Participation
• Competitive
• Active
• Involved
• None
• Social Participation
• Competitive
• Active
• Involved
• None

61
Academic Participation

• Competitive
• Competitive academic participation requires that
  a student with AAC needs meet the academic
  standards expected of peers who do not use AAC
• Active
• Not all students with AAC systems can be
  academically competitive in all areas,
  nevertheless, many students can be academically
  active and participate in the general curriculum,
  although they may not be able to meet the same
  academic standards as their peers
• Involved
• Some students, together with their educational
  teams and parents, may decide that participation
  in certain academic areas will be limited to
  academic involvement, rather than competitive or
  active participation. In this case, the student
  attends general class activities along with peer
  students but participates less actively in the
  general curriculum.
• None
• The level of no academic participation is never
  acceptable or defensible, although it occurs far
  too often

62
Social Participation

• Competitive
• Socially competitive students are active
  participants in a social group of peers, they are
  involved in the activities of the group, at least
  by choosing whether to engage in activities, and
  exert influence over group decisions
• Active
• Not all students with or without disabilities are
  socially competitive, but many are socially
  active. They make choices about and are involved
  in social activities, although they may not exert
  much influence over the social climate of a group
  and its interaction patterns.
• Involved
• Students who are socially involved attend class
  with their peers who do not have disabilities and
  may be involved in some extracurricular
  activities
• None
• Students who have no social participation have
  limited access to their peers during school hours
  and thus have no opportunities to form
  friendships or make acquaintances

63
Activity/Standards Inventory and Barrier
Assessment

• The first step is completing an
  activity/standards inventory in the classroom at
  the beginning of the school year. This inventory
  involves a detailed list of all activities that
  typical students are expected to complete during
  the school day, along with expected levels of
  academic participation.

64
Assess Opportunity Barriers

• First, we consider a variety of opportunity
  barriers that may interfere with inclusion
  efforts. It is often helpful to identify
  opportunity barriers during a team meeting among
  representatives of the family, educational staff,
  and educational administrators.

65
Assess Barriers to Access

• Assess the Communication Patterns and Vocabulary
  Requirements of the Classroom
• Teacher-Directed Large-Group Instruction
• Teacher-Directed Small-Group Instruction
• Sharing Time
• Cooperative Group Instruction
• One-to-One Interactions

66
Teacher-Directed Large-Group Instruction

• 10 unofficial rules that guide most
  teacher-directed large-group instructional
  activities
• Teachers mostly talk and students mostly listen,
  except when the teacher grants permission to
  talk
• Teachers give cues about when to listen closely
• Teachers convey content about things and
  procedures about how to do things
• Teacher talk gets more complex in the upper
  grades
• Teachers ask questions and expect specific
  responses
• Teachers give hints about what is correct and
  what is important to them
• Student talk should be brief and to the point
• Students should ask few questions and keep them
  short
• Students talk to teachers, not to other students
• Students can make a limited number of spontaneous
  comments, but only about the process or content
  of the lesson

67

• Teacher-Directed Small-Group Instruction
• Usually, the purpose of small-group instruction
  is to develop language, literacy, and thinking
  skills, with an emphasis on comprehension of text
  material and verbal expression
• Sharing Time
• Teachers usually employ a sharing format for
  current events presentations, reports, and
  show-and-tell activities. People use language,
  sharing contexts primarily to describe events in
  a logical and temporal sequence, usually in past
  tense
• Cooperative Group Instruction
• Researchers have a poor understanding of the
  interactions that occur in the context of
  cooperative learning. In a cooperative learning
  group, there is often no designated leader.
  Thus, communication patterns among students in
  such groups appear to resemble more closely those
  that occur in peer conversational interactions
  than those that occur during teacher-led group
  instruction.
• One-to-One Interactions
• The AAC user will need specific vocabulary words
  related to educational activities as well as
  vocabulary to manage conversational interactions
  that occur on a one-to-one basis

68
Assess Teacher Style

• Augmenting Comprehension
• Mapping Language
• Pooling Responses
• Bidding for Response Opportunities

69

• Augmenting Comprehension
• During assessment, it is useful to determine
  whether the specific augmented comprehension
  strategies used by a teacher will be useful to
  the particular AAC student who may be placed in
  that classroom.
• Mapping Language
• During classroom assessment, AAC teams need to
  address the question of how often a teacher maps
  language and the strategies that he or she uses
  to do so.
• Pooling Responses
• Teachers vary widely in the strategies they use
  to pool potential responses for their students by
  providing multiple response options. Some
  teachers augment comprehension regularly with
  tangible objects, photos, or illustrations.
• Bidding for Response Opportunities
• Finally, teachers vary considerably in the ways
  they expect their students to bid for response
  opportunities in the classroom. Some may call on
  specific children and prefer to have one child
  respond at a time. Others may expect the
  children who know the answer to bid for a turn by
  raising their hands the teacher then selects a
  student to respond.

70
Assisting Students to Manage Time Constraints

• Students with severe communication and motor
  impairments often find it difficult to keep up
  with the pace of a general classroom because they
  have difficulty manipulating educational
  materials such as books and worksheets
• Advance Preparation
• Use of Peer Instruction
• Adapting Academic Testing
• Reduced Workloads
• Selective Retention

71

• Advance Preparation
• It may be necessary for AAC teams to work with
  general education staff to preview upcoming
  assignments, topic areas, and class projects, so
  that they have ample time to create related
  adaptations
• Teachers can encourage students who use AAC to
  prepare questions in advance or compose their
  answers to assigned questions at home in order to
  compensate for their reduced communication rates
• Use of Peer Instruction
• Applying cooperative or peer instruction
  approaches to students who use AAC systems can be
  very effective in helping them meet classroom
  time demands
• Adapting Academic Testing
• If adjustments in time limits are not made, these
  students are either penalized for their
  disabilities or must rely on the assistance of a
  paraprofessional to complete tests in the time
  allotted
• Reduced Workloads
• Students who are expected to participate at a
  competitive level (i.e., held to the same
  standards as their peers without disabilities) do
  not necessarily have to complete the same amount
  of work as their peers
• Some students and families favor the selective
  participation strategy of not enrolling in
  classes that are not required or for which the
  student can meet the requirements in a different
  way
• Selective Retention
• In the United States, children with disabilities
  are eligible to remain as public school students
  past the age of 18 when most of their peers
  graduate. This extra time for students who use
  AAC systems means that rather than rushing
  through an educational program at the same pace
  as their peers without disabilities, they and
  their families may opt for retention at a grade
  level in order to meet specific academic goals.