Techniques
This section of the manual deals with some of the issues and techniques that may be used when developing AAC skills. Some people may find one or two of the points controversial. Good! The more these items are debated, the nearer we may come to finding solutions.
In order to ensure that communication is successful, facilitators must adapt their own interaction strategies and adjust to the client’s competencies and weaknesses. The literature suggests that the following strategies may be effectively used by facilitators to support communicative interaction: structuring the environment to provide opportunities for communication; responding to and developing client initiations; pausing; expecting the client to communicate; prompting; modelling; and providing language input at an appropriate level. (LIGHT J., McNAUGHTON D., & PARNES P. 1986)
In order to ensure that communication is successful, facilitators must adapt their own interaction strategies and adjust to the client’s competencies and weaknesses. The literature suggests that the following strategies may be effectively used by facilitators to support communicative interaction: structuring the environment to provide opportunities for communication; responding to and developing client initiations; pausing; expecting the client to communicate; prompting; modelling; and providing language input at an appropriate level. (LIGHT J., McNAUGHTON D., & PARNES P. 1986)
TECHNIQUES 2 - Task & Discussion Sheet
Uncover the information section. Ask the staff to think of reasons why there are no ‘shortcuts’. Uncover the task. Allow time (5 - 10 minutes is reasonable) to complete it. Some suggestions might be (for a student or pupil we shall call Sarah):
C ensure that the system is ready each morning and travels with the Sarah;
C listen to what she has to say;
C encourage her to communicate by choosing questions carefully to reflect the her known vocabulary;
C give her more choice;
C give her time and opportunity to communicate;
C reduce the number of yes or no questions;
C talk to other members of staff positively about the system;
C encourage Sarah to do things that will involve communicating;
C offer support to the communications facilitator;
C play (verbal) games with Sarah using the system;
C involve her in conversations and ask her opinion;
C feedback positive results to the communication facilitator and to other staff;
C keep a record of all problems encountered so they can be raised at the next team meeting or privately with the communications facilitator;
C encourage the use of her AAC system directing others in any task;
C change the routine occasionally so things do not happen automatically;
C ensure whenever Sarah is unable to make her point easily, helpful vocabulary is noted and passed on;
C help select vocabulary for my (the teacher’s) specialist area;
C record spontaneous utterances.
The discussion centres around a number of statements. These are neither true nor false and there is no correct answer. The statements do not necessarily reflect an opinion. There is no need to work through them all. Select the ones that are appropriate to the group and the topic. Add new ones. Adopt, adapt, or reject as you see fit. The points raised in the topics are covered in the techniques overheads.
C ensure that the system is ready each morning and travels with the Sarah;
C listen to what she has to say;
C encourage her to communicate by choosing questions carefully to reflect the her known vocabulary;
C give her more choice;
C give her time and opportunity to communicate;
C reduce the number of yes or no questions;
C talk to other members of staff positively about the system;
C encourage Sarah to do things that will involve communicating;
C offer support to the communications facilitator;
C play (verbal) games with Sarah using the system;
C involve her in conversations and ask her opinion;
C feedback positive results to the communication facilitator and to other staff;
C keep a record of all problems encountered so they can be raised at the next team meeting or privately with the communications facilitator;
C encourage the use of her AAC system directing others in any task;
C change the routine occasionally so things do not happen automatically;
C ensure whenever Sarah is unable to make her point easily, helpful vocabulary is noted and passed on;
C help select vocabulary for my (the teacher’s) specialist area;
C record spontaneous utterances.
The discussion centres around a number of statements. These are neither true nor false and there is no correct answer. The statements do not necessarily reflect an opinion. There is no need to work through them all. Select the ones that are appropriate to the group and the topic. Add new ones. Adopt, adapt, or reject as you see fit. The points raised in the topics are covered in the techniques overheads.
TECHNIQUES 3 - The primary goal is communication
There are examples of staff, untrained in AAC, whose attempts to involve a user’s AAC system in a lesson are more likely to suppress motivation than to increase it:
CASE STUDY: X is a 13-year-old boy with cerebral palsy. He has little knowledge of literacy. He has a VOCA but is not using it as an effective augmentative communication tool. Each afternoon his class tutors write words on a piece of paper which have some basic connection with the lesson they are presenting. This is placed in front of X and the spelling option is selected on the VOCA. X is tasked to copy the words to the VOCA and print them at the end of the afternoon. X makes many mistakes. His attention wanders from the task frequently and he stops for long periods to watch what the other children are doing. He attention is refocused by the class tutors from time to time. In a two-hour period he copies eight words with approximately 50% accuracy. The class tutors state they are helping X develop literacy skills.
There were times when my teacher wouldn’t even listen to me because she said AUse your Canon,” even if it was a Ayes” or Ano.” (SMITH-LEWIS M. & FORD A. 1987)
CASE STUDY: A pupil’s VOCA was set to spelling even though it could generate words and phrases using symbols. When asked why it was set to spelling the teacher replied, Abecause he will never learn to spell if he keeps using those silly symbols.”
CASE STUDY: A teacher had programmed a VOCA to say ‘I want to go to the toilet’. Although the child had indicated by alternative means (which were acceptable only a week before) that he needed to go he was told that he would not be allowed to go until he said it on his talker.
The problem is communication - this is our focus. However, there is a danger that bad practice involving the use of AAC in other areas of the curriculum will result in a user having a pejorative attitude towards the system. Communication should pervade the entire curriculum, it is the foundation stone on which we may build. However, poor implementation of AAC, as in the case studies above, may cause more problems than it solves. Staff training and awareness is extremely important:
Children with severe disabilities have, at best, a 30% chance of learning to read and write as well as their nondisabled peers. In preschool classrooms, they are often taught by teachers unaware of emergent literacy research, who consequently provide few literacy-based learning opportunities or who provide skills-based instruction with few opportunities to listen, read, or compose text. (ERICKSON K. & STAPLES A. 1995 Page 4)
Literacy is extremely important. Literacy enhances a person’s potential. Teaching literacy to users of AAC system must not be neglected but it should be intermixed with the primary goal of communication, with users who have not achieved functional communication, with thought and with care. Books and other aspects of literacy can form the basis of a program that is used to teach communication. Using the AAC system to join in a literacy game within a group or to help a user read the words or phrases from a book or as a means of exploring language and the user’s world are examples good practice (See, for example, NYGARD J. & PETERS V. 1990 or KOVACH T. & SEMENTELLI C. 1990 on the work of McCORD S.). Literacy should be seen as more than learning to read and write (or spell as in two of the case studies above); it is exciting source of rich and varied material for communication development:
First of all, literacy is more than learning to read, write, and spell proficiently. It is learning to enjoy words and stories when someone else is reading them. It is learning to love books and all of the worlds that can be opened by books. It is a way of achieving social closeness through sharing literacy experiences with friends or classmates. It is finding out about the way things are in places we have never visited or in places that have never existed. If we understand that literacy is all of these things and more, we can also understand that everyone can achieve some degree of literacy if given opportunities and exposure (MIRENDA P. 1993, page 7)
Literacy can be used in a creative and stimulating manner for communication purposes and, as such, serve the primary goal. There is a growing amount of literature on the subject of literacy and AAC (BEUKELMAN D., WOLVERTON R., & HIATT E. 1988; DRUCKMAN M. 1988; KELFORD SMITH A. & LAGEER N. 1988; KOPPENHAVER D. & YODER D. 1988; MANN K. 1988; THUMA-REW S. 1988; KOPPENHAVER D. 1989; KOPPENHAVER D. & YODER D. 1989; JOHNSEN B. 1990; KING-DeBAUN P. 1990; KOPPENHAVER D. 1990; KOPPENHAVER D. & YODER D. 1990; KOVACH T., McCORD S., MOORE S., & SEMENTELLI C. 1990; McNAUGHTON S. 1990; COLEMAN P. 1991; COLEMAN P., KOPPENHAVER D., & YODER D. 1991; KING-DeBAUN P. 1991; KOPPENHAVER D. 1991; KOPPENHAVER D., COLEMAN P., KALMAN S., & YODER D. 1991; KOPPENHAVER D., COLEMAN P., STEELMAN J., & YODER D. 1991; KOPPENHAVER D., EVANS D., & YODER D. 1991; KOPPENHAVER D., PIERCE P., STEELMAN J., & YODER D. 1991; JOHNSEN B. & JENNISCHE M. 1991; MUSSELWHITE C. 1991; PEBLEY M. 1991; HIGGINS J., BAKER B., & ZABALA J. 1992; KOPPENHAVER D. 1992; KOPPENHAVER D., COLEMAN P., STEELMAN J., & YODER D. 1992; KOPPENHAVER D., HENDRICK W., ABRAHAM L., & YODER D. 1992; KOPPENHAVER D. & PIERCE P. 1992; KOPPENHAVER D. & YODER D. 1992; KOVACH T. 1992; McNAIRN P. 1992; McNAIRN P. & SHIOLENO C. 1992; MOORE S., KOVACH T. & SEMENTELLI C. 1992; MUSSELWHITE C. 1992; STEELMAN J. 1992; STEELMAN J., COLEMAN P. & KOPPENHAVER D. 1992; STEELMAN J., PIERCE P., ALGER M., SHANNON J., KOPPENHAVER D., & YODER D. 1992; STEELMAN J., PIERCE P., & KOPPENHAVER D. 1992; WOOD L. & LOWRY J. 1992; BAKER L. 1993; LIGHT J. & KELFORD SMITH A. 1993; KOPPENHAVER D., STEELMAN J., PIERCE P., YODER D., & STAPLES A. 1993; KOPPENHAVER D. & YODER D. 1993; KOVACH T. & MOORE S. 1993; McNAUGHTON S. 1993; McNAUGHTON D. & TAWNEY J. 1993; PIERCE P. & KUBLIN K. 1993; PIERCE P. & McWILLIAM P. 1993; STEELMAN J., PIERCE P., & KOPPENHAVER D. 1993; TAYLOR D. & BURKE C. 1993; CALL CENTRE paper ‘AAC and Literacy’ 1994; LIGHT J., BINGER C., & KELFORD SMITH A. 1994; BLISCHAK D. 1994; EMBREY J. & SAUERS J. 1994; ERICKSON K. 1994; ERICKSON K., KOPPENHAVER D., & YODER D. 1994; ERICKSON K. & STAPLES A. 1994; KERR J. & MILLAR S. 1994; MUSSELWHITE C. R. & KING-DeBAUN P. 1994; KOPPENHAVER D. & ERICKSON K. 1994; KOPPENHAVER D. & PIERCE P. 1994; KOPPENHAVER D., PIERCE P., STEELMAN J., & YODER D. 1994; KOPPENHAVER D., STAPLES A., PIERCE P., ERICKSON K., & STEELMAN J. 1994; KOPPENHAVER D., PIERCE P., STEELMAN J., STAPLES A., ERICKSON K., & YODER D. 1994; PIERCE P. 1994; STAPLES A. 1994; BEDROSIAN J., ROBERTS B., RAAP D., NEYNABER M., & JAMES K. 1995; ERICKSON K. 1995; ERICKSON K. & KOPPENHAVER D. 1995; ERICKSON K. & STAPLES A. 1995; KOPPENHAVER D. 1995; MUSSELWHITE C. 1995; McNAUGHTON S. & LINDSAY P. 1995; STAPLES A. & KOPPENHAVER D. 1995; BEDROSIAN J. 1996; ERICKSON K. 1996; ERICKSON K. & KOPPENHAVER D. 1996; MUSSELWHITE C. 1996; SANDBERG A. D. & HJELMQUIST E. 1996; WILLIAMS B. 1996; KING-DeBAUN P. & MUSSELWHITE C. 1997)(Please note - this list of authors is intended to illustrate the wealth of material available and is not meant to be comprehensive).
NOTE: Those of you working in the U.K. may like to contact Sally Millar at the CALL Centre in Edinburgh (Address and telephone number at the beginning of this manual) and those of you working in the USA may like to attend a workshop given by any person on the above list - especially those listed more than once!
The growing body of research and the wealth of work done in this area suggest that working with AAC and literacy can be extremely advantageous. However, I urge a little caution. Facilitators should be aware of the dangers. The first case study in this section highlights an example of poor practice in which the stated goal of literacy skills development is having a negative influence on the use of the communication aid. AAC can help develop literacy skills and literacy can be used to help develop AAC. Good practice and positive user experiences are necessary ingredients in both. I would urge facilitators thinking of working with AAC and literacy to explore some of the ideas given by the authors in the papers above before embarking on the journey.
CASE STUDY: At a special interest group meeting a speech professional said that it was her experience that the introduction of AAC systems to teachers through the medium of literacy had positive benefits. By starting with a familiar subject area (the development of literacy skills) the teachers gradually became conversant with the AAC systems and their confidence grew. They then began to work on communication within the classroom.
The cartoon illustrates rather poor practice in using AAC for behaviour modification. When implemented properly, the development of AAC in general, and alternatives to the problem behaviours through augmentative communication in particular, can create positive results. However, I would urge a study of the literature available in this area before using AAC for this purpose.
In some cases, behaviour problems occur and continue as a result of a person’s inability to communicate effectively:
Observing a student who has severe disabilities engaging in a tantrum often brings with it a sense of frustration; an inability to comfort or respond in a satisfactory way. Parents, teachers, and other caregivers frequently report that they wish the students could just Atell us what they want”. (DURAND V. 1991 page 29)
If we can figure out the underlying ‘message’ within the behaviour (See DONNELLAN A., MIRENDA P., MESAROS R., & FASSBENDER L. 1984) and make suitable changes perhaps the undesirable behaviour will be reduced:
The principle of appropriate listening states that when people communicate through challenging behavior, sometimes the most appropriate response is to Alisten” to what they are saying and change the situation accordingly. (MIRENDA P. 1993, page 7)
In these instances, the development of effective functional channels of communication, teaching the user to communicate, may help to alleviate a problem (CARR E. & DURAND V. 1985; BIRD F., DORES P., MONIZ D., ROBINSON J. 1989; DOSS S. & REICHLE J. 1989; DURAND V. 1990; DURAND V. 1991; DURAND V. & CARR E. 1991; DURAND V. 1993; ROBINSON L. & OWENS R. 1995),
The principle of functional equivalence states that when people communicate through challenging behavior, sometimes the most appropriate response is to teach an alternative way to communicate the same message. (MIRENDA P. 1993, page 8)
D’s communication board was successful not only in giving her a means for communicating wants and needs but also in contributing seemingly to a decrease of her display of maladaptive behaviours. (ROBINSON L. & OWENS R. 1995)
and may provide the foundation on which subsequent communicative work is built. Certainly, the use of communication as an alternative to some of the more drastic measures that have been used for behaviour modification would seem a positive step:
To illustrate, let us suppose that a young man is hitting himself to escape academic tasks because they are boring and not sufficiently challenging. Punishing his self-injury by spraying water in his face fails to provide him with more interesting activities, and does not teach him a more appropriate way to express his displeasure. One could predict that even if the water spray were sufficiently aversive to suppress his self-injury, the young man would attempt other ways to escape these tasks. Relying on negative consequences to Again control until teaching can take place” bypasses the fundamental issue -- why is he hitting himself (what is he trying to tell us) and how can we address these concerns? (DURAND V. 1991 page 33)
While I have urged a little caution (with people who are just beginning to learn an AAC system) when using AAC as the basis for intervention in other problem areas, there are no hard and fast rules. While the primary goal is (functional) communication, there are many pathways which may lead to its achievement. One path may be quicker than others. One path may be fraught with dangers. One path may intertwine with another such that in achieving one goal another is also met.
An AAC system should not be seen as a panacea for all ills. If an AAC system is to be directly involved in attempts to solve other problems then care should be exercised to ensure that this does not:
C compound the problem to the detriment of the development of functional communication skills;
C overtask, bore, or alienate the user;
C overtask, bore, or alienate significant others;
C force the user to focus on one aspect of the system to the detriment of others which may be of enormous benefit;
C result in a negative attitude towards the AAC system.
CASE STUDY: X is a 13-year-old boy with cerebral palsy. He has little knowledge of literacy. He has a VOCA but is not using it as an effective augmentative communication tool. Each afternoon his class tutors write words on a piece of paper which have some basic connection with the lesson they are presenting. This is placed in front of X and the spelling option is selected on the VOCA. X is tasked to copy the words to the VOCA and print them at the end of the afternoon. X makes many mistakes. His attention wanders from the task frequently and he stops for long periods to watch what the other children are doing. He attention is refocused by the class tutors from time to time. In a two-hour period he copies eight words with approximately 50% accuracy. The class tutors state they are helping X develop literacy skills.
There were times when my teacher wouldn’t even listen to me because she said AUse your Canon,” even if it was a Ayes” or Ano.” (SMITH-LEWIS M. & FORD A. 1987)
CASE STUDY: A pupil’s VOCA was set to spelling even though it could generate words and phrases using symbols. When asked why it was set to spelling the teacher replied, Abecause he will never learn to spell if he keeps using those silly symbols.”
CASE STUDY: A teacher had programmed a VOCA to say ‘I want to go to the toilet’. Although the child had indicated by alternative means (which were acceptable only a week before) that he needed to go he was told that he would not be allowed to go until he said it on his talker.
The problem is communication - this is our focus. However, there is a danger that bad practice involving the use of AAC in other areas of the curriculum will result in a user having a pejorative attitude towards the system. Communication should pervade the entire curriculum, it is the foundation stone on which we may build. However, poor implementation of AAC, as in the case studies above, may cause more problems than it solves. Staff training and awareness is extremely important:
Children with severe disabilities have, at best, a 30% chance of learning to read and write as well as their nondisabled peers. In preschool classrooms, they are often taught by teachers unaware of emergent literacy research, who consequently provide few literacy-based learning opportunities or who provide skills-based instruction with few opportunities to listen, read, or compose text. (ERICKSON K. & STAPLES A. 1995 Page 4)
Literacy is extremely important. Literacy enhances a person’s potential. Teaching literacy to users of AAC system must not be neglected but it should be intermixed with the primary goal of communication, with users who have not achieved functional communication, with thought and with care. Books and other aspects of literacy can form the basis of a program that is used to teach communication. Using the AAC system to join in a literacy game within a group or to help a user read the words or phrases from a book or as a means of exploring language and the user’s world are examples good practice (See, for example, NYGARD J. & PETERS V. 1990 or KOVACH T. & SEMENTELLI C. 1990 on the work of McCORD S.). Literacy should be seen as more than learning to read and write (or spell as in two of the case studies above); it is exciting source of rich and varied material for communication development:
First of all, literacy is more than learning to read, write, and spell proficiently. It is learning to enjoy words and stories when someone else is reading them. It is learning to love books and all of the worlds that can be opened by books. It is a way of achieving social closeness through sharing literacy experiences with friends or classmates. It is finding out about the way things are in places we have never visited or in places that have never existed. If we understand that literacy is all of these things and more, we can also understand that everyone can achieve some degree of literacy if given opportunities and exposure (MIRENDA P. 1993, page 7)
Literacy can be used in a creative and stimulating manner for communication purposes and, as such, serve the primary goal. There is a growing amount of literature on the subject of literacy and AAC (BEUKELMAN D., WOLVERTON R., & HIATT E. 1988; DRUCKMAN M. 1988; KELFORD SMITH A. & LAGEER N. 1988; KOPPENHAVER D. & YODER D. 1988; MANN K. 1988; THUMA-REW S. 1988; KOPPENHAVER D. 1989; KOPPENHAVER D. & YODER D. 1989; JOHNSEN B. 1990; KING-DeBAUN P. 1990; KOPPENHAVER D. 1990; KOPPENHAVER D. & YODER D. 1990; KOVACH T., McCORD S., MOORE S., & SEMENTELLI C. 1990; McNAUGHTON S. 1990; COLEMAN P. 1991; COLEMAN P., KOPPENHAVER D., & YODER D. 1991; KING-DeBAUN P. 1991; KOPPENHAVER D. 1991; KOPPENHAVER D., COLEMAN P., KALMAN S., & YODER D. 1991; KOPPENHAVER D., COLEMAN P., STEELMAN J., & YODER D. 1991; KOPPENHAVER D., EVANS D., & YODER D. 1991; KOPPENHAVER D., PIERCE P., STEELMAN J., & YODER D. 1991; JOHNSEN B. & JENNISCHE M. 1991; MUSSELWHITE C. 1991; PEBLEY M. 1991; HIGGINS J., BAKER B., & ZABALA J. 1992; KOPPENHAVER D. 1992; KOPPENHAVER D., COLEMAN P., STEELMAN J., & YODER D. 1992; KOPPENHAVER D., HENDRICK W., ABRAHAM L., & YODER D. 1992; KOPPENHAVER D. & PIERCE P. 1992; KOPPENHAVER D. & YODER D. 1992; KOVACH T. 1992; McNAIRN P. 1992; McNAIRN P. & SHIOLENO C. 1992; MOORE S., KOVACH T. & SEMENTELLI C. 1992; MUSSELWHITE C. 1992; STEELMAN J. 1992; STEELMAN J., COLEMAN P. & KOPPENHAVER D. 1992; STEELMAN J., PIERCE P., ALGER M., SHANNON J., KOPPENHAVER D., & YODER D. 1992; STEELMAN J., PIERCE P., & KOPPENHAVER D. 1992; WOOD L. & LOWRY J. 1992; BAKER L. 1993; LIGHT J. & KELFORD SMITH A. 1993; KOPPENHAVER D., STEELMAN J., PIERCE P., YODER D., & STAPLES A. 1993; KOPPENHAVER D. & YODER D. 1993; KOVACH T. & MOORE S. 1993; McNAUGHTON S. 1993; McNAUGHTON D. & TAWNEY J. 1993; PIERCE P. & KUBLIN K. 1993; PIERCE P. & McWILLIAM P. 1993; STEELMAN J., PIERCE P., & KOPPENHAVER D. 1993; TAYLOR D. & BURKE C. 1993; CALL CENTRE paper ‘AAC and Literacy’ 1994; LIGHT J., BINGER C., & KELFORD SMITH A. 1994; BLISCHAK D. 1994; EMBREY J. & SAUERS J. 1994; ERICKSON K. 1994; ERICKSON K., KOPPENHAVER D., & YODER D. 1994; ERICKSON K. & STAPLES A. 1994; KERR J. & MILLAR S. 1994; MUSSELWHITE C. R. & KING-DeBAUN P. 1994; KOPPENHAVER D. & ERICKSON K. 1994; KOPPENHAVER D. & PIERCE P. 1994; KOPPENHAVER D., PIERCE P., STEELMAN J., & YODER D. 1994; KOPPENHAVER D., STAPLES A., PIERCE P., ERICKSON K., & STEELMAN J. 1994; KOPPENHAVER D., PIERCE P., STEELMAN J., STAPLES A., ERICKSON K., & YODER D. 1994; PIERCE P. 1994; STAPLES A. 1994; BEDROSIAN J., ROBERTS B., RAAP D., NEYNABER M., & JAMES K. 1995; ERICKSON K. 1995; ERICKSON K. & KOPPENHAVER D. 1995; ERICKSON K. & STAPLES A. 1995; KOPPENHAVER D. 1995; MUSSELWHITE C. 1995; McNAUGHTON S. & LINDSAY P. 1995; STAPLES A. & KOPPENHAVER D. 1995; BEDROSIAN J. 1996; ERICKSON K. 1996; ERICKSON K. & KOPPENHAVER D. 1996; MUSSELWHITE C. 1996; SANDBERG A. D. & HJELMQUIST E. 1996; WILLIAMS B. 1996; KING-DeBAUN P. & MUSSELWHITE C. 1997)(Please note - this list of authors is intended to illustrate the wealth of material available and is not meant to be comprehensive).
NOTE: Those of you working in the U.K. may like to contact Sally Millar at the CALL Centre in Edinburgh (Address and telephone number at the beginning of this manual) and those of you working in the USA may like to attend a workshop given by any person on the above list - especially those listed more than once!
The growing body of research and the wealth of work done in this area suggest that working with AAC and literacy can be extremely advantageous. However, I urge a little caution. Facilitators should be aware of the dangers. The first case study in this section highlights an example of poor practice in which the stated goal of literacy skills development is having a negative influence on the use of the communication aid. AAC can help develop literacy skills and literacy can be used to help develop AAC. Good practice and positive user experiences are necessary ingredients in both. I would urge facilitators thinking of working with AAC and literacy to explore some of the ideas given by the authors in the papers above before embarking on the journey.
CASE STUDY: At a special interest group meeting a speech professional said that it was her experience that the introduction of AAC systems to teachers through the medium of literacy had positive benefits. By starting with a familiar subject area (the development of literacy skills) the teachers gradually became conversant with the AAC systems and their confidence grew. They then began to work on communication within the classroom.
The cartoon illustrates rather poor practice in using AAC for behaviour modification. When implemented properly, the development of AAC in general, and alternatives to the problem behaviours through augmentative communication in particular, can create positive results. However, I would urge a study of the literature available in this area before using AAC for this purpose.
In some cases, behaviour problems occur and continue as a result of a person’s inability to communicate effectively:
Observing a student who has severe disabilities engaging in a tantrum often brings with it a sense of frustration; an inability to comfort or respond in a satisfactory way. Parents, teachers, and other caregivers frequently report that they wish the students could just Atell us what they want”. (DURAND V. 1991 page 29)
If we can figure out the underlying ‘message’ within the behaviour (See DONNELLAN A., MIRENDA P., MESAROS R., & FASSBENDER L. 1984) and make suitable changes perhaps the undesirable behaviour will be reduced:
The principle of appropriate listening states that when people communicate through challenging behavior, sometimes the most appropriate response is to Alisten” to what they are saying and change the situation accordingly. (MIRENDA P. 1993, page 7)
In these instances, the development of effective functional channels of communication, teaching the user to communicate, may help to alleviate a problem (CARR E. & DURAND V. 1985; BIRD F., DORES P., MONIZ D., ROBINSON J. 1989; DOSS S. & REICHLE J. 1989; DURAND V. 1990; DURAND V. 1991; DURAND V. & CARR E. 1991; DURAND V. 1993; ROBINSON L. & OWENS R. 1995),
The principle of functional equivalence states that when people communicate through challenging behavior, sometimes the most appropriate response is to teach an alternative way to communicate the same message. (MIRENDA P. 1993, page 8)
D’s communication board was successful not only in giving her a means for communicating wants and needs but also in contributing seemingly to a decrease of her display of maladaptive behaviours. (ROBINSON L. & OWENS R. 1995)
and may provide the foundation on which subsequent communicative work is built. Certainly, the use of communication as an alternative to some of the more drastic measures that have been used for behaviour modification would seem a positive step:
To illustrate, let us suppose that a young man is hitting himself to escape academic tasks because they are boring and not sufficiently challenging. Punishing his self-injury by spraying water in his face fails to provide him with more interesting activities, and does not teach him a more appropriate way to express his displeasure. One could predict that even if the water spray were sufficiently aversive to suppress his self-injury, the young man would attempt other ways to escape these tasks. Relying on negative consequences to Again control until teaching can take place” bypasses the fundamental issue -- why is he hitting himself (what is he trying to tell us) and how can we address these concerns? (DURAND V. 1991 page 33)
While I have urged a little caution (with people who are just beginning to learn an AAC system) when using AAC as the basis for intervention in other problem areas, there are no hard and fast rules. While the primary goal is (functional) communication, there are many pathways which may lead to its achievement. One path may be quicker than others. One path may be fraught with dangers. One path may intertwine with another such that in achieving one goal another is also met.
An AAC system should not be seen as a panacea for all ills. If an AAC system is to be directly involved in attempts to solve other problems then care should be exercised to ensure that this does not:
C compound the problem to the detriment of the development of functional communication skills;
C overtask, bore, or alienate the user;
C overtask, bore, or alienate significant others;
C force the user to focus on one aspect of the system to the detriment of others which may be of enormous benefit;
C result in a negative attitude towards the AAC system.
TECHNIQUES 4 - Increase the time you spend chatting to people using AAC systems
‘Idle chatter’? No way! This is the primary purpose of AAC. Time spent in chatting with a user is time well spent. That is if the person is not being spoken at but is chatted with. In the hurly burly that is the average school, college, community centre, home, etc, significant others are generally very busy people. Sometimes sufficient time is not allowed for the simple interchange of information and gossip:
AHello [significant other], Can I ........”
AHiya Sam! NO time to stop now - see you”
It is imperative for success that users have someone to talk to and that time is available to chat. Frank Smith’s book on reading (SMITH F. 1978) said that reading is best learnt by reading. Communication is perhaps best learnt by communicating.
Sometimes opportunities for communicating are missed:
C In the car / travelling: What do most people do while they are travelling? Chat. This is an ideal opportunity. There needs to be an adaptation so that the system is in a position where it may be easily used (clipped to the head restraint on the front seats?). If the user is in a wheelchair and the car is specially adapted to take a wheelchair then the VOCA travels with the person. For symbol board users a third person is required so the driver does not cause an accident while trying to read the board and watch the road.
Nothing to talk about in the car? I don’t believe it! Why not play a game? I spy, 20 questions, Car licence plates, etc.
C While working: If you cook a meal; dry the user’s hair; dig the garden, you can have a conversation with a VOCA user. A VOCA does not require that you read a display only that you are able to listen to what is being said.
C At the table: Systems are often removed at the table - ‘They get in the way and they might get food on them’. Do not remove them. What do I do when I am eating? I talk (VOCA users can talk with a full mouth). If the primary goal of meal time is to teach independence through eating skills leave the AAC system aside and concentrate on the primary goal. However, if this is not the case, then provide access to both communication and food. (A large symbol board on the wall nearby for eye-pointing? A special place setting? A scanning system and a single switch operated at a distance? A new position for the VOCA while eating?). While ‘Pass the salt’, ‘More’, ‘That’s enough’, ‘Please’ and ‘thank you’ are probably essential vocabulary items for meal times, they are hardly sparkling conversational topics. The topic of conversation can be manipulated to enable users to practise using their vocabulary.
The pragmatics of conversation may be developed when the user is given the opportunity to chat. However, time is not often set aside for a chatting as everyone has the pressures of the daily routine and the user is slow and demanding. Building chat times into lesson plans and encouraging others to spend time chatting is a positive step. Chat times may be given a more educationally acceptable label such as ‘ADAPT’ - ‘Augmentative Discourse And Pragmatics Tuition’. Chatting may not be seen by others as holding the same value as tuition in discourse. The name may make all the difference!
There are at least two forms of ADAPT sessions: structured and freestyle (sometimes called open‑ended). During a structured discourse session the topic of conversation is controlled by the facilitator who encourages the user to make active use of vocabulary already studied.
Non‑verbal children typically have not had the experience to develop interactive communication skills. Therefore, the provision of a Acommunication nucleus”, a highly controlled topic area, provides a common frame of reference, thereby promoting success (ANDERSEN P. & KIERNAN S. 1987)
In an interesting twist of the focus of attention REES N. (1978), BLANK M. (1983, 1990), and BLANK M. & MARQUIS M. (1987) show how the facilitator’s role in this activity is crucial to the development of pragmatic skills:
To the degree that it has been studied, the ideas have commonly been framed in terms of the CHILDREN’S behaviour ..... The issue of the topics offered to children by the ADULTS has been almost unnoticed (BLANK M. & MARQUIS M. 1987)
The facilitator’s language during conversational ‘texts’ (structured discourse) must reflect, as far as is possible, normal everyday conversational use, and not an atypical form:
It’s a cup, it’s plastic, you drink out of it (REES N. 1978)
The bizarre pragmatic style of many language disordered people may result, in part, from the manner in which the facilitator has presented and modelled language. Thus, the style of teaching, or language used can lead users:
to use language in ways that are not simply different, but also inappropriately different, from those of the average person (BLANK M. 1990)
Therefore, structured discourse should be pre-planned and given careful consideration. Conversation during a discourse should be kept as simple but as normal as possible.
Freestyle discourse differs from structured discourse in that the session is user controlled . The facilitator may need to initiate the topic of conversation ‘sister’s wedding’, ‘dad’s illness’, ‘mum’s new car’, ‘new boyfriend’, etc, but should in no way attempt to steer the conversation along pre‑determined pathways. The facilitator’s role is to:
C enable conversation;
C maintain discourse;
C help with forgotten symbols or symbol sequences;
C help with spelling and literacy skills;
C role model correct syntactic forms;
C help with pragmatic skills.
Freestyle discourse can highlight new areas of vocabulary which need to be added to the user’s system. It may also highlight areas of pragmatic skills where the user needs help and possible training.
There are a number of times during the day when a significant other can get on with one task while holding a conversation with a user with a VOCA. Make use of them. Equally, there are also inappropriate times for a user tries to engage in conversation. If this is a user who very rarely communicates spontaneously and for whom a polite AI can’t talk now” would be a regressive step then the significant other’s task must wait. However, if this is a user who is usually communicative then a normal response is all that is required:
AI’m sorry Tim. I can’t talk just now, I’m really busy. Tell you what, I’ve got a few minutes at 3.00. Why don’t you pop back then?”
The user has just learnt a pragmatic skill - there are times when communication is not appropriate.
It may not always be easy to attempt structured or freestyle discourse. Some users will be at the pre‑discourse level and the conversation will tend to be a little one sided. However, if users have no opportunity to see (hear) conversation and engage in it, how are they to develop the necessary skills? Too often, passive communicators are made more passive or entrenched in the role that has become their lot, by our actions, behaviour, and use of language. The user, irrespective of cognitive ability, must be given the opportunity, the framework in which to use the vocabulary that has been studied. To do otherwise is to negate your own efforts.
During these methods much can be made of such skills as turn taking, appropriate use of language, exchange structure, etc.
WARNING ‑ Try to avoid the phrase:
AUse your machine to tell me”
or ATell me with your board”
These phrases emphasise the difference between aided and natural speech, the difference between voiced communication and synthetic communication. Rather, use a standard phrase. For example:
ACan you tell me”
AI’m listening, what do you want to say to me?”
Users rarely generalise skills taught within clinical settings, using them infrequently for functional spontaneous communication in their normal daily activities and interactions (NIETUPSKI J., SCHEUTZ G., & OCKWOOD L. 1980; WULZ S., MYERS S., KLEIN D., HALL M., WALDO L. 1982; RIEKE J. & LEWIS J. 1984; HAMILTON B. & SNELL M. 1993) It is essential that all significant others enable users to transfer skills and to generalise in new environments.
The gap that exists between practice of a given dialogue and its actualization in real world interaction presents ...... users with a difficult transitional task. Moving from structured practice of dialogue to free communicative expression is a task which necessitates specific programmatic efforts, primarily because communication normally involves an element of choice (SALTER W. & CLEMENTS N. 1988)
AHello [significant other], Can I ........”
AHiya Sam! NO time to stop now - see you”
It is imperative for success that users have someone to talk to and that time is available to chat. Frank Smith’s book on reading (SMITH F. 1978) said that reading is best learnt by reading. Communication is perhaps best learnt by communicating.
Sometimes opportunities for communicating are missed:
C In the car / travelling: What do most people do while they are travelling? Chat. This is an ideal opportunity. There needs to be an adaptation so that the system is in a position where it may be easily used (clipped to the head restraint on the front seats?). If the user is in a wheelchair and the car is specially adapted to take a wheelchair then the VOCA travels with the person. For symbol board users a third person is required so the driver does not cause an accident while trying to read the board and watch the road.
Nothing to talk about in the car? I don’t believe it! Why not play a game? I spy, 20 questions, Car licence plates, etc.
C While working: If you cook a meal; dry the user’s hair; dig the garden, you can have a conversation with a VOCA user. A VOCA does not require that you read a display only that you are able to listen to what is being said.
C At the table: Systems are often removed at the table - ‘They get in the way and they might get food on them’. Do not remove them. What do I do when I am eating? I talk (VOCA users can talk with a full mouth). If the primary goal of meal time is to teach independence through eating skills leave the AAC system aside and concentrate on the primary goal. However, if this is not the case, then provide access to both communication and food. (A large symbol board on the wall nearby for eye-pointing? A special place setting? A scanning system and a single switch operated at a distance? A new position for the VOCA while eating?). While ‘Pass the salt’, ‘More’, ‘That’s enough’, ‘Please’ and ‘thank you’ are probably essential vocabulary items for meal times, they are hardly sparkling conversational topics. The topic of conversation can be manipulated to enable users to practise using their vocabulary.
The pragmatics of conversation may be developed when the user is given the opportunity to chat. However, time is not often set aside for a chatting as everyone has the pressures of the daily routine and the user is slow and demanding. Building chat times into lesson plans and encouraging others to spend time chatting is a positive step. Chat times may be given a more educationally acceptable label such as ‘ADAPT’ - ‘Augmentative Discourse And Pragmatics Tuition’. Chatting may not be seen by others as holding the same value as tuition in discourse. The name may make all the difference!
There are at least two forms of ADAPT sessions: structured and freestyle (sometimes called open‑ended). During a structured discourse session the topic of conversation is controlled by the facilitator who encourages the user to make active use of vocabulary already studied.
Non‑verbal children typically have not had the experience to develop interactive communication skills. Therefore, the provision of a Acommunication nucleus”, a highly controlled topic area, provides a common frame of reference, thereby promoting success (ANDERSEN P. & KIERNAN S. 1987)
In an interesting twist of the focus of attention REES N. (1978), BLANK M. (1983, 1990), and BLANK M. & MARQUIS M. (1987) show how the facilitator’s role in this activity is crucial to the development of pragmatic skills:
To the degree that it has been studied, the ideas have commonly been framed in terms of the CHILDREN’S behaviour ..... The issue of the topics offered to children by the ADULTS has been almost unnoticed (BLANK M. & MARQUIS M. 1987)
The facilitator’s language during conversational ‘texts’ (structured discourse) must reflect, as far as is possible, normal everyday conversational use, and not an atypical form:
It’s a cup, it’s plastic, you drink out of it (REES N. 1978)
The bizarre pragmatic style of many language disordered people may result, in part, from the manner in which the facilitator has presented and modelled language. Thus, the style of teaching, or language used can lead users:
to use language in ways that are not simply different, but also inappropriately different, from those of the average person (BLANK M. 1990)
Therefore, structured discourse should be pre-planned and given careful consideration. Conversation during a discourse should be kept as simple but as normal as possible.
Freestyle discourse differs from structured discourse in that the session is user controlled . The facilitator may need to initiate the topic of conversation ‘sister’s wedding’, ‘dad’s illness’, ‘mum’s new car’, ‘new boyfriend’, etc, but should in no way attempt to steer the conversation along pre‑determined pathways. The facilitator’s role is to:
C enable conversation;
C maintain discourse;
C help with forgotten symbols or symbol sequences;
C help with spelling and literacy skills;
C role model correct syntactic forms;
C help with pragmatic skills.
Freestyle discourse can highlight new areas of vocabulary which need to be added to the user’s system. It may also highlight areas of pragmatic skills where the user needs help and possible training.
There are a number of times during the day when a significant other can get on with one task while holding a conversation with a user with a VOCA. Make use of them. Equally, there are also inappropriate times for a user tries to engage in conversation. If this is a user who very rarely communicates spontaneously and for whom a polite AI can’t talk now” would be a regressive step then the significant other’s task must wait. However, if this is a user who is usually communicative then a normal response is all that is required:
AI’m sorry Tim. I can’t talk just now, I’m really busy. Tell you what, I’ve got a few minutes at 3.00. Why don’t you pop back then?”
The user has just learnt a pragmatic skill - there are times when communication is not appropriate.
It may not always be easy to attempt structured or freestyle discourse. Some users will be at the pre‑discourse level and the conversation will tend to be a little one sided. However, if users have no opportunity to see (hear) conversation and engage in it, how are they to develop the necessary skills? Too often, passive communicators are made more passive or entrenched in the role that has become their lot, by our actions, behaviour, and use of language. The user, irrespective of cognitive ability, must be given the opportunity, the framework in which to use the vocabulary that has been studied. To do otherwise is to negate your own efforts.
During these methods much can be made of such skills as turn taking, appropriate use of language, exchange structure, etc.
WARNING ‑ Try to avoid the phrase:
AUse your machine to tell me”
or ATell me with your board”
These phrases emphasise the difference between aided and natural speech, the difference between voiced communication and synthetic communication. Rather, use a standard phrase. For example:
ACan you tell me”
AI’m listening, what do you want to say to me?”
Users rarely generalise skills taught within clinical settings, using them infrequently for functional spontaneous communication in their normal daily activities and interactions (NIETUPSKI J., SCHEUTZ G., & OCKWOOD L. 1980; WULZ S., MYERS S., KLEIN D., HALL M., WALDO L. 1982; RIEKE J. & LEWIS J. 1984; HAMILTON B. & SNELL M. 1993) It is essential that all significant others enable users to transfer skills and to generalise in new environments.
The gap that exists between practice of a given dialogue and its actualization in real world interaction presents ...... users with a difficult transitional task. Moving from structured practice of dialogue to free communicative expression is a task which necessitates specific programmatic efforts, primarily because communication normally involves an element of choice (SALTER W. & CLEMENTS N. 1988)
TECHNIQUES 5 - The Pointer!
Forcing individuals to use a communication aid when it is not functional, in the belief that they will become better at communicating because they are pointing at a graphic sign instead of an object, has little purpose. (VON TETZCHNER S. & MARTINSEN H. 1992)
The quote above may appear to suggest that individuals should not be encouraged to use an AAC system when they are able to point. The relevant words are ‘forcing’ and ‘not functional’. As in the cartoon, forcing the dog to point at the Bliss Bone is non-functional when the bone is in view and therefore ‘has little purpose’. However, it is useful for the dog to be able to talk about bones when bones are not present and a link has to be established between the sign or symbol for bone and the real thing. To practice the use of a symbol - object association it will be necessary creatively to engineer the environment to give the user a desire to talk about the object in question. The object must not be present in the environment so pointing is nullified.
Thus, while total communication may involve the use of aided (both high and low technology) and unaided systems, there may be occasions where some means of communication (that are available to the user) are creatively and temporarily negated.
To develop communication skills using an aided communication technique (VOCA, Bliss, etc.) it may be temporarily necessary to inhibit, in a creative manner, the already acquired forms of AAC.
CASE STUDY: X is a 15-year-old girl. She has a VOCA. She is not using it spontaneously. Her school is a total signing environment. All the pupils sign, all the staff sign. Sign is the primary means of communication at the school. The VOCA was purchased because X is rapidly reaching an age when she will have to move out into the community. It was recognised that the signing system employed by everyone in the school is not used in society. The staff wished to give X the opportunity to partake as fully as possible with the provision of the aid. Although she knows how to use it, she is not.
CASE STUDY: X is a 10-year-old boy. Both at home and at school he makes his wishes known by unaided communication. Generally this means pointing. He has a VOCA but is not using it preferring to point at the items which he needs.
CASE STUDY: X is a 17-year-old adolescent who is a good Bliss user and has recently been learning to use a VOCA. Although he understands and can demonstrate good use of the VOCA in lessons he will use the Bliss board in all other situations.
The ‘Irish Question’: In Ireland recently a question was put on a VOCA training day:
AIf a person has developed a way of communicating by body language, such that the person is comfortable with his or her family, what right have we to impose another form of AAC?”
My answer might have been:
AShow me any other 19-year-old (without such a disability) who can only communicate with her or his family and I’ll agree we have no right.”
To take a fuller part in society means movement (at least part way) to meet the unwritten criteria that appear to call for ‘normalisation’. If it is necessary for the good of the individual to develop communication skills using a new AAC system, it may be temporarily necessary to inhibit, in a creative manner, both unaided communicative techniques and already acquired forms of AAC. Once the new AAC skills have been mastered the user has a choice and is in charge of communicative methodology.
I must be cruel only to be kind (SHAKESPEARE: Hamlet III.4 179)
To clarify the situation further:
C Unaided communication is valuable. Negation does not imply that the unaided communication is less valuable;
C Unaided communication should only be negated creatively;
C The reason for the creative negation is to provide more choice and to empower the individual through active communication skills;
C It is not necessary to negate every aspect of unaided communication at every instance throughout the day;
C The negation is a temporary measure. Control is returned to the user;
C For some individuals (notably those with severe cognitive impairments) it may be better to avoid replacing the already acquired (and perhaps idiosyncratic) signs and initially chose other ‘vocabulary units’ until the ‘new’ system is well-founded;
C Where an individual is introduced to a further AAC system, such that she or he has both a high tech (new system) and a low tech (existing system) but continues to use the existing system, the above points may also apply. This is not to devalue or denigrate the existing system.
The goal is the development of active communication and not the suppression of unaided communication. Unaided communication is valuable as a vital part of a person’s total communication system. The reason for creative negation is not because unaided communication is seen as undesirable rather that it may hinder the development of new skills. All negation has to be creative. The environment is engineered to limit the options:
1) AJohn, what would you like to drink?”
John points at the coffee pot
ANo, No John don’t point at the coffee, say it on your VOCA.”
2) AJohn, what would you like to drink?”
The choice of drinks is not in view. John points to coffee on his Bliss Board
ACoffee.”
3) AJohn, what would you like to drink?”
The choice of drinks is not in view.
ACoffee.”
The first is not creative and is not recommended. However, in the second and third the environment is creatively modified such that pointing is no longer an option. John selects Bliss or the VOCA as a means of responding. You may ask ‘What happens if he doesn’t respond?’
AJohn, what would you like to drink?”
The choice of drinks is not in view
John does not respond
AJohn, I’m not sure if you heard me. What would you like to drink?”
Still no response. Facilitator gains eye contact
AJohn. There’s coffee, there’s tea, and there’s a milkshake.
Which would you like?”
ACoffee”
In this case, the facilitator moves to the right through the communication continuum (See the chart in the ‘Open and Closed’ Questions section) listing the choices and focussing John into the conversation by repeating his name and gaining eye contact.
A further example of creative negation of the communicative method selected by the dog in the cartoon would be for Mr. Lukforjob to put Pointer’s bone out of sight, perhaps in a cupboard. Now Pointer can no longer point to the bone and has to use the ‘Doggy Bliss’ chart.
CASE STUDY: A speech professional was attempting to teach signing to a young, married, head-injured male. He was being uncooperative and would do almost anything other than sign. She tried to teach him to use the sign ‘where’ so that he could ask for directions. Eventually she hit on the idea of asking his wife to hide items that he would need instead of putting them in the normal place. At first he was exasperated that his things just appeared to have gone missing but soon hit on the idea of asking his wife where they where by signing. There was a eureka point in which the man realised the usefulness and value of the sign as a means of communication. From that point on things began to improve for the speech professional, for the man’s wife, and for the man.
For some individuals, communication is inextricably linked with the here and now. That is, they can communicate about what they can see and their communicative attempts are made decipherable by the immediacy of the context. However, a cognitively more demanding task, and one that facilitator’s should strive to help an individual achieve, is the ability to talk about an item or an event when it is out of sight, both prior and subsequent to the incident. In Piagetarian terms this is related to the concept of object permanence (PIAGET J. 1952) and in psycholinguistic terms to one of Brown’s (BROWN R. 1974) key properties of language - the notion of ‘displacement’:
Displacement is universal in human language. It allows us to make experience cumulative and to retrieve the lessons learned from earlier experience. When we retrieve or utter a message that is disengaged in time from its context, we must somehow reconstruct those structural elements and relationships - were the message not displaced- that would be immediately apprehensible to the listener. (LINDEN E. 1976 page 53)
By creatively engineering the environment the facilitator provides an opportunity for an individual to engaged in displacement of communication. Direct pointing, although an effective means of communicating and an important part of an individual’s total communication system, is necessarily contextual. The creative negation of one channel of communication in favour of another may help an individual augmented communicator:
C take a cognitive step forward;
C to talk about an object which is spatially or temporally displaced;
C to see the practical relevance of one channel of communication with respect to another without the devaluation of the other channel:
CASE STUDY: A good communication board user was provided with a voice output communication aid. He worked well with it in lessons but did not use it out of lesson. He would arrive in therapy after school and begin to chat using his board but never with his VOCA. His therapist hit upon the idea of temporarily negating the communication board by always saying that she was very busy and could not spend the time sitting and watching what he was doing but, if he would ‘talk’ to her, she could carry on and do the two things at the same time. He then switched to his VOCA and began to communicate. He is now beginning to use both systems interchangeably.
Note - The topic of engineering the environment to creatively negate channels of communication is debated further in ‘monitoring communication’ in the ‘target small relevant areas’ section of ‘Vocabulary Issues’.
The quote above may appear to suggest that individuals should not be encouraged to use an AAC system when they are able to point. The relevant words are ‘forcing’ and ‘not functional’. As in the cartoon, forcing the dog to point at the Bliss Bone is non-functional when the bone is in view and therefore ‘has little purpose’. However, it is useful for the dog to be able to talk about bones when bones are not present and a link has to be established between the sign or symbol for bone and the real thing. To practice the use of a symbol - object association it will be necessary creatively to engineer the environment to give the user a desire to talk about the object in question. The object must not be present in the environment so pointing is nullified.
Thus, while total communication may involve the use of aided (both high and low technology) and unaided systems, there may be occasions where some means of communication (that are available to the user) are creatively and temporarily negated.
To develop communication skills using an aided communication technique (VOCA, Bliss, etc.) it may be temporarily necessary to inhibit, in a creative manner, the already acquired forms of AAC.
CASE STUDY: X is a 15-year-old girl. She has a VOCA. She is not using it spontaneously. Her school is a total signing environment. All the pupils sign, all the staff sign. Sign is the primary means of communication at the school. The VOCA was purchased because X is rapidly reaching an age when she will have to move out into the community. It was recognised that the signing system employed by everyone in the school is not used in society. The staff wished to give X the opportunity to partake as fully as possible with the provision of the aid. Although she knows how to use it, she is not.
CASE STUDY: X is a 10-year-old boy. Both at home and at school he makes his wishes known by unaided communication. Generally this means pointing. He has a VOCA but is not using it preferring to point at the items which he needs.
CASE STUDY: X is a 17-year-old adolescent who is a good Bliss user and has recently been learning to use a VOCA. Although he understands and can demonstrate good use of the VOCA in lessons he will use the Bliss board in all other situations.
The ‘Irish Question’: In Ireland recently a question was put on a VOCA training day:
AIf a person has developed a way of communicating by body language, such that the person is comfortable with his or her family, what right have we to impose another form of AAC?”
My answer might have been:
AShow me any other 19-year-old (without such a disability) who can only communicate with her or his family and I’ll agree we have no right.”
To take a fuller part in society means movement (at least part way) to meet the unwritten criteria that appear to call for ‘normalisation’. If it is necessary for the good of the individual to develop communication skills using a new AAC system, it may be temporarily necessary to inhibit, in a creative manner, both unaided communicative techniques and already acquired forms of AAC. Once the new AAC skills have been mastered the user has a choice and is in charge of communicative methodology.
I must be cruel only to be kind (SHAKESPEARE: Hamlet III.4 179)
To clarify the situation further:
C Unaided communication is valuable. Negation does not imply that the unaided communication is less valuable;
C Unaided communication should only be negated creatively;
C The reason for the creative negation is to provide more choice and to empower the individual through active communication skills;
C It is not necessary to negate every aspect of unaided communication at every instance throughout the day;
C The negation is a temporary measure. Control is returned to the user;
C For some individuals (notably those with severe cognitive impairments) it may be better to avoid replacing the already acquired (and perhaps idiosyncratic) signs and initially chose other ‘vocabulary units’ until the ‘new’ system is well-founded;
C Where an individual is introduced to a further AAC system, such that she or he has both a high tech (new system) and a low tech (existing system) but continues to use the existing system, the above points may also apply. This is not to devalue or denigrate the existing system.
The goal is the development of active communication and not the suppression of unaided communication. Unaided communication is valuable as a vital part of a person’s total communication system. The reason for creative negation is not because unaided communication is seen as undesirable rather that it may hinder the development of new skills. All negation has to be creative. The environment is engineered to limit the options:
1) AJohn, what would you like to drink?”
John points at the coffee pot
ANo, No John don’t point at the coffee, say it on your VOCA.”
2) AJohn, what would you like to drink?”
The choice of drinks is not in view. John points to coffee on his Bliss Board
ACoffee.”
3) AJohn, what would you like to drink?”
The choice of drinks is not in view.
ACoffee.”
The first is not creative and is not recommended. However, in the second and third the environment is creatively modified such that pointing is no longer an option. John selects Bliss or the VOCA as a means of responding. You may ask ‘What happens if he doesn’t respond?’
AJohn, what would you like to drink?”
The choice of drinks is not in view
John does not respond
AJohn, I’m not sure if you heard me. What would you like to drink?”
Still no response. Facilitator gains eye contact
AJohn. There’s coffee, there’s tea, and there’s a milkshake.
Which would you like?”
ACoffee”
In this case, the facilitator moves to the right through the communication continuum (See the chart in the ‘Open and Closed’ Questions section) listing the choices and focussing John into the conversation by repeating his name and gaining eye contact.
A further example of creative negation of the communicative method selected by the dog in the cartoon would be for Mr. Lukforjob to put Pointer’s bone out of sight, perhaps in a cupboard. Now Pointer can no longer point to the bone and has to use the ‘Doggy Bliss’ chart.
CASE STUDY: A speech professional was attempting to teach signing to a young, married, head-injured male. He was being uncooperative and would do almost anything other than sign. She tried to teach him to use the sign ‘where’ so that he could ask for directions. Eventually she hit on the idea of asking his wife to hide items that he would need instead of putting them in the normal place. At first he was exasperated that his things just appeared to have gone missing but soon hit on the idea of asking his wife where they where by signing. There was a eureka point in which the man realised the usefulness and value of the sign as a means of communication. From that point on things began to improve for the speech professional, for the man’s wife, and for the man.
For some individuals, communication is inextricably linked with the here and now. That is, they can communicate about what they can see and their communicative attempts are made decipherable by the immediacy of the context. However, a cognitively more demanding task, and one that facilitator’s should strive to help an individual achieve, is the ability to talk about an item or an event when it is out of sight, both prior and subsequent to the incident. In Piagetarian terms this is related to the concept of object permanence (PIAGET J. 1952) and in psycholinguistic terms to one of Brown’s (BROWN R. 1974) key properties of language - the notion of ‘displacement’:
Displacement is universal in human language. It allows us to make experience cumulative and to retrieve the lessons learned from earlier experience. When we retrieve or utter a message that is disengaged in time from its context, we must somehow reconstruct those structural elements and relationships - were the message not displaced- that would be immediately apprehensible to the listener. (LINDEN E. 1976 page 53)
By creatively engineering the environment the facilitator provides an opportunity for an individual to engaged in displacement of communication. Direct pointing, although an effective means of communicating and an important part of an individual’s total communication system, is necessarily contextual. The creative negation of one channel of communication in favour of another may help an individual augmented communicator:
C take a cognitive step forward;
C to talk about an object which is spatially or temporally displaced;
C to see the practical relevance of one channel of communication with respect to another without the devaluation of the other channel:
CASE STUDY: A good communication board user was provided with a voice output communication aid. He worked well with it in lessons but did not use it out of lesson. He would arrive in therapy after school and begin to chat using his board but never with his VOCA. His therapist hit upon the idea of temporarily negating the communication board by always saying that she was very busy and could not spend the time sitting and watching what he was doing but, if he would ‘talk’ to her, she could carry on and do the two things at the same time. He then switched to his VOCA and began to communicate. He is now beginning to use both systems interchangeably.
Note - The topic of engineering the environment to creatively negate channels of communication is debated further in ‘monitoring communication’ in the ‘target small relevant areas’ section of ‘Vocabulary Issues’.
TECHNIQUES 6 - Verbal Games
Working with AAC should be fun (See TECHNIQUES 13). Games of all types are a great weapon in the facilitator’s armoury. If the games are verbal games so much the better. Some require literacy skills and some do not. Some may need amending to suit the physical and cognitive abilities of the learners.
The use of games as a pragmatic strategy has been highlighted by NORDQUIST C. and FALEY SMITH J. (1988) (See also JEFFREE D. & McCONKEY R. 1976, MUSSELWHITE C. 1985, KALOUSTIAN H. & WINN P. 1989, CRISLIP D. & OSTERLING A. 1994; JANS D. & GILBRIDE R. 1994; PRICE K. 1995; KIRKLAND J., BODE T., & CLARKE A.). Nordquist and Faley‑Smith (op.cit.) identify six ‘aspects inherent in playing games’ that ‘help the..... system user practice and acquire conversational skills’:
C turn taking;
C listening and response skills;
C making requests;
C commenting;
C control or direction of action;
C use of appropriate language.
Further, JANS D. and GILBRIDE R. (1994) list five philosophical points which should underpin any game:
C communication should be fun;
C games should be based on the normal activities of children;
C games should be easy to use;
C games should be flexible to meet changing individual needs or circumstances;
C games should promote active communication.
Not only is playing games highly motivational but much of the language can be predicted and taught in advance. Parents may feel easier and more natural playing a game with their child rather than following an intervention programme which may be alien to their normal home routine. Games can be identified which are commonly played at home (or other places frequented by users) and the words needed can be added to the vocabulary. Work can then proceed in teaching the vocabulary and playing one or two games in the educational setting.
‘Simon Says’ is one such game. It can be easily programmed to reflect the area of study:
Simon says, ‘Drink coke’
Simon says, ‘Drink tea’
and for verbs:
Simon says, ‘Run’
Simon says, ‘Kiss’
The facilitator performing the actions until the user says either:
Simon says, ‘Stop’, or plain ‘Stop’ (In which case, if you do, you are out!)
A further source of material is the computer game. Generally speaking, space invader type games are not very useful since by the time the user has commented on the next move, the aliens have blown up all the bases. However, there are a number of computer games in which the computer waits for the player to input some information (‘Connect Four’, or a simple adventure game). The facilitator can encourage the user to direct what should be keyed in. Again some preparatory work will probably be necessary before embarking on such a venture. Many electronic communication aids can be used as keyboard emulators and the user can directly input information to the computer. In some cases, the information the computer requires is not language but perhaps a grid reference or pointing with a cursor. This does not encourage language use to make explicit the user’s chosen move. However, a facilitator, sitting close by, can interact with the user to encourage comments on the game.
The telling of a joke is also a useful way of teaching both syntax and pragmatics (See MURPHY J. W. 1989). For the joke to have a pay‑off, the syntax used must be reasonably correct to ensure listener comprehension. In many jokestc \l4 "jokes the use of turn taking also applies:
USER: What do you give to a hurt lemon?
LISTENER: I don’t know. What do you give to a hurt lemon?
USER: Lemon‑aid!
PATIENT: Doctor, Doctor - I have lost my memory!
DOCTOR: When did this happen?
PATIENT: When did what happen?
In the joke above, the system user has to role‑play both parts. Many electronic communication aids have a multi-voice option. In the teaching environment, the idea is not that a key is pressed and the whole joke is spoken with the appropriate voice changes already programmed. The user tells the joke part by part or word by word and, if capable, makes adjustments to the voice as appropriate. Of course, the whole joke may be stored for use outside the teaching environment.
For the joke to be successful the user must comprehend it. It should also be borne in mind that the user may repeat a stored joke many times to the distraction of all. The young child that constantly repeats a joke, ‘Where does a sheep get a haircut?’ ‑ ‘At the Baaa‑Baaas!’ to all kith and kin, may eventually try the patience of the most stoical of adults. However, the child continues to gain from the interchange.
Some verbal games are listed by name on the OHP. The way the games are structured, they way they are played, and their rules can be varied according to the cognitive and physical level of the AAC system user as well as the user’s current state of learning. These and other ideas for games are detailed below:
20 QUESTIONS: Think of a noun, any common noun (preferably one that has been taught). Tell the AAC user you have thought of a word they know and they can ask up to 20 questions a day but are only allowed one guess a day. A variation on this is ‘Guess it - Keep it’. Wrap up, in bright paper, a little gift. The user has to guess what it is, following the rules, to keep it. A further variation on this theme is to pretend to be an item and to give clues about what you are:
I am hard; I am held in the hand; I am made of metal: I have four points on the end of me; I am used for eating; .....
I am big; people climb inside me; I take them places; I have lots of seats; ....
KIM’S GAME: There are many variations of Kim’s game but, basically, it involves placing a few items on a tray which is covered with a cloth. The tray is placed in front of a person chosen to be the ‘guesser’ and the cloth is removed. The guesser is allowed to study the tray for a pre-set amount of time. The tray is then taken away and one of the items is removed. The tray is then replaced in front of the guesser who has to figure out which item has gone. The game can be made more or less difficult by varying:
C the amount of time the guesser has to study the items on the tray;
C the number of items on the tray;
C the nature of the items on the tray (if everything is a fruit except for a cup and the cup is the item that is removed);
C the number of clues with can give!
Variations on Kim’s game may involve:
C adding an item to a tray of others. Which one is new?;
C moving the position of one item on a tray. Which one has moved?;
C changing an attribute of an item on the tray (the blue cup becomes a red cup, a small red box becomes a large red box). Which one has changed?
C changing the orientation of an item on the tray (the cup is turned upside-down, the teddy is facing left instead of right). Which one has changed?
C changing the prepositional aspect of an item on the tray (The apple in the box becomes the apple on the box). What’s different?
MAKE-A-STORY: The user says a word today and you respond with another word. The user then goes away to think of the next word for tomorrow. The idea is together we ‘Make-a-Story’. The words must make sense. So that the words are remembered they will probably need to be written down somewhere. However, in this format, it is surprising how memorable the words of the story are.
CAR NUMBER PLATES: Travelling games are very useful tools. Car number plates can be used creatively for lots of games.
Teaching the alphabet and letter recognition. Find a number plate with an A in it. Now one with a B on so on.
Make a phrase. Take the licence plate and turn it into a phrase using the letters. ILM? I Love Me! I Like Marzipan. Iceland Lost Money. If Larry Must. Ice Looks Marvellous.
Make a word. Take the licence plate and turn it into a word containing the letters in that sequence MST? MaST, MiST, MuST, MiSTer, MonSTer, MySTery, etc.
Anagrams: Take any two or three plates and see how many words you can make using the letters.
I SPY: I spy does not have to be based on literacy skills:
I spy something that is brown
I spy something made out of wood
I spy something that rhymes with hair
I spy something that you can sit on
I spy can be played at home, while travelling, in the supermarket, anywhere!
SECRET MESSAGES: Get a person to give a secret coded message to another member of staff or another pupil or student. The message is:
BIG DOG SINGS GREEN DOORS
Because the words can be nonsense (although syntactically correct), we are free to use any of the words in the user’s vocabulary. Further, the number of words can be varied according to the cognitive level of the user. The code has some meaning to the staff member to whom the secret message is given. The colour and the animal may be the key (for example) such that the user returns with a quickly drawn picture of a green dog to confirm the secret message has reached its target. The staff member who receives the message should be told only that the colour and the animal in the message make up the item to be drawn. To avoid prompting ensure that the staff member does not know the colour or the animal.
GUESS THE SONG: The user is told a word a day. The words are from a famous song. The user has to guess the song. If songs are stored into a VOCA then the song could be sung. This is nice but not necessary. As I cannot give you a word a day in this manual, the next few pages have a word written in the top RH corner. Try and guess the song with as few words as possible. The first word is ‘I’
CHINESE WHISPERS: A message is given to student A who has to pass it on to student B who has it pass it on to student C and so on. The resulting message often bears no comparison to the original.
WHAT IS IT CALLED: What is it called can be played anywhere with any topic. It can be related to a song on the radio or an item in the news. Simply put, the idea is to use the words from anything and replace then with
WILL
rhyming words. Then a clue is given which begins ‘What is it called when......’
‘What’s it called when you are singing a famous Christmas carol and start ripping pieces of paper into three long strips?’
Answer - I tore three strips (I saw three ships)
‘What’s it called when a famous person in the field of AAC changes into a desert that has no communication?’
Answer - Sahara Lack-phone
INSULTS: I insult you, you insult me! No expletives allowed! Only the creative use of the present vocabulary:
‘You are a big pig’
‘Well you are a fat cow’
‘You have a little brain’
‘Well that is a lot more than you’ ........
JIGSAW UNCOVER: Many people with a severe physical impairment cannot work with jigsaws. There are several computer programs that allow a picture to be manipulated in this manner which might be motivating. Jigsaw Uncover is another way of approaching this. A picture of something is covered by a sheet of blank paper (the item underneath must not be able to be seen through the paper). The paper has previously been cut into several pieces and attached with ‘Blutack’ or something similar. It this way, a ‘jigsaw’ piece may be peeled off revealing a part of the picture below. The user has to guess what it is. One piece a day perhaps, a piece when a question is answered correctly, a piece as a reward for a task successfully completed. A variation is to colour the pieces and the user has to state which colour is to be removed. A further variation is to label the pieces with, let’s say, animals. The user has to name the animal on the piece for it to be removed. The label may be a picture or, for the literate user, a word.
ALWAYS
SYMBOL TREASURE TRAIL: Children love treasure trails. Make up a symbol treasure trail where the symbols direct people to the next clue to the hidden treasure. One of the clues may be something like:
‘Ask [Mrs. Accomplice] for a Blue Box. The next clue is there’
Mrs. Accomplice only responds to certain words. Blue bag? No! Black box? No! Box on its own No! Only blue and box will get the desired clue. However, if asked for a box, Mrs. Accomplice could have a number of boxes ready and give an empty brown box! Any colour but blue could be presented to prompt the user into asking for the right colour.
VOCA’s themselves can be used to provide clues. If the symbols written above the VOCA represent:
‘Press YELLOW HOUSE’
Where the choices are between red, green, and yellow, houses, cars, and apples, then pressing the yellow house will give the clue. However false clues should be placed under other choices on the VOCA to prevent the user from just pressing everything in sight. A switch user? The switch user can join in. If the VOCA is controlled by a row of switches of different colours then:
‘Press the YELLOW switch’
Pictures can be attached to the top of the switches:
‘Press the KANGAROO switch’
Alternatively, a scanning VOCA can be prepared with eight selections. A single switch is mounted so that any person can operate it but it is specially positioned for the switch user. All others in the game have to use the switch as well.
CONNECTIONS: What is the connection between:
C Baby pigs and paper on the street?
C A tree and the sound of a dog?
C A drink and a colour?
C A writing desk and a raven?
LOVE
CRYPTIC CROSSWORD CLUES: Only for the brave.
C This animal was found inside when the crab bit the bather (6)
C A dry gate is a recipe for disaster (7)
C This would put the wind up any relative on Halloween (7)
Answers at the end of the techniques section!
WORD CHANGE: Can be used with those with literacy skills or those without (change the rules). It does not have to lead anywhere because playing the game is all that matters. Say a word. The next day say another word which either:
C has one letter changed (cord....... card);
C rhymes with the previous word (card ...... hard);
C is an antonym of the previous word (hard ..... easy);
C is a synonym of the previous word (easy .... simple).
It never finishes and is an easy game to play. Where do we go from the word ‘simple’? Any of the four rules above can be used but, a word once used can never be used again.
Simple ..... dimple ..... pimple .... spot .... spit ..... slit ...... flit ..... flat .... bumpy ...... smooth .... rough .... tough ......
The non-literate user may use the rhyme or opposite options. Alternatively, new options can be added:
C is a member of the same set;
C has something in common with the previous word,
and so on:
cat ..... dog ...... log ..... tree ..... bee ..... ant ..... black ......
YOU
Did you guess the song? ..... ‘I will always love you’
GUESS WHO: A child is chosen to be it and goes behind a screen or into an adjoining room. One of the remaining class members is selected at random to give clues about who s/he is: colour of hair, number of siblings, favourite group, etc. The child on the other side of the screen has to guess who is speaking. If a child is unable to speak aloud for him or her self (for example a symbol board user) then she or he can point to the items on the board and another child or member of staff can speak on her or his behalf.
With our variety of ages and experience levels in assistive device use, we needed a fun way to practice saying each other’s names quickly and to learn to recognize the voice characteristics of each student’s device. Our answer was the game ADoggie, doggie, who’s got the bone?” In this game one student was sheltered behind a screen while a Abone” was hidden in another student’s lap or pack. The student behind the screen then asked ADoggie, doggie, who’s got the bone?” The holder of the bone responded with Abark, bark.” The screen was then removed and the previously sheltered student guessed whose voice had been barking. (FUNK J., WINGATE M., & CHIU W. 1990)
PASS - WORDS: Create passwords to enter into fun activities. The user has to generate the pass - word(s) every time they want to join in with the activity. If they forget the password(s) then they should have a sentence stored which says something like AWhat’s the password for ...” and must ask a friend or a nominated member of staff.
AToilet? What’s the pass words?”
ABig water seat”
APass friend!”
Not that I’m advocating preventing someone from going to the toilet. The main feature of this game, is that it makes learning and remembering vocabulary fun! Users will remember what they use each day. Asking for passwords will become automatic to staff. Start small with just one password or passwords. The, when successful, introduce another for a further event and so on. Very soon you’ll have lots of them. A password could be just one word - Atelephone” or a group of words Amessy food fun”. The words used should be concrete - part of the core vocabulary (that is choose words that a person is likely to use outside the password scheme - don’t choose ‘elephant’ choose ‘cat’ for example). Passwords could be created by the users themselves. Use parasemantic skills - toilet becomes ‘big water seat’ and cookery becomes ‘messy food fun’.
REAL COOL DUDE: The Real Cool Dude idea is to get users to invent a saying or a greeting of the week. It could be stored as a sentence or, better still, be generated on the spot from two or three words. Each week a new greeting /saying is chosen which should not use words that have been used previously. Everybody, staff and pupils or students alike, greets each other with the saying for an entire week! It’s a fun way to learn vocabulary! The format could be AAC:
Adverbial Adjective Common noun (really nice man)
or
Adjective Adjective Common noun (real cool sister/brother)
The use of games as a pragmatic strategy has been highlighted by NORDQUIST C. and FALEY SMITH J. (1988) (See also JEFFREE D. & McCONKEY R. 1976, MUSSELWHITE C. 1985, KALOUSTIAN H. & WINN P. 1989, CRISLIP D. & OSTERLING A. 1994; JANS D. & GILBRIDE R. 1994; PRICE K. 1995; KIRKLAND J., BODE T., & CLARKE A.). Nordquist and Faley‑Smith (op.cit.) identify six ‘aspects inherent in playing games’ that ‘help the..... system user practice and acquire conversational skills’:
C turn taking;
C listening and response skills;
C making requests;
C commenting;
C control or direction of action;
C use of appropriate language.
Further, JANS D. and GILBRIDE R. (1994) list five philosophical points which should underpin any game:
C communication should be fun;
C games should be based on the normal activities of children;
C games should be easy to use;
C games should be flexible to meet changing individual needs or circumstances;
C games should promote active communication.
Not only is playing games highly motivational but much of the language can be predicted and taught in advance. Parents may feel easier and more natural playing a game with their child rather than following an intervention programme which may be alien to their normal home routine. Games can be identified which are commonly played at home (or other places frequented by users) and the words needed can be added to the vocabulary. Work can then proceed in teaching the vocabulary and playing one or two games in the educational setting.
‘Simon Says’ is one such game. It can be easily programmed to reflect the area of study:
Simon says, ‘Drink coke’
Simon says, ‘Drink tea’
and for verbs:
Simon says, ‘Run’
Simon says, ‘Kiss’
The facilitator performing the actions until the user says either:
Simon says, ‘Stop’, or plain ‘Stop’ (In which case, if you do, you are out!)
A further source of material is the computer game. Generally speaking, space invader type games are not very useful since by the time the user has commented on the next move, the aliens have blown up all the bases. However, there are a number of computer games in which the computer waits for the player to input some information (‘Connect Four’, or a simple adventure game). The facilitator can encourage the user to direct what should be keyed in. Again some preparatory work will probably be necessary before embarking on such a venture. Many electronic communication aids can be used as keyboard emulators and the user can directly input information to the computer. In some cases, the information the computer requires is not language but perhaps a grid reference or pointing with a cursor. This does not encourage language use to make explicit the user’s chosen move. However, a facilitator, sitting close by, can interact with the user to encourage comments on the game.
The telling of a joke is also a useful way of teaching both syntax and pragmatics (See MURPHY J. W. 1989). For the joke to have a pay‑off, the syntax used must be reasonably correct to ensure listener comprehension. In many jokestc \l4 "jokes the use of turn taking also applies:
USER: What do you give to a hurt lemon?
LISTENER: I don’t know. What do you give to a hurt lemon?
USER: Lemon‑aid!
PATIENT: Doctor, Doctor - I have lost my memory!
DOCTOR: When did this happen?
PATIENT: When did what happen?
In the joke above, the system user has to role‑play both parts. Many electronic communication aids have a multi-voice option. In the teaching environment, the idea is not that a key is pressed and the whole joke is spoken with the appropriate voice changes already programmed. The user tells the joke part by part or word by word and, if capable, makes adjustments to the voice as appropriate. Of course, the whole joke may be stored for use outside the teaching environment.
For the joke to be successful the user must comprehend it. It should also be borne in mind that the user may repeat a stored joke many times to the distraction of all. The young child that constantly repeats a joke, ‘Where does a sheep get a haircut?’ ‑ ‘At the Baaa‑Baaas!’ to all kith and kin, may eventually try the patience of the most stoical of adults. However, the child continues to gain from the interchange.
Some verbal games are listed by name on the OHP. The way the games are structured, they way they are played, and their rules can be varied according to the cognitive and physical level of the AAC system user as well as the user’s current state of learning. These and other ideas for games are detailed below:
20 QUESTIONS: Think of a noun, any common noun (preferably one that has been taught). Tell the AAC user you have thought of a word they know and they can ask up to 20 questions a day but are only allowed one guess a day. A variation on this is ‘Guess it - Keep it’. Wrap up, in bright paper, a little gift. The user has to guess what it is, following the rules, to keep it. A further variation on this theme is to pretend to be an item and to give clues about what you are:
I am hard; I am held in the hand; I am made of metal: I have four points on the end of me; I am used for eating; .....
I am big; people climb inside me; I take them places; I have lots of seats; ....
KIM’S GAME: There are many variations of Kim’s game but, basically, it involves placing a few items on a tray which is covered with a cloth. The tray is placed in front of a person chosen to be the ‘guesser’ and the cloth is removed. The guesser is allowed to study the tray for a pre-set amount of time. The tray is then taken away and one of the items is removed. The tray is then replaced in front of the guesser who has to figure out which item has gone. The game can be made more or less difficult by varying:
C the amount of time the guesser has to study the items on the tray;
C the number of items on the tray;
C the nature of the items on the tray (if everything is a fruit except for a cup and the cup is the item that is removed);
C the number of clues with can give!
Variations on Kim’s game may involve:
C adding an item to a tray of others. Which one is new?;
C moving the position of one item on a tray. Which one has moved?;
C changing an attribute of an item on the tray (the blue cup becomes a red cup, a small red box becomes a large red box). Which one has changed?
C changing the orientation of an item on the tray (the cup is turned upside-down, the teddy is facing left instead of right). Which one has changed?
C changing the prepositional aspect of an item on the tray (The apple in the box becomes the apple on the box). What’s different?
MAKE-A-STORY: The user says a word today and you respond with another word. The user then goes away to think of the next word for tomorrow. The idea is together we ‘Make-a-Story’. The words must make sense. So that the words are remembered they will probably need to be written down somewhere. However, in this format, it is surprising how memorable the words of the story are.
CAR NUMBER PLATES: Travelling games are very useful tools. Car number plates can be used creatively for lots of games.
Teaching the alphabet and letter recognition. Find a number plate with an A in it. Now one with a B on so on.
Make a phrase. Take the licence plate and turn it into a phrase using the letters. ILM? I Love Me! I Like Marzipan. Iceland Lost Money. If Larry Must. Ice Looks Marvellous.
Make a word. Take the licence plate and turn it into a word containing the letters in that sequence MST? MaST, MiST, MuST, MiSTer, MonSTer, MySTery, etc.
Anagrams: Take any two or three plates and see how many words you can make using the letters.
I SPY: I spy does not have to be based on literacy skills:
I spy something that is brown
I spy something made out of wood
I spy something that rhymes with hair
I spy something that you can sit on
I spy can be played at home, while travelling, in the supermarket, anywhere!
SECRET MESSAGES: Get a person to give a secret coded message to another member of staff or another pupil or student. The message is:
BIG DOG SINGS GREEN DOORS
Because the words can be nonsense (although syntactically correct), we are free to use any of the words in the user’s vocabulary. Further, the number of words can be varied according to the cognitive level of the user. The code has some meaning to the staff member to whom the secret message is given. The colour and the animal may be the key (for example) such that the user returns with a quickly drawn picture of a green dog to confirm the secret message has reached its target. The staff member who receives the message should be told only that the colour and the animal in the message make up the item to be drawn. To avoid prompting ensure that the staff member does not know the colour or the animal.
GUESS THE SONG: The user is told a word a day. The words are from a famous song. The user has to guess the song. If songs are stored into a VOCA then the song could be sung. This is nice but not necessary. As I cannot give you a word a day in this manual, the next few pages have a word written in the top RH corner. Try and guess the song with as few words as possible. The first word is ‘I’
CHINESE WHISPERS: A message is given to student A who has to pass it on to student B who has it pass it on to student C and so on. The resulting message often bears no comparison to the original.
WHAT IS IT CALLED: What is it called can be played anywhere with any topic. It can be related to a song on the radio or an item in the news. Simply put, the idea is to use the words from anything and replace then with
WILL
rhyming words. Then a clue is given which begins ‘What is it called when......’
‘What’s it called when you are singing a famous Christmas carol and start ripping pieces of paper into three long strips?’
Answer - I tore three strips (I saw three ships)
‘What’s it called when a famous person in the field of AAC changes into a desert that has no communication?’
Answer - Sahara Lack-phone
INSULTS: I insult you, you insult me! No expletives allowed! Only the creative use of the present vocabulary:
‘You are a big pig’
‘Well you are a fat cow’
‘You have a little brain’
‘Well that is a lot more than you’ ........
JIGSAW UNCOVER: Many people with a severe physical impairment cannot work with jigsaws. There are several computer programs that allow a picture to be manipulated in this manner which might be motivating. Jigsaw Uncover is another way of approaching this. A picture of something is covered by a sheet of blank paper (the item underneath must not be able to be seen through the paper). The paper has previously been cut into several pieces and attached with ‘Blutack’ or something similar. It this way, a ‘jigsaw’ piece may be peeled off revealing a part of the picture below. The user has to guess what it is. One piece a day perhaps, a piece when a question is answered correctly, a piece as a reward for a task successfully completed. A variation is to colour the pieces and the user has to state which colour is to be removed. A further variation is to label the pieces with, let’s say, animals. The user has to name the animal on the piece for it to be removed. The label may be a picture or, for the literate user, a word.
ALWAYS
SYMBOL TREASURE TRAIL: Children love treasure trails. Make up a symbol treasure trail where the symbols direct people to the next clue to the hidden treasure. One of the clues may be something like:
‘Ask [Mrs. Accomplice] for a Blue Box. The next clue is there’
Mrs. Accomplice only responds to certain words. Blue bag? No! Black box? No! Box on its own No! Only blue and box will get the desired clue. However, if asked for a box, Mrs. Accomplice could have a number of boxes ready and give an empty brown box! Any colour but blue could be presented to prompt the user into asking for the right colour.
VOCA’s themselves can be used to provide clues. If the symbols written above the VOCA represent:
‘Press YELLOW HOUSE’
Where the choices are between red, green, and yellow, houses, cars, and apples, then pressing the yellow house will give the clue. However false clues should be placed under other choices on the VOCA to prevent the user from just pressing everything in sight. A switch user? The switch user can join in. If the VOCA is controlled by a row of switches of different colours then:
‘Press the YELLOW switch’
Pictures can be attached to the top of the switches:
‘Press the KANGAROO switch’
Alternatively, a scanning VOCA can be prepared with eight selections. A single switch is mounted so that any person can operate it but it is specially positioned for the switch user. All others in the game have to use the switch as well.
CONNECTIONS: What is the connection between:
C Baby pigs and paper on the street?
C A tree and the sound of a dog?
C A drink and a colour?
C A writing desk and a raven?
LOVE
CRYPTIC CROSSWORD CLUES: Only for the brave.
C This animal was found inside when the crab bit the bather (6)
C A dry gate is a recipe for disaster (7)
C This would put the wind up any relative on Halloween (7)
Answers at the end of the techniques section!
WORD CHANGE: Can be used with those with literacy skills or those without (change the rules). It does not have to lead anywhere because playing the game is all that matters. Say a word. The next day say another word which either:
C has one letter changed (cord....... card);
C rhymes with the previous word (card ...... hard);
C is an antonym of the previous word (hard ..... easy);
C is a synonym of the previous word (easy .... simple).
It never finishes and is an easy game to play. Where do we go from the word ‘simple’? Any of the four rules above can be used but, a word once used can never be used again.
Simple ..... dimple ..... pimple .... spot .... spit ..... slit ...... flit ..... flat .... bumpy ...... smooth .... rough .... tough ......
The non-literate user may use the rhyme or opposite options. Alternatively, new options can be added:
C is a member of the same set;
C has something in common with the previous word,
and so on:
cat ..... dog ...... log ..... tree ..... bee ..... ant ..... black ......
YOU
Did you guess the song? ..... ‘I will always love you’
GUESS WHO: A child is chosen to be it and goes behind a screen or into an adjoining room. One of the remaining class members is selected at random to give clues about who s/he is: colour of hair, number of siblings, favourite group, etc. The child on the other side of the screen has to guess who is speaking. If a child is unable to speak aloud for him or her self (for example a symbol board user) then she or he can point to the items on the board and another child or member of staff can speak on her or his behalf.
With our variety of ages and experience levels in assistive device use, we needed a fun way to practice saying each other’s names quickly and to learn to recognize the voice characteristics of each student’s device. Our answer was the game ADoggie, doggie, who’s got the bone?” In this game one student was sheltered behind a screen while a Abone” was hidden in another student’s lap or pack. The student behind the screen then asked ADoggie, doggie, who’s got the bone?” The holder of the bone responded with Abark, bark.” The screen was then removed and the previously sheltered student guessed whose voice had been barking. (FUNK J., WINGATE M., & CHIU W. 1990)
PASS - WORDS: Create passwords to enter into fun activities. The user has to generate the pass - word(s) every time they want to join in with the activity. If they forget the password(s) then they should have a sentence stored which says something like AWhat’s the password for ...” and must ask a friend or a nominated member of staff.
AToilet? What’s the pass words?”
ABig water seat”
APass friend!”
Not that I’m advocating preventing someone from going to the toilet. The main feature of this game, is that it makes learning and remembering vocabulary fun! Users will remember what they use each day. Asking for passwords will become automatic to staff. Start small with just one password or passwords. The, when successful, introduce another for a further event and so on. Very soon you’ll have lots of them. A password could be just one word - Atelephone” or a group of words Amessy food fun”. The words used should be concrete - part of the core vocabulary (that is choose words that a person is likely to use outside the password scheme - don’t choose ‘elephant’ choose ‘cat’ for example). Passwords could be created by the users themselves. Use parasemantic skills - toilet becomes ‘big water seat’ and cookery becomes ‘messy food fun’.
REAL COOL DUDE: The Real Cool Dude idea is to get users to invent a saying or a greeting of the week. It could be stored as a sentence or, better still, be generated on the spot from two or three words. Each week a new greeting /saying is chosen which should not use words that have been used previously. Everybody, staff and pupils or students alike, greets each other with the saying for an entire week! It’s a fun way to learn vocabulary! The format could be AAC:
Adverbial Adjective Common noun (really nice man)
or
Adjective Adjective Common noun (real cool sister/brother)
TECHNIQUES 7 - Give the user errands to run
Another way in which conative uses of language are taught is by asking the child to require someone else to carry out an action: AGo and ask Daddy if he will bring in some butter when he comes home.” (WILKINSON A. 1971)
Empower users by giving them errands which will involve communication. The errands can be genuine or engineered and can be to any significant other. The significant other, although primed, should not be aware of the message, only knowing that ‘Jimmy will be coming for something this morning’. The item (or message) that the user is sent to fetch (or pass on) can be as simple or as complex as the user’s abilities dictate:
(Holding up a red book)
AJimmy can you go and get me one of these from Mr. Sayes?”
Jimmy returns with a book from Mr. Sayes but it’s the wrong colour.
AJimmy that is not quite right. Look. This is what I wanted (hold up Red book) and this is what you gave me (hold up green book). Can you see the difference? Will you go back and get me one like this please?”
Encouraging peer interaction is important. The errand may be to get something from another pupil or student or to ask another pupil or student a question.
AMrs. Gudcare wants to know ‘Are you going swimming on Friday?’”
CASE STUDY: The only child with a disability and a communication aid (a VOCA) in a school was not a successful augmentative communicator until the staff decided to change their tactics. They made him responsible for a number of routine tasks. Every day he has to find out from the cook the lunch menu. He has then to report to the rest of his class so that they can decide what they would like. He has to find out which children are going to the tennis club each Friday and collect the money involved. He is often sent on various errands by his class tutor and by his specialist support worker.
Empower users by giving them errands which will involve communication. The errands can be genuine or engineered and can be to any significant other. The significant other, although primed, should not be aware of the message, only knowing that ‘Jimmy will be coming for something this morning’. The item (or message) that the user is sent to fetch (or pass on) can be as simple or as complex as the user’s abilities dictate:
(Holding up a red book)
AJimmy can you go and get me one of these from Mr. Sayes?”
Jimmy returns with a book from Mr. Sayes but it’s the wrong colour.
AJimmy that is not quite right. Look. This is what I wanted (hold up Red book) and this is what you gave me (hold up green book). Can you see the difference? Will you go back and get me one like this please?”
Encouraging peer interaction is important. The errand may be to get something from another pupil or student or to ask another pupil or student a question.
AMrs. Gudcare wants to know ‘Are you going swimming on Friday?’”
CASE STUDY: The only child with a disability and a communication aid (a VOCA) in a school was not a successful augmentative communicator until the staff decided to change their tactics. They made him responsible for a number of routine tasks. Every day he has to find out from the cook the lunch menu. He has then to report to the rest of his class so that they can decide what they would like. He has to find out which children are going to the tennis club each Friday and collect the money involved. He is often sent on various errands by his class tutor and by his specialist support worker.
TECHNIQUES 8 - Pass a message
Messages may also be passed from school to home and from home to school. Sometimes a VOCA has a message key which speaks out the entire message when pressed. Although this may be a suitable starting position, eventually the method should be altered so that the message is carried by the messenger and not by the system. This works well for both high and low-tech systems. A child is given a message to give to Mum at home. Mum is expecting a message (as one is given every day) but does not know what it will be. The child passes on the message. Mum either writes down the message or stores it in a location on the VOCA. The facilitator can then check what message was passed. Mum gives a message to be taken to school. The tutor is unaware of the content of the message. When this message is passed, this is also written or stored (in the same location, overwriting the previous day’s message after it has been checked).
Home and school will need to liaise. This can be done over the phone or in person once a week to compare notes, deal with any problems, revise strategies, and plan for the future.
Messages can be passed between any significant others. The user becomes a ‘go-between’. The message can be tailored to suit the cognitive level of the user involved. In some instances, creative use of messages can lead to the development of parasemantic skills, that is a user’s ability to use words other than those he or she has heard to pass the message:
TUTOR AJenny will you do me a favour? Will you go and tell Mr Green that Mrs Getwell [a nurse] is coming to the surgery [word not stored] in her Landrover [not stored] this afternoon”
JENNY ANurse car come”
Mr GREEN AThe nurse is coming. Do you know when?”
JENNY Aafternoon”
Mr GREEN AThanks Jenny”
The above interchange presupposes that Jenny knows that Mrs Getwell is a nurse and that a Landrover is a vehicle. Although Jenny could have said ‘nurse room’ for surgery she does not pass on this aspect on the message. However, it does not appear to be a vital component. The idea is that the message need not necessarily be composed of words that are available on the user’s system. Indeed, after some basic messages comprised of words available to the user have been passed successfully, the creative use of new words (providing the user understands them) to develop user parasemanticity is to be encouraged.
Home and school will need to liaise. This can be done over the phone or in person once a week to compare notes, deal with any problems, revise strategies, and plan for the future.
Messages can be passed between any significant others. The user becomes a ‘go-between’. The message can be tailored to suit the cognitive level of the user involved. In some instances, creative use of messages can lead to the development of parasemantic skills, that is a user’s ability to use words other than those he or she has heard to pass the message:
TUTOR AJenny will you do me a favour? Will you go and tell Mr Green that Mrs Getwell [a nurse] is coming to the surgery [word not stored] in her Landrover [not stored] this afternoon”
JENNY ANurse car come”
Mr GREEN AThe nurse is coming. Do you know when?”
JENNY Aafternoon”
Mr GREEN AThanks Jenny”
The above interchange presupposes that Jenny knows that Mrs Getwell is a nurse and that a Landrover is a vehicle. Although Jenny could have said ‘nurse room’ for surgery she does not pass on this aspect on the message. However, it does not appear to be a vital component. The idea is that the message need not necessarily be composed of words that are available on the user’s system. Indeed, after some basic messages comprised of words available to the user have been passed successfully, the creative use of new words (providing the user understands them) to develop user parasemanticity is to be encouraged.
TECHNIQUES 9 - Scripting
...scripts are conversational texts based on natural interactions that are stored sentence by sentence (GLENNEN S. 1986)
By their very nature, word-based and sentenced/phrase-based aided AAC system require predictable message sets. That is, when associating graphic symbols with words or sentences and creating graphic overlays for message storage and retrieval, it is mandatory to know in advance which messages will be needed. Analysis of the messages required in the interactive activities of the activity-based curriculum identifies these messages. This expressive language which mediates the action sequence of the goal-orientated activity is referred to as a script. (ELDER P. & GOOSSENS C. 1993 page 35)
Reference to scripting is usually made for use with AAC systems following an approach which makes use of sentences rather than individual words although this does not have to be the case (See IACONO T. & DUNCUM J. 1995). There are two varieties of scripts that may be produced which I will call closed scripts and open scripts.
Closed scripting comprises a set of communicative interactions between person A and person B which is prepared and made available through the modality of the user's system. The sentences chosen should reflect both the cognitive abilities of the user and their usefulness in practical daily activities. They should therefore be age and cognitively appropriate and reflect typical daily patterns of interaction (for the user)(See BAKER B. & STUART 1986, GLENNEN S. 1986). The user is then encouraged to role play, together with the facilitator, the conversation stored, first as person B and then as person A.
In closed scripting use may be made of environmentally non-specific, pivotal, and concatenated phrases to facilitate transfer of the skills learned in these sessions to other environments, as appropriate, throughout the day:
C environmentally non‑specific is a term used to describe a phrase that may be used in more than one form of communication interaction. Consider the phrase AI don’t like peas”. It may only be invoked when the user is given peas or asked if s/he would like peas ‑ normally at meal times. If the phrase is altered to make it environmentally non‑specific it becomes AI don’t like that” which would suffice for indicating a distaste for peas at dinner but may also be used in a number of other settings ‑ AShall we watch the sport” AI don’t like that!”
C pivotal phrases are open ended phrases to which another word or group of words can be added to create new forms. For example, ACan I have a ...”, AI want to go to the ...”, AI have a pain in my ...”, AI want to talk to you about ...”. These phrases can be stored as above. The user recalls the phrase and from a separate word bank adds an appropriate ending. The MinspeakJ synthesizer the LiberatorJ has an ability to create a ‘Minsert’ which is a blank within a prestored sentence which may be filled with any suitable vocabulary:
AHello <MINSERT’ how are you?
Where the Minsert could be any name (Peter, Mum, mate, etc.)
C a concatenated phrase is a short phrase that may be useful when combined with other short phrases to generate novel speech. Consider the phrases Aa cup of”, Aa bottle of”, Aa packet of”. These, when combined with a pivotal phrase, increase the permutations available to any user :
ACan I have ...”Aa bottle of ...”
AWill you get me ...”Aa packet of ....”
The transition to environmentally non‑specific, pivotal, and concatenated phrases may best take place after the script has been designed and successfully implemented. The facilitator re-examines the script and attempts to:
C alter the phrases to make them useful in other environments;
C breakdown the phrases into opening pivotal phrases and following concatenated phrases which are then stored separately.
The user now can practise the previously successful scripts with the new variations. Scripts should be both natural and client-centred(as opposed to facilitator driven) so that they are more likely to be used in the post training period. One way of assembling natural scripts is to shadow or monitor an individual during a period of his or her day for which a script is being prepared, for example, a drinks break.
As an example of the above process the following short dialogue has been assembled between a boy and a girl in a centre’s leisure area:
A) Hello Jane B) Hi
A) What are you having to drink? B) Coke.
A) I’m having milk.
A) (to lady at counter) Can I have a glass of milk please?
The leisure area was chosen as the user goes there daily. It is known that he likes Jane and does talk to her. First attempts can be tidied and split into smaller, more useful, phrases....
A) Hello Jane
B) Hi (or whatever is the more popular greeting)
A) What are you having? (environmentally non-specific)
B) Coke (no changes made)
A) I’m having a ..... (pivotal) milk (stored separately)
A) Can I have ..... (pivotal) a glass of (pivotal)
milk ..... please (stored separately)
There are a number of problems with the example given above:
C while role playing the individual parts (as in a play) may work perfectly, however, in reality, Jane may not respond to the user’s opening gambit in the manner scripted: AHello Jane” - AGet lost!”;
C the language used may be too advanced for the individual concerned;
C the language chosen may reflect the facilitator’s language style and not be typical of the language used by the user’s peers in a similar situation;
C rarely is communication neatly packaged into small A B A B A B interactions. Note that the end of the script is A A.
We can try to ensure that the language chosen reflects user ability and is both age and stylistically appropriate: this can be achieved by close observations of the individual user in the natural environment. We can also accept, for the moment, that an interchange between two people is not always of the form scripted. However, Jane’s reaction is an unknown and is unlikely to be the same on different days but, if a staff member is used as the second person in the script, then the dialogue can be fixed (for example, buying an item from the tuck shop where the assistant has been primed with exactly what to say). This may provide the user with motivating early experiences of success and may be used as the foundation for subsequent work using alternate techniques. Again, it is unlikely that the average shop assistant will use exactly the word structure offered by a script (although McDonald’s staff tend to use the same opening gambits and phrase structures). If this is problematic, a more flexible approach is provided by open scripting.
In open scripting many of the problems above are avoided by creating a number of possible responses to each event. An activity is chosen which is functional, an activity which the user engages in regularly (getting dressed or changing clothes is one example), and a script is prepared around the activity taking into account:
C the items involved (socks, pants, jacket, drawers, wardrobes, etc.);
C the descriptors involved (colours of clothes, styles of clothes);
C the actors involved (Who is likely to be involved in this activity other than the user her/himself? What are they likely to say and do?);
C the actions involved (get it out, look in the wardrobe, turn the key);
C the stages involved (asking to get dressed, deciding what to wear, finding the clothes, laying out clothes, getting dressed).
In this way, a list of things the actors may say and do can be prepared and user statements and responses can be added to the system. Real life activities can be monitored to find out what typically occurs and the language that facilitators normally use.
Help me Jane I want to get ready
Where is it I want to get changed
I can’t find the key It’s in the top drawer
Which one do you want to wear? Look on top of the wardrobe
You have a choice of colour Get it out
I like the other one I don’t like that
You haven’t got all day It’s in the bottom drawer
What shall I do with it? red, green, blue, white, ...
I can’t find it put it on the bed
It’s dirty It’s dirty
It’s not here Is it clean
Doesn’t really go with your jeans Put it .... in the wash
There’s no time now Let me see
It’s in the wash jacket, jeans, blouse, .....
I want to change my ....
This list can also involve environmentally non-specific phrases, pivotal statements, and concatenations as detailed earlier. From this list a script is prepared that allows the user a choice of comment as an initiating remark or as a response to a statement or question made by another. The script can be practised in the classroom with other users but it may be better to work in the environment in which the activity will actually occur and with the actors who will naturally be involved. The use of other techniques such as creative asininity and environmental anomaly (see below) may help promote the use of the phrases learned.
I want to change my blouse
What right now? Yes
Will you help me?
OK. Which one do you want to wear? Blue
Where is it? It’s in the top drawer
I think
It’s not here wardrobe
OK. Yes got it. What do you want to do
with the blouse you’re wearing? in the wash
You look really nice Thanks
(For more detail on this form of scripting see the work of Pam Elder and Carol Goossens 1993)
It would appear from the text above that scripting only involves the use of pre-stored phrases and sentences. This is not the case as single word scripts can also be prepared. Again, these should ideally be based on naturally occurring activities and be user-centred perhaps created by the user and the facilitator(s) together after a period of observation of a play activity, a social activity, an educational activity, etc. - indeed, any activity that:
C is routine;
C is structured - such that it is possible to predict the vocabulary that is likely to occur in future sessions;
C is reasonably frequent;
C involves interaction and thus creates opportunities for communication;
C enjoyed by the user;
The vocabulary chosen for the Cooking script consisted of the following 19 words: stove, biscuits, in, out, roll, open, playdough, on, off, ready, pan, look, candle, apron, Joanne, Lisa, cut, eat, and more. (IACONO T. & DUNCUM J. 1995)
A limited single word script has some advantages:
C it is suitable for users operating at low cognitive and linguistic levels;
C work can begin at the single word utterance level;
C it can help to develop syntax skills (movement to a two word level);
C the words learnt may be more readily generalizable to other situations (See KIM Y. & LOMBARDINO L. 1991);
C scripts can provide a means by which vocabulary is selected (IACONO T. & DUNCUM J. 1995);
C staff are presented with a limited vocabulary of signs or symbols to learn and thus can develop sign and symbol skills alongside the user;
C when symbols are used, they can be displayed on a single overlay;
C symbols and signs can be displayed as a wall chart / poster in the environment in which will be used and are likely to spontaneously occur aiding the learning of others.
C because such scripts are used repeatedly in a predictive fashion they can tend to lessen the cognitive load on any individual (See CONSTABLE C. 1986);
Some of the above are also applicable to sentence-based scripts. Sentence based scripts may have other potential advantages. They may be better suited to developing turn-taking skills rather than syntax for example. There is no hard and fast rule which says that scripts must be either sentence or words based, they could (and probably should) include both. For work on scripting the reader may like to refer to the following books, articles and papers: CONSTABLE C. 1986; FEY M. 1986; GLENNEN S. 1986; NELSON K. 1986; KIM Y. & LOMBARDINO L. 1991; ELDER P. 1992; SPECK J. & McGUINNESS R. 1992; ELDER P. & GOOSSENS C. 1993; IACONO T. & DUNCUM J. 1995
By their very nature, word-based and sentenced/phrase-based aided AAC system require predictable message sets. That is, when associating graphic symbols with words or sentences and creating graphic overlays for message storage and retrieval, it is mandatory to know in advance which messages will be needed. Analysis of the messages required in the interactive activities of the activity-based curriculum identifies these messages. This expressive language which mediates the action sequence of the goal-orientated activity is referred to as a script. (ELDER P. & GOOSSENS C. 1993 page 35)
Reference to scripting is usually made for use with AAC systems following an approach which makes use of sentences rather than individual words although this does not have to be the case (See IACONO T. & DUNCUM J. 1995). There are two varieties of scripts that may be produced which I will call closed scripts and open scripts.
Closed scripting comprises a set of communicative interactions between person A and person B which is prepared and made available through the modality of the user's system. The sentences chosen should reflect both the cognitive abilities of the user and their usefulness in practical daily activities. They should therefore be age and cognitively appropriate and reflect typical daily patterns of interaction (for the user)(See BAKER B. & STUART 1986, GLENNEN S. 1986). The user is then encouraged to role play, together with the facilitator, the conversation stored, first as person B and then as person A.
In closed scripting use may be made of environmentally non-specific, pivotal, and concatenated phrases to facilitate transfer of the skills learned in these sessions to other environments, as appropriate, throughout the day:
C environmentally non‑specific is a term used to describe a phrase that may be used in more than one form of communication interaction. Consider the phrase AI don’t like peas”. It may only be invoked when the user is given peas or asked if s/he would like peas ‑ normally at meal times. If the phrase is altered to make it environmentally non‑specific it becomes AI don’t like that” which would suffice for indicating a distaste for peas at dinner but may also be used in a number of other settings ‑ AShall we watch the sport” AI don’t like that!”
C pivotal phrases are open ended phrases to which another word or group of words can be added to create new forms. For example, ACan I have a ...”, AI want to go to the ...”, AI have a pain in my ...”, AI want to talk to you about ...”. These phrases can be stored as above. The user recalls the phrase and from a separate word bank adds an appropriate ending. The MinspeakJ synthesizer the LiberatorJ has an ability to create a ‘Minsert’ which is a blank within a prestored sentence which may be filled with any suitable vocabulary:
AHello <MINSERT’ how are you?
Where the Minsert could be any name (Peter, Mum, mate, etc.)
C a concatenated phrase is a short phrase that may be useful when combined with other short phrases to generate novel speech. Consider the phrases Aa cup of”, Aa bottle of”, Aa packet of”. These, when combined with a pivotal phrase, increase the permutations available to any user :
ACan I have ...”Aa bottle of ...”
AWill you get me ...”Aa packet of ....”
The transition to environmentally non‑specific, pivotal, and concatenated phrases may best take place after the script has been designed and successfully implemented. The facilitator re-examines the script and attempts to:
C alter the phrases to make them useful in other environments;
C breakdown the phrases into opening pivotal phrases and following concatenated phrases which are then stored separately.
The user now can practise the previously successful scripts with the new variations. Scripts should be both natural and client-centred(as opposed to facilitator driven) so that they are more likely to be used in the post training period. One way of assembling natural scripts is to shadow or monitor an individual during a period of his or her day for which a script is being prepared, for example, a drinks break.
As an example of the above process the following short dialogue has been assembled between a boy and a girl in a centre’s leisure area:
A) Hello Jane B) Hi
A) What are you having to drink? B) Coke.
A) I’m having milk.
A) (to lady at counter) Can I have a glass of milk please?
The leisure area was chosen as the user goes there daily. It is known that he likes Jane and does talk to her. First attempts can be tidied and split into smaller, more useful, phrases....
A) Hello Jane
B) Hi (or whatever is the more popular greeting)
A) What are you having? (environmentally non-specific)
B) Coke (no changes made)
A) I’m having a ..... (pivotal) milk (stored separately)
A) Can I have ..... (pivotal) a glass of (pivotal)
milk ..... please (stored separately)
There are a number of problems with the example given above:
C while role playing the individual parts (as in a play) may work perfectly, however, in reality, Jane may not respond to the user’s opening gambit in the manner scripted: AHello Jane” - AGet lost!”;
C the language used may be too advanced for the individual concerned;
C the language chosen may reflect the facilitator’s language style and not be typical of the language used by the user’s peers in a similar situation;
C rarely is communication neatly packaged into small A B A B A B interactions. Note that the end of the script is A A.
We can try to ensure that the language chosen reflects user ability and is both age and stylistically appropriate: this can be achieved by close observations of the individual user in the natural environment. We can also accept, for the moment, that an interchange between two people is not always of the form scripted. However, Jane’s reaction is an unknown and is unlikely to be the same on different days but, if a staff member is used as the second person in the script, then the dialogue can be fixed (for example, buying an item from the tuck shop where the assistant has been primed with exactly what to say). This may provide the user with motivating early experiences of success and may be used as the foundation for subsequent work using alternate techniques. Again, it is unlikely that the average shop assistant will use exactly the word structure offered by a script (although McDonald’s staff tend to use the same opening gambits and phrase structures). If this is problematic, a more flexible approach is provided by open scripting.
In open scripting many of the problems above are avoided by creating a number of possible responses to each event. An activity is chosen which is functional, an activity which the user engages in regularly (getting dressed or changing clothes is one example), and a script is prepared around the activity taking into account:
C the items involved (socks, pants, jacket, drawers, wardrobes, etc.);
C the descriptors involved (colours of clothes, styles of clothes);
C the actors involved (Who is likely to be involved in this activity other than the user her/himself? What are they likely to say and do?);
C the actions involved (get it out, look in the wardrobe, turn the key);
C the stages involved (asking to get dressed, deciding what to wear, finding the clothes, laying out clothes, getting dressed).
In this way, a list of things the actors may say and do can be prepared and user statements and responses can be added to the system. Real life activities can be monitored to find out what typically occurs and the language that facilitators normally use.
Help me Jane I want to get ready
Where is it I want to get changed
I can’t find the key It’s in the top drawer
Which one do you want to wear? Look on top of the wardrobe
You have a choice of colour Get it out
I like the other one I don’t like that
You haven’t got all day It’s in the bottom drawer
What shall I do with it? red, green, blue, white, ...
I can’t find it put it on the bed
It’s dirty It’s dirty
It’s not here Is it clean
Doesn’t really go with your jeans Put it .... in the wash
There’s no time now Let me see
It’s in the wash jacket, jeans, blouse, .....
I want to change my ....
This list can also involve environmentally non-specific phrases, pivotal statements, and concatenations as detailed earlier. From this list a script is prepared that allows the user a choice of comment as an initiating remark or as a response to a statement or question made by another. The script can be practised in the classroom with other users but it may be better to work in the environment in which the activity will actually occur and with the actors who will naturally be involved. The use of other techniques such as creative asininity and environmental anomaly (see below) may help promote the use of the phrases learned.
I want to change my blouse
What right now? Yes
Will you help me?
OK. Which one do you want to wear? Blue
Where is it? It’s in the top drawer
I think
It’s not here wardrobe
OK. Yes got it. What do you want to do
with the blouse you’re wearing? in the wash
You look really nice Thanks
(For more detail on this form of scripting see the work of Pam Elder and Carol Goossens 1993)
It would appear from the text above that scripting only involves the use of pre-stored phrases and sentences. This is not the case as single word scripts can also be prepared. Again, these should ideally be based on naturally occurring activities and be user-centred perhaps created by the user and the facilitator(s) together after a period of observation of a play activity, a social activity, an educational activity, etc. - indeed, any activity that:
C is routine;
C is structured - such that it is possible to predict the vocabulary that is likely to occur in future sessions;
C is reasonably frequent;
C involves interaction and thus creates opportunities for communication;
C enjoyed by the user;
The vocabulary chosen for the Cooking script consisted of the following 19 words: stove, biscuits, in, out, roll, open, playdough, on, off, ready, pan, look, candle, apron, Joanne, Lisa, cut, eat, and more. (IACONO T. & DUNCUM J. 1995)
A limited single word script has some advantages:
C it is suitable for users operating at low cognitive and linguistic levels;
C work can begin at the single word utterance level;
C it can help to develop syntax skills (movement to a two word level);
C the words learnt may be more readily generalizable to other situations (See KIM Y. & LOMBARDINO L. 1991);
C scripts can provide a means by which vocabulary is selected (IACONO T. & DUNCUM J. 1995);
C staff are presented with a limited vocabulary of signs or symbols to learn and thus can develop sign and symbol skills alongside the user;
C when symbols are used, they can be displayed on a single overlay;
C symbols and signs can be displayed as a wall chart / poster in the environment in which will be used and are likely to spontaneously occur aiding the learning of others.
C because such scripts are used repeatedly in a predictive fashion they can tend to lessen the cognitive load on any individual (See CONSTABLE C. 1986);
Some of the above are also applicable to sentence-based scripts. Sentence based scripts may have other potential advantages. They may be better suited to developing turn-taking skills rather than syntax for example. There is no hard and fast rule which says that scripts must be either sentence or words based, they could (and probably should) include both. For work on scripting the reader may like to refer to the following books, articles and papers: CONSTABLE C. 1986; FEY M. 1986; GLENNEN S. 1986; NELSON K. 1986; KIM Y. & LOMBARDINO L. 1991; ELDER P. 1992; SPECK J. & McGUINNESS R. 1992; ELDER P. & GOOSSENS C. 1993; IACONO T. & DUNCUM J. 1995
TECHNIQUES 10 - Role play to real play
Role play may differ to the structured approach of scripting in that the user is free to decide on the choice of phrase or words involved. The facilitator may have taught a section of the vocabulary involving drinks for example. The users can role play asking for a drink at a café or a shop, with the facilitator or another user as the barman or shop assistant. Any scenario can be used reflecting the vocabulary taught to date. Role play situations should be followed by real play situations as some users may not generalise the work in the classroom to other areas of their daily life when the users are confident with the vocabulary taught and the various aspects of the situation being studied. It is better that role play should use real life situations as soon as possible without being too threatening to the individuals concerned. If possible, the use of the canteen or any other place where drinks are served to learn the drink names and to enact ‘asking for a drink’ is a better strategy than learning drink names in isolation in the communication room.
Drama departments are extremely useful to the facilitator in the area of role play. Users can now have a speaking role in school or college or amateur dramatic productions (See FRUMKIN J. 1986; SALTER W. & CLEMENTS N. 1988; CARNEY R. 1995 a & b).
The user ability to role play depends on a number of factors. The user must:
C have available the necessary vocabulary suited to the role;
C comprehend the situation in which s/he is to be placed. Thus, to begin with, familiar situation which the user encounters daily are a better choice than abstract learning in the communication area or infrequent and unfamiliar situations (like a trip to the zoo);
C comprehend the vocabulary that will be needed in the situation chosen;
C know how to access the vocabulary on the AAC system.
This requires careful preparation. The target area should ideally be specified fairly precisely, that is not ‘entering a café’ rather ‘entering a café to buy a drink’. The choice of drinks available may also be specified ‑ ‘Entering a café to buy a cup of tea or coffee’. The person playing the assistant (this may be another user) might have a list of available drinks on the wall (if users are pre‑literate, this could be a picture list ‑ start saving magazine cuttings now) or a selection of bottles and cans of drinks on the counter from which the buyer may choose (start collecting empty drink cans now) At first, there is little wrong in prompting the user, but try to avoid parroting. That is, do not tell the user exactly what to say, but gradually prompt the user in the choice of phrase through careful questioning and/or light cueing or pointing to selected areas of the communication system. Prompting should be faded and should be as little intrusive as possible. Allow the user time to think and to respond:
AHello Sir. What would you like to drink?” NO RESPONSE
AWhich would you like?” NO RESPONSE
AYou can have any of these” SIGNING ‘WHICH’
OVER THE RANGE
OF DRINKS
NO RESPONSE
ACan you tell me the name of the drink?” SIGNING ‘NAME’
NO RESPONSE
ALet’s see. You could have a coke, or an orange, or a lemonade. Which would you like?”
NO RESPONSE
AWould you like a coke, POINTING TO COKE
or an orange, or POINTING TO ORANGE
some lemonade?” POINT TO LEMONADE
(user responds) .... Acoke”..
The user has deliberately been made non‑cooperative in responding to the assistant’s questions. It is unlikely that the facilitator would have to go to such lengths to elicit a response from any user. However, in order to illustrate the technique involved the user has been given a very passive character!
The follow up stage, is to transfer from role play to real life. Try to make this as non-threatening as possible. To continue with the drinks scenario, an objective may require that the user is able to ask for a drink during the break period. When the user is comfortable and has been successful in role play then transfer can take place to the real play situation (if it hasn't already happened). I f possible the staff involved in the real play situation should have been involved in the role play. However, in the real world this isn’t always possible. In this instance, the staff will need to be prepared and are encouraged to use phrases similar to those used during role play:
AWhat would you like to drink David?”
It is highly unlikely that staff will have to go to the lengths detailed above if the proper ground work has been done in the role play situation. The vast majority of users will be keen to demonstrate their new found augmented communication skills. Given this scenario is successful, the next stage may be a trip out for a coke. If this involves large numbers of users choose a quiet day and prepare by contacting the establishment first. Managers are generally extremely helpful and may even set up a special till where the users do not feel pressurised.
CASE STUDY: A group of users visited McDonald’s on several occasions. Initially, at the request of the facilitator, a waitress came to the group and took individual orders. On a subsequent trip, a special till was set up and users went to the counter to ask for their orders. Finally, no special arrangements were made, the users did as everyone else does, queue and order.
The reward (for both facilitator and user) comes when a user is able to go out on his or her own and is successful in obtaining a meal and a drink.
Some people may argue that the ideas set out above are contrived and thus do not represent the real world to the user. This is true. However, when I am learning to do something, generally I like to make my first attempts in private, on my own or with close friends, where my bumblings and my mistakes are not annoying or, worse still, the source of amusement to anyone else. Personally, I feel happier moving forward in this way.
Drama departments are extremely useful to the facilitator in the area of role play. Users can now have a speaking role in school or college or amateur dramatic productions (See FRUMKIN J. 1986; SALTER W. & CLEMENTS N. 1988; CARNEY R. 1995 a & b).
The user ability to role play depends on a number of factors. The user must:
C have available the necessary vocabulary suited to the role;
C comprehend the situation in which s/he is to be placed. Thus, to begin with, familiar situation which the user encounters daily are a better choice than abstract learning in the communication area or infrequent and unfamiliar situations (like a trip to the zoo);
C comprehend the vocabulary that will be needed in the situation chosen;
C know how to access the vocabulary on the AAC system.
This requires careful preparation. The target area should ideally be specified fairly precisely, that is not ‘entering a café’ rather ‘entering a café to buy a drink’. The choice of drinks available may also be specified ‑ ‘Entering a café to buy a cup of tea or coffee’. The person playing the assistant (this may be another user) might have a list of available drinks on the wall (if users are pre‑literate, this could be a picture list ‑ start saving magazine cuttings now) or a selection of bottles and cans of drinks on the counter from which the buyer may choose (start collecting empty drink cans now) At first, there is little wrong in prompting the user, but try to avoid parroting. That is, do not tell the user exactly what to say, but gradually prompt the user in the choice of phrase through careful questioning and/or light cueing or pointing to selected areas of the communication system. Prompting should be faded and should be as little intrusive as possible. Allow the user time to think and to respond:
AHello Sir. What would you like to drink?” NO RESPONSE
AWhich would you like?” NO RESPONSE
AYou can have any of these” SIGNING ‘WHICH’
OVER THE RANGE
OF DRINKS
NO RESPONSE
ACan you tell me the name of the drink?” SIGNING ‘NAME’
NO RESPONSE
ALet’s see. You could have a coke, or an orange, or a lemonade. Which would you like?”
NO RESPONSE
AWould you like a coke, POINTING TO COKE
or an orange, or POINTING TO ORANGE
some lemonade?” POINT TO LEMONADE
(user responds) .... Acoke”..
The user has deliberately been made non‑cooperative in responding to the assistant’s questions. It is unlikely that the facilitator would have to go to such lengths to elicit a response from any user. However, in order to illustrate the technique involved the user has been given a very passive character!
The follow up stage, is to transfer from role play to real life. Try to make this as non-threatening as possible. To continue with the drinks scenario, an objective may require that the user is able to ask for a drink during the break period. When the user is comfortable and has been successful in role play then transfer can take place to the real play situation (if it hasn't already happened). I f possible the staff involved in the real play situation should have been involved in the role play. However, in the real world this isn’t always possible. In this instance, the staff will need to be prepared and are encouraged to use phrases similar to those used during role play:
AWhat would you like to drink David?”
It is highly unlikely that staff will have to go to the lengths detailed above if the proper ground work has been done in the role play situation. The vast majority of users will be keen to demonstrate their new found augmented communication skills. Given this scenario is successful, the next stage may be a trip out for a coke. If this involves large numbers of users choose a quiet day and prepare by contacting the establishment first. Managers are generally extremely helpful and may even set up a special till where the users do not feel pressurised.
CASE STUDY: A group of users visited McDonald’s on several occasions. Initially, at the request of the facilitator, a waitress came to the group and took individual orders. On a subsequent trip, a special till was set up and users went to the counter to ask for their orders. Finally, no special arrangements were made, the users did as everyone else does, queue and order.
The reward (for both facilitator and user) comes when a user is able to go out on his or her own and is successful in obtaining a meal and a drink.
Some people may argue that the ideas set out above are contrived and thus do not represent the real world to the user. This is true. However, when I am learning to do something, generally I like to make my first attempts in private, on my own or with close friends, where my bumblings and my mistakes are not annoying or, worse still, the source of amusement to anyone else. Personally, I feel happier moving forward in this way.
TECHNIQUES 11 - Creative asininity
Bruner (1983) referred to a technique which he called ‘scaffolding’. This involves the selective modification of a person’s environment to promote the use of language and encourage participation in communication interactions which, without the use of such a technique, would probably fail to occur.
According to Bruner, children acquire language through social interactions scaffolded by more expert communicators than themselves (LETTO M., BEDROSIAN J., & SKARAKIS-DOYLE E. 1994)
Letto et al. (LETTO M., BEDROSIAN J., & SKARAKIS-DOYLE E. 1994) traced the roots of Bruner’s scaffolding theory to the Russian psychologist Vygotsky’s (VYGOTSKY L. S. 1978) notion of the ‘zone of proximal development’:
The ZPD involves the difference between the child’s actual level of development as determined by independent performance and the child’s potential level of development accomplished through collaborative interaction with the more skilled partner. (LETTO M., BEDROSIAN J., & SKARAKIS-DOYLE E. 1994)
One of Vygotsky’s main contributions to educational theory is a concept termed the ‘zone of proximal development’. This he used to refer to the ‘gap’ that exists for an individual between what he is able to do alone and what he can achieve with help from one more knowledgeable or skilled than himself. (WOOD D. 1988)
The mother (facilitator) must always be a step ahead, in what Vygotsky calls the Azone of proximal development”; the infant (learner) cannot move into, or conceive of, the next stage ahead except through its being occupied and communicated to him by his mother (facilitator) (SACKS O. 1989)(My additions in brackets in italics)
This idea is related to Wittgenstein’s notion of the ‘language game’ (WITTGENSTEIN L. 1953) and to De Saussure’s F. M. (DE SAUSSURE F. M. 1916) pioneering work (See also PEARS D. 1971, KENNY A. 1973, CULLER J. 1976, HARRIS R. 1988, McGUINNESS B. 1988). This section and some of the subsequent sections concentrate on specific ideas related to Wittgenstein’s ‘language game’(WITTGENSTEIN L. 1953), Vygotsky’s ‘Zone of proximal development’(VYGOTSKY L. S. 1978), and Bruner’s ‘scaffolding’(BRUNER J. S. 1983). The first of these ideas is known as Creative Asininity.
Creative Asininity is a term first used by Ashworth and Jones (ASHWORTH S. & JONES A.P. 1989) in a paper on Initiation Management. It was used to describe an intervention strategy which employs environmental engineering, inventive language usage, cognitive management, and Creative Asininity to maximise communication.
Initiation Management is a technique in which users are placed in a managed situation where the emphasis is on communication. This fundamentally differs to scripting (see GLENNEN S. 1986) because there is no prepared script for the user, although some variations of scripting may have many similar elements (see ELDER P. & GOOSSENS C. 1993). The environment is carefully engineered to encourage spontaneous utterances of more than a single word. The user is not aware of being stage managed. Creative Asininity refers to a technique where the facilitator (or other) deliberately obstructs any easy unaided route to the user’s goal and forces the extensive use of speech.
Examples will help to make ‘Initiation Management’ and ‘Creative Asininity’ clearer:
The facilitator holds up a book and asks a user to go and get one from a nearby room:
AJohn, will you go to [Mrs. Accomplice] and get me one of these, please?” (POINTING TO BOOK)
The facilitator is careful not to name the object nor to state its attributes. Mrs. Accomplice is, of course, primed. On a shelf in her room, out of reach, are several books of different colours and sizes. The user has to ask for the book. Mrs. Accomplice can be as helpful or unhelpful in this task as is required. If the user points to the book Mrs. Accomplice can make use of creative asininity to block this unaided strategy:
ASorry, my eyes aren’t too good today, and I’ve not got my glasses. Can you tell me what you want?”
(A better technique is not to have the books on view.)
She may prompt the user on the choice of colour and size or alternatively allow an incorrect choice to be made. If the user returns with a book that is not the same colour as the book shown, the facilitator can request a return visit clarifying the user’s mistake:
ANo not quite John. Look at my book. Now look at the book you have brought. Do you think you can get me a book that is the same colour?”
If the establishment has a small shop the user might be asked to purchase something:
ASally, I’m very busy. Could you get me a can of coke from the shop? Here’s the money.”
The shop keeper should have been primed so as to negate the possibility of Sally pointing at the desired item. The environment is engineered so the particular item is not on display. If Sally attempts to sign the word then the shop keeper can use Creative Asininity to negate this route:
AErr, I don’t sign. Sorry”
or:
ASorry Sally, I’ve got a headache and my eyes are hurting. My signing is not too good today. What is it you want?”
And, if Sally were to use her communication board and not her voice output communication aid (Please note that is not my intent to devalue or denigrate the use of communication boards but, in the instance where the goal is to get Sally to use her voice output communication aid) the shop keeper could again use Creative Asininity:
AI can’t see what you are pointing to from here but I can hear you. Can you tell me?”
or:
AI’m really too busy to stop and watch what you are doing right now Sally but, if you speak, I can continue with what I’m doing.”
Although the user may have to make repeated journeys to succeed in bringing back the desired item, failure is not a consideration. Contingency plans are built into every Initiation Management situation such that the amount of help given is proportional to the number of journeys made.
An additional (and rather more complex) example of Initiation Management requires three members of staff and a piece of cake. Member of staff A keeps a user back after class on a pretence. A has a piece of cake on a plate which she or he is about to eat. At that moment staff member B pops into the room and says there is an urgent phone call for A. A leaves the room with B but asks the user to mind the cake. The user is thus left alone in charge of the cake. Then member of staff C comes into the room. C sits down in front of the user and says AAh! A piece of cake”, and picks it up pretending to be about to take a bite. However, C holds back from actually biting into the cake, stopping just short of this act and engages the user in conversation, starting to tell the user about a busy day or some other irrelevance. C’s job is to keep raising the cake as if to eat, but then stopping short, to carry on the conversation. A predetermined time is set before C actually eats the cake. If the user does not initiate conversation to stop C eating the cake in this time then C eats the cake and leaves the room. However, this is not the end of the matter. A returns from the phone call at this point and blames the user for eating the cake. The user is expected to explain the situation.
Initiation Management fosters communication. The user is unaware that the situation is engineered and responses are monitored for later review. Much useful insight into the minds of users can be gleaned. There are many situations that can be easily created. The number is limited only by the imagination.
There are some prerequisites for any person in an initiation management situation:
C the user must be capable of using appropriate vocabulary;
C the user must be able to comprehend your request;
C Mrs. Accomplice must be primed;
C contingency plans covering all eventualities should be laid down in advance;
C results should be recorded and evaluated.
The cartoon depicts an example of the use of Creative Asininity which was used to motivate a student at a college:
CASE STUDY: Student X is 17 and loves swimming. It was decided that on the day he was to go swimming to modify the routine slightly! Instead of taking a right turn at a T-junction in the college corridor towards the swimming pool, the carer would make a left turn. The objective was for X to say that they were going away from swimming and not towards it. A list was made of the acceptable vocabulary which would be allowable as a remedy to this situation. The team made sure X knew this range of words. Contingency plans were laid down. If X did not make any sign of responding to the change in the routine, the carer would prompt at a certain point:
(At the top of the college drive, just outside, in a puzzled tone)
AWell, I’m completely lost now. I don’t know where I should have taken you. My mind is all confused today.”
If this did not bring about the desired response, then the next prompt would be:
AIt’s no good, you’ll have to help me. Where should we be going. I think it should be either cooking, swimming, life skills, or is it numeracy?”
In the event, no sooner had the carer turned in the wrong direct than X said clearly ASwim”
This case study highlights another technique which may be used to initiate communication: Create anomaly.
According to Bruner, children acquire language through social interactions scaffolded by more expert communicators than themselves (LETTO M., BEDROSIAN J., & SKARAKIS-DOYLE E. 1994)
Letto et al. (LETTO M., BEDROSIAN J., & SKARAKIS-DOYLE E. 1994) traced the roots of Bruner’s scaffolding theory to the Russian psychologist Vygotsky’s (VYGOTSKY L. S. 1978) notion of the ‘zone of proximal development’:
The ZPD involves the difference between the child’s actual level of development as determined by independent performance and the child’s potential level of development accomplished through collaborative interaction with the more skilled partner. (LETTO M., BEDROSIAN J., & SKARAKIS-DOYLE E. 1994)
One of Vygotsky’s main contributions to educational theory is a concept termed the ‘zone of proximal development’. This he used to refer to the ‘gap’ that exists for an individual between what he is able to do alone and what he can achieve with help from one more knowledgeable or skilled than himself. (WOOD D. 1988)
The mother (facilitator) must always be a step ahead, in what Vygotsky calls the Azone of proximal development”; the infant (learner) cannot move into, or conceive of, the next stage ahead except through its being occupied and communicated to him by his mother (facilitator) (SACKS O. 1989)(My additions in brackets in italics)
This idea is related to Wittgenstein’s notion of the ‘language game’ (WITTGENSTEIN L. 1953) and to De Saussure’s F. M. (DE SAUSSURE F. M. 1916) pioneering work (See also PEARS D. 1971, KENNY A. 1973, CULLER J. 1976, HARRIS R. 1988, McGUINNESS B. 1988). This section and some of the subsequent sections concentrate on specific ideas related to Wittgenstein’s ‘language game’(WITTGENSTEIN L. 1953), Vygotsky’s ‘Zone of proximal development’(VYGOTSKY L. S. 1978), and Bruner’s ‘scaffolding’(BRUNER J. S. 1983). The first of these ideas is known as Creative Asininity.
Creative Asininity is a term first used by Ashworth and Jones (ASHWORTH S. & JONES A.P. 1989) in a paper on Initiation Management. It was used to describe an intervention strategy which employs environmental engineering, inventive language usage, cognitive management, and Creative Asininity to maximise communication.
Initiation Management is a technique in which users are placed in a managed situation where the emphasis is on communication. This fundamentally differs to scripting (see GLENNEN S. 1986) because there is no prepared script for the user, although some variations of scripting may have many similar elements (see ELDER P. & GOOSSENS C. 1993). The environment is carefully engineered to encourage spontaneous utterances of more than a single word. The user is not aware of being stage managed. Creative Asininity refers to a technique where the facilitator (or other) deliberately obstructs any easy unaided route to the user’s goal and forces the extensive use of speech.
Examples will help to make ‘Initiation Management’ and ‘Creative Asininity’ clearer:
The facilitator holds up a book and asks a user to go and get one from a nearby room:
AJohn, will you go to [Mrs. Accomplice] and get me one of these, please?” (POINTING TO BOOK)
The facilitator is careful not to name the object nor to state its attributes. Mrs. Accomplice is, of course, primed. On a shelf in her room, out of reach, are several books of different colours and sizes. The user has to ask for the book. Mrs. Accomplice can be as helpful or unhelpful in this task as is required. If the user points to the book Mrs. Accomplice can make use of creative asininity to block this unaided strategy:
ASorry, my eyes aren’t too good today, and I’ve not got my glasses. Can you tell me what you want?”
(A better technique is not to have the books on view.)
She may prompt the user on the choice of colour and size or alternatively allow an incorrect choice to be made. If the user returns with a book that is not the same colour as the book shown, the facilitator can request a return visit clarifying the user’s mistake:
ANo not quite John. Look at my book. Now look at the book you have brought. Do you think you can get me a book that is the same colour?”
If the establishment has a small shop the user might be asked to purchase something:
ASally, I’m very busy. Could you get me a can of coke from the shop? Here’s the money.”
The shop keeper should have been primed so as to negate the possibility of Sally pointing at the desired item. The environment is engineered so the particular item is not on display. If Sally attempts to sign the word then the shop keeper can use Creative Asininity to negate this route:
AErr, I don’t sign. Sorry”
or:
ASorry Sally, I’ve got a headache and my eyes are hurting. My signing is not too good today. What is it you want?”
And, if Sally were to use her communication board and not her voice output communication aid (Please note that is not my intent to devalue or denigrate the use of communication boards but, in the instance where the goal is to get Sally to use her voice output communication aid) the shop keeper could again use Creative Asininity:
AI can’t see what you are pointing to from here but I can hear you. Can you tell me?”
or:
AI’m really too busy to stop and watch what you are doing right now Sally but, if you speak, I can continue with what I’m doing.”
Although the user may have to make repeated journeys to succeed in bringing back the desired item, failure is not a consideration. Contingency plans are built into every Initiation Management situation such that the amount of help given is proportional to the number of journeys made.
An additional (and rather more complex) example of Initiation Management requires three members of staff and a piece of cake. Member of staff A keeps a user back after class on a pretence. A has a piece of cake on a plate which she or he is about to eat. At that moment staff member B pops into the room and says there is an urgent phone call for A. A leaves the room with B but asks the user to mind the cake. The user is thus left alone in charge of the cake. Then member of staff C comes into the room. C sits down in front of the user and says AAh! A piece of cake”, and picks it up pretending to be about to take a bite. However, C holds back from actually biting into the cake, stopping just short of this act and engages the user in conversation, starting to tell the user about a busy day or some other irrelevance. C’s job is to keep raising the cake as if to eat, but then stopping short, to carry on the conversation. A predetermined time is set before C actually eats the cake. If the user does not initiate conversation to stop C eating the cake in this time then C eats the cake and leaves the room. However, this is not the end of the matter. A returns from the phone call at this point and blames the user for eating the cake. The user is expected to explain the situation.
Initiation Management fosters communication. The user is unaware that the situation is engineered and responses are monitored for later review. Much useful insight into the minds of users can be gleaned. There are many situations that can be easily created. The number is limited only by the imagination.
There are some prerequisites for any person in an initiation management situation:
C the user must be capable of using appropriate vocabulary;
C the user must be able to comprehend your request;
C Mrs. Accomplice must be primed;
C contingency plans covering all eventualities should be laid down in advance;
C results should be recorded and evaluated.
The cartoon depicts an example of the use of Creative Asininity which was used to motivate a student at a college:
CASE STUDY: Student X is 17 and loves swimming. It was decided that on the day he was to go swimming to modify the routine slightly! Instead of taking a right turn at a T-junction in the college corridor towards the swimming pool, the carer would make a left turn. The objective was for X to say that they were going away from swimming and not towards it. A list was made of the acceptable vocabulary which would be allowable as a remedy to this situation. The team made sure X knew this range of words. Contingency plans were laid down. If X did not make any sign of responding to the change in the routine, the carer would prompt at a certain point:
(At the top of the college drive, just outside, in a puzzled tone)
AWell, I’m completely lost now. I don’t know where I should have taken you. My mind is all confused today.”
If this did not bring about the desired response, then the next prompt would be:
AIt’s no good, you’ll have to help me. Where should we be going. I think it should be either cooking, swimming, life skills, or is it numeracy?”
In the event, no sooner had the carer turned in the wrong direct than X said clearly ASwim”
This case study highlights another technique which may be used to initiate communication: Create anomaly.
TECHNIQUES 12 - Create anomaly in the routine
Creating natural opportunities for teaching learners spontaneously to request spoons is straightforward - applesauce is provided without a spoon (REICHLE J. & SIGAFOOS J. 1991 p. 159)
An easy way of creating the desire to communicate is to create anomaly in the routine. The cartoon suggests one such idea, leaving the milk or the sugar out of a person’s drink to see if they will complain. Another idea is to forget the straw. If the user creates a fuss but does not use his or her system then Creative Asininity can be brought into play:
AWhat on Earth’s the matter Sam. You’ve got your drink, just they way you like it. Now get on and drink it there’s a good fellow.”
AStraw? Oh dear! Oh silly me! A straw you say. I am silly forgetting to put a straw in. Must be old age.”
Anomaly may involve doing something differently that has always previously been carried out in the same routine manner:
CASE STUDY: A speech professional was fed up with her group of adult head injured clients because they would not initiate. Then she had an idea. The next time she had a group session she arrived in her wedding dress complete with veil.
CASE STUDY: To get his group to comment a tutor went into class without his trousers in just his jockey pants.
CASE STUDY: A Speech Professional decided to create a situation in which her therapy group would want to comment. She arrived with a plastic pig firmly stuck to her forehead. However, she was called out to answer the telephone and forgot that she had the pig still in place. Some of the other staff thought she had succumbed to the pressures of the job!
Strategies include:
C changing the way something is done;
C changing the furniture around;
C changing the order;
C doing something strange to an item in the room (television upside-down);
C doing something odd or amusing;
C forgetting to do something;
C giving something to the wrong person;
C missing someone out;
C making something that the augmented communicator normally finds easy to do hard to do - a door doesn’t open, a TV won’t switch on. Reichle, Anderson, and Schermer (1986) fixed a twist tie on a bread bag so that it was really difficult to undo and Kouri (1988) placed items out of reach as well as screwing a jar lid on very tightly in order to increase the possibility of spontaneous requests for help.
Creating anomaly then, may involve deliberately manipulating the environment to increase user potential for spontaneous communication:
Items were placed out of subjects’ direct reach and routine activities interfered with (e.g. a lid was screwed on too tight for subject to open) in order to elicit spoken or gestural requests which were then reinforced by the clinician’s compliance. (KOURI T. 1988)
The environment can be arranged in ways that optimize the probability that the learner will make requests spontaneously. The learner’s propensity to make requests spontaneously may depend on the interaction between conditions imposed by the environment and the learner’s state at any particular point in time. (REICHLE J. & SIGAFOOS J. 1991 p. 160)
Adolescents and adults who are moderately or severely developmentally delayed and use AAC systems often do not readily recognize opportunities to communicate. the normally occurring environmental events may not be salient enough for individuals who have learned to be passive participants and passive communicators. For these individuals sabotage routines may prove beneficial. When the AAC user is already familiar with the action sequences of an activity, sabotage routines are powerful techniques to facilitate message generation. (ELDER P. & GOOSSENS C. 1993 page 41)
Preparation is essential. To make comment using the signs or symbols for the items involved the user must have been taught the necessary vocabulary (although, as we shall see in Techniques 13, the anomaly may be used as an opportunity to teach the vocabulary). A checklist of acceptable words and phrases is required to measure the user’s response. If a word or phrase from the list is uttered then the situation is resolved. In some situations (going in full wedding dress for example) almost any comment is welcome.
Create anomaly!
An easy way of creating the desire to communicate is to create anomaly in the routine. The cartoon suggests one such idea, leaving the milk or the sugar out of a person’s drink to see if they will complain. Another idea is to forget the straw. If the user creates a fuss but does not use his or her system then Creative Asininity can be brought into play:
AWhat on Earth’s the matter Sam. You’ve got your drink, just they way you like it. Now get on and drink it there’s a good fellow.”
AStraw? Oh dear! Oh silly me! A straw you say. I am silly forgetting to put a straw in. Must be old age.”
Anomaly may involve doing something differently that has always previously been carried out in the same routine manner:
CASE STUDY: A speech professional was fed up with her group of adult head injured clients because they would not initiate. Then she had an idea. The next time she had a group session she arrived in her wedding dress complete with veil.
CASE STUDY: To get his group to comment a tutor went into class without his trousers in just his jockey pants.
CASE STUDY: A Speech Professional decided to create a situation in which her therapy group would want to comment. She arrived with a plastic pig firmly stuck to her forehead. However, she was called out to answer the telephone and forgot that she had the pig still in place. Some of the other staff thought she had succumbed to the pressures of the job!
Strategies include:
C changing the way something is done;
C changing the furniture around;
C changing the order;
C doing something strange to an item in the room (television upside-down);
C doing something odd or amusing;
C forgetting to do something;
C giving something to the wrong person;
C missing someone out;
C making something that the augmented communicator normally finds easy to do hard to do - a door doesn’t open, a TV won’t switch on. Reichle, Anderson, and Schermer (1986) fixed a twist tie on a bread bag so that it was really difficult to undo and Kouri (1988) placed items out of reach as well as screwing a jar lid on very tightly in order to increase the possibility of spontaneous requests for help.
Creating anomaly then, may involve deliberately manipulating the environment to increase user potential for spontaneous communication:
Items were placed out of subjects’ direct reach and routine activities interfered with (e.g. a lid was screwed on too tight for subject to open) in order to elicit spoken or gestural requests which were then reinforced by the clinician’s compliance. (KOURI T. 1988)
The environment can be arranged in ways that optimize the probability that the learner will make requests spontaneously. The learner’s propensity to make requests spontaneously may depend on the interaction between conditions imposed by the environment and the learner’s state at any particular point in time. (REICHLE J. & SIGAFOOS J. 1991 p. 160)
Adolescents and adults who are moderately or severely developmentally delayed and use AAC systems often do not readily recognize opportunities to communicate. the normally occurring environmental events may not be salient enough for individuals who have learned to be passive participants and passive communicators. For these individuals sabotage routines may prove beneficial. When the AAC user is already familiar with the action sequences of an activity, sabotage routines are powerful techniques to facilitate message generation. (ELDER P. & GOOSSENS C. 1993 page 41)
Preparation is essential. To make comment using the signs or symbols for the items involved the user must have been taught the necessary vocabulary (although, as we shall see in Techniques 13, the anomaly may be used as an opportunity to teach the vocabulary). A checklist of acceptable words and phrases is required to measure the user’s response. If a word or phrase from the list is uttered then the situation is resolved. In some situations (going in full wedding dress for example) almost any comment is welcome.
Create anomaly!
TECHNIQUES 13 - Choices, choices, choices
The ability to make choices is another critical building block of communication. (BEUKELMAN D. & MIRENDA P. 1992 page 185)
Everything that happens during the day is a teaching opportunity. At lunchtime the children are not just eating lunch or even learning to feed themselves. They are learning to make choices of what they want to eat - they will all go up to the serving hatch, and if possible, indicate what they want to eat. They are learning anything from how to pour a drink to table manners and social interaction. (THOMAS P. 1992)
Further, few communication demands may be made of these students in their daily routine, little reinforcement for spontaneous communication may occur, and rare opportunities for making choices and peer interaction exist that can provide salient opportunities for communication (HAMILTON B. & SNELL M. 1993)(My italics)
I have lived for the past 30 years in a nursing home. It has been awful. All of my choices have been taken from me. I have been treated like a helpless baby. I want to choose the people I live with and make my own decisions in directing my life (LF in BRYEN D. N., SLESARANSKY G., & BAKER D. B. 1995, p. 85)
There is a growing amount of information which supports the notion that providing choice is a positive step for people with disabilities (SHEVIN M. & KLEIN N. 1984; DATTILO J. & RUSCH F. 1985; GUESS D., BENSON H., & SIEGEL-CAUSEY E. 1985; DATTILO J. & MIRENDA P. 1987; BANNERMAN D., SHELDON J., SHERMAN J., & HARCHIK A. 1990; DYER K., DUNLAP G., & WINTERLING V. 1990; PARSONS M. & REID D. 1990; REID D. & PARSONS M. 1991; DUNLAP G., KERN-DUNLAP L., CLARKE S., & ROBBINS F. 1991; NEWTON J., HORNER R., & LUND L. 1991; VAUGHN B. & HORNER R. 1995). While the choices given in the cartoon are a little over the top, it does make the point that choice promotes communication (PECK C. 1985; HARING T., NEETZ J., LOVINGER L., PECK C., & SEMMEL M. 1987). Furthermore, it has been shown that the provision of choices can reduce frustration and decrease problem behaviours in some individuals (DYER K., DUNLAP G., & WINTERLING V. 1990; BROWN F. 1991; DOSS S. & REICHLE J. 1991; DUNLAP G., KERN-DUNLAP L., CLARKE S., & ROBBINS F. 1991; DUNLAP G. & KERN L. 1993; VAUGHN B. & HORNER R. 1995). Choices should be given as often as possible:
AThe red one or the white one?”
AThe jumper or the jacket?”
ARegular or diet coke?”
AOne lump or two?”
Augmented communicators may be able to generate a choice from their system without prompting and without understanding the words involved. Making a choice does not guarantee comprehension:
AEthnomethodology or phenomenology?”
AErr phenomenology. I think!”
Thus, the verbal choice prompt when given alone can be ineffective with some people. However, more positive results have been obtained when individual choice was made through the use of symbols (SCHULER A. & BALDWIN M. 1981; MIRENDA P. 1985; MIRENDA P. & SCHULER A. 1989; BEUKELMAN D. & MIRENDA P. 1992; VAUGHN B. & HORNER R. 1995). However, it should not be assumed that a choice selected from a set of symbols or pictures necessarily equates with comprehension. If a person is tasked to choose from a set of six photographs of drinks at a mid-morning break and the person eye points to tea it does not necessarily follow that he or she:
C understands the concept of drink;
C understands the concept of tea;
C has made a conscious decision to take tea during break.
Likewise, after a choice has been prompted and a choice has been made, it does not follow that staff have:
C understood the chooser’s intent in selecting a particular symbol;
C read the chooser’s pointing correctly;
C checked that the choice was intended.
A car indicating to turn right does not mean that the car will turn right or that the cars indicators are working. It only means that the car’s indicators are flashing on the right side. They may be broken and continually flashing; the driver may have hit the indicators by accident; the driver may be intending to turn left but is signalling right by mistake. Likewise a person tasked as above may appear to be making the correct moves but selection does not guarantee comprehension of the task or specify a desired outcome. The person may have accidentally been assumed to have selected one of the pictures when looking at the board; selected the wrong picture by mistake; or realised that some pointing was required and pointed at random to please the member of staff concerned.
Consider what you might do given these rather strange events occurred. You are out walking at night alone and suddenly a light appears in the sky. An alien ship! You are captured and put into a room. After a while a creature approaches making strange alien sounds. The creature holds up a board divided into six segments. In each segment is a strange symbol. The creature moves a part of its body over the board and makes more strange noises. What does it want and what do you do? Staff may wish to put themselves into the position of the captured person and then into the position of the alien. How can the alien make its intent clear? Indeed, can it make its intent clear at all?
If a person normally has tea in the morning, staff may assume he or she is eye pointing to the tea symbol without actually checking and provide a drink of tea. Further, given a board displaying six drink symbols it is impossible for a person to make an incorrect choice as all the choices provided are drinks and therefore equally valid. Thus, the very act of pointing guarantees a ‘correct’ choice which the person may passively drink or refuse as though he or she has had a change of mind. This notion is reviewed later in this manual in the section on monitoring (See MONITORING 5).
Build choice into the routine. Indeed make choice routine: the daily menu; the drinks trolley; the route to school (or the route home if time is pressing in the mornings); TV programme (or TV Channel); game to play; thing to do next; where to go for holiday; what to buy next at the supermarket.
It may be argued that an increase in choice also means an increase in demands made on staff duties and staff time. It may but as it can also increase user understanding and decrease user frustration it may be found that, in the long run, that time is actually saved and relationships between staff and the people they are working with are improved. Even if the provision of choice does increase staff time the questions must be asked:
C Why are we working with people with disabilities and speech impairment?
C What does the word ‘special’ in ‘special education’ mean?
C What does the word ‘individual’ in ‘individual education’ mean?
At least in part, an answer to these questions is that staff working with special needs have the flexibility, the desire, and the time to help. It does not follow, however, that choice should always take priority over situational demands. Giving choices to children at ten to nine in the morning, when they must be in school in five minutes, is a recipe for disaster.
CASE STUDY: M was dressed every morning by his two carers. They did not give him a choice of clothing. They made the selections on his behalf and dressed him as quickly as possible. His communication tutor thought it would be a good idea to provide him with the vocabulary to make choices of clothing. M was taught these vocabulary items over the next two weeks. When the tutor went to see how M was getting along with his new morning vocabulary he was dismayed to find that the routine was still the same. M was given no choice. The staff concerned could hardly be blamed as they had several students to get up, washed, toiletted, dressed, and finally fed before the commencement of lessons at 9.00 am. In order to allow M to make his choice of clothing he would have had to be got out of bed naked, placed in his chair, the VOCA removed from charge and fitted to his chair, and the necessary symbols choices made. This wasn’t going to speed things up in the morning. The care team really wanted to help but were pushed to the limit already. The situation was resolved by M instructing the night care team to lay out his desired choice of clothes for the morning the night before when time wasn’t an issue.
Choices that can not or will not be fulfilled should be avoided:
‘Want to go to the supermarket or Moscow?’
‘Moscow’
‘Oh! I didn’t think you’d say that!’
Remember:
CHOOSY PEOPLE CHOOSE CHOICE!
Everything that happens during the day is a teaching opportunity. At lunchtime the children are not just eating lunch or even learning to feed themselves. They are learning to make choices of what they want to eat - they will all go up to the serving hatch, and if possible, indicate what they want to eat. They are learning anything from how to pour a drink to table manners and social interaction. (THOMAS P. 1992)
Further, few communication demands may be made of these students in their daily routine, little reinforcement for spontaneous communication may occur, and rare opportunities for making choices and peer interaction exist that can provide salient opportunities for communication (HAMILTON B. & SNELL M. 1993)(My italics)
I have lived for the past 30 years in a nursing home. It has been awful. All of my choices have been taken from me. I have been treated like a helpless baby. I want to choose the people I live with and make my own decisions in directing my life (LF in BRYEN D. N., SLESARANSKY G., & BAKER D. B. 1995, p. 85)
There is a growing amount of information which supports the notion that providing choice is a positive step for people with disabilities (SHEVIN M. & KLEIN N. 1984; DATTILO J. & RUSCH F. 1985; GUESS D., BENSON H., & SIEGEL-CAUSEY E. 1985; DATTILO J. & MIRENDA P. 1987; BANNERMAN D., SHELDON J., SHERMAN J., & HARCHIK A. 1990; DYER K., DUNLAP G., & WINTERLING V. 1990; PARSONS M. & REID D. 1990; REID D. & PARSONS M. 1991; DUNLAP G., KERN-DUNLAP L., CLARKE S., & ROBBINS F. 1991; NEWTON J., HORNER R., & LUND L. 1991; VAUGHN B. & HORNER R. 1995). While the choices given in the cartoon are a little over the top, it does make the point that choice promotes communication (PECK C. 1985; HARING T., NEETZ J., LOVINGER L., PECK C., & SEMMEL M. 1987). Furthermore, it has been shown that the provision of choices can reduce frustration and decrease problem behaviours in some individuals (DYER K., DUNLAP G., & WINTERLING V. 1990; BROWN F. 1991; DOSS S. & REICHLE J. 1991; DUNLAP G., KERN-DUNLAP L., CLARKE S., & ROBBINS F. 1991; DUNLAP G. & KERN L. 1993; VAUGHN B. & HORNER R. 1995). Choices should be given as often as possible:
AThe red one or the white one?”
AThe jumper or the jacket?”
ARegular or diet coke?”
AOne lump or two?”
Augmented communicators may be able to generate a choice from their system without prompting and without understanding the words involved. Making a choice does not guarantee comprehension:
AEthnomethodology or phenomenology?”
AErr phenomenology. I think!”
Thus, the verbal choice prompt when given alone can be ineffective with some people. However, more positive results have been obtained when individual choice was made through the use of symbols (SCHULER A. & BALDWIN M. 1981; MIRENDA P. 1985; MIRENDA P. & SCHULER A. 1989; BEUKELMAN D. & MIRENDA P. 1992; VAUGHN B. & HORNER R. 1995). However, it should not be assumed that a choice selected from a set of symbols or pictures necessarily equates with comprehension. If a person is tasked to choose from a set of six photographs of drinks at a mid-morning break and the person eye points to tea it does not necessarily follow that he or she:
C understands the concept of drink;
C understands the concept of tea;
C has made a conscious decision to take tea during break.
Likewise, after a choice has been prompted and a choice has been made, it does not follow that staff have:
C understood the chooser’s intent in selecting a particular symbol;
C read the chooser’s pointing correctly;
C checked that the choice was intended.
A car indicating to turn right does not mean that the car will turn right or that the cars indicators are working. It only means that the car’s indicators are flashing on the right side. They may be broken and continually flashing; the driver may have hit the indicators by accident; the driver may be intending to turn left but is signalling right by mistake. Likewise a person tasked as above may appear to be making the correct moves but selection does not guarantee comprehension of the task or specify a desired outcome. The person may have accidentally been assumed to have selected one of the pictures when looking at the board; selected the wrong picture by mistake; or realised that some pointing was required and pointed at random to please the member of staff concerned.
Consider what you might do given these rather strange events occurred. You are out walking at night alone and suddenly a light appears in the sky. An alien ship! You are captured and put into a room. After a while a creature approaches making strange alien sounds. The creature holds up a board divided into six segments. In each segment is a strange symbol. The creature moves a part of its body over the board and makes more strange noises. What does it want and what do you do? Staff may wish to put themselves into the position of the captured person and then into the position of the alien. How can the alien make its intent clear? Indeed, can it make its intent clear at all?
If a person normally has tea in the morning, staff may assume he or she is eye pointing to the tea symbol without actually checking and provide a drink of tea. Further, given a board displaying six drink symbols it is impossible for a person to make an incorrect choice as all the choices provided are drinks and therefore equally valid. Thus, the very act of pointing guarantees a ‘correct’ choice which the person may passively drink or refuse as though he or she has had a change of mind. This notion is reviewed later in this manual in the section on monitoring (See MONITORING 5).
Build choice into the routine. Indeed make choice routine: the daily menu; the drinks trolley; the route to school (or the route home if time is pressing in the mornings); TV programme (or TV Channel); game to play; thing to do next; where to go for holiday; what to buy next at the supermarket.
It may be argued that an increase in choice also means an increase in demands made on staff duties and staff time. It may but as it can also increase user understanding and decrease user frustration it may be found that, in the long run, that time is actually saved and relationships between staff and the people they are working with are improved. Even if the provision of choice does increase staff time the questions must be asked:
C Why are we working with people with disabilities and speech impairment?
C What does the word ‘special’ in ‘special education’ mean?
C What does the word ‘individual’ in ‘individual education’ mean?
At least in part, an answer to these questions is that staff working with special needs have the flexibility, the desire, and the time to help. It does not follow, however, that choice should always take priority over situational demands. Giving choices to children at ten to nine in the morning, when they must be in school in five minutes, is a recipe for disaster.
CASE STUDY: M was dressed every morning by his two carers. They did not give him a choice of clothing. They made the selections on his behalf and dressed him as quickly as possible. His communication tutor thought it would be a good idea to provide him with the vocabulary to make choices of clothing. M was taught these vocabulary items over the next two weeks. When the tutor went to see how M was getting along with his new morning vocabulary he was dismayed to find that the routine was still the same. M was given no choice. The staff concerned could hardly be blamed as they had several students to get up, washed, toiletted, dressed, and finally fed before the commencement of lessons at 9.00 am. In order to allow M to make his choice of clothing he would have had to be got out of bed naked, placed in his chair, the VOCA removed from charge and fitted to his chair, and the necessary symbols choices made. This wasn’t going to speed things up in the morning. The care team really wanted to help but were pushed to the limit already. The situation was resolved by M instructing the night care team to lay out his desired choice of clothes for the morning the night before when time wasn’t an issue.
Choices that can not or will not be fulfilled should be avoided:
‘Want to go to the supermarket or Moscow?’
‘Moscow’
‘Oh! I didn’t think you’d say that!’
Remember:
CHOOSY PEOPLE CHOOSE CHOICE!
TECHNIQUES 14 - Forget to remember or remember to forget
Another simple technique is to forget to remember a word or item of vocabulary which you expect the augmented communicator to fill in. Forget an important item from a shopping list:
AI know there’s something I meant to get but I can’t think what it is.”
Of course, the individual must be primed before the trip:
ASally, don’t let me forget to buy some more coffee, will you?”
However, if you ‘forget’ the coffee and Sally does not react to the above prompt, what then? Take Sally near to the aisle where the coffee is stacked and provide some verbal cues:
AI know there’s something I need. Oh dear, I wish I could remember!”
Although this should be fun, it also should be taken seriously. If Sally fails to remind you then you must leave the store without buying coffee. There is no point in remembering if you set up a situation in which you decide to forget. Sally will learn that if she says nothing you will always remember anyway. If you remember the coffee there is no consequence to Sally’s forgetting. Actions (in this case inactions) must have consequences. Go home and then remember. Tell Sally she forgot to remind you:
ASally! I know what it was I forgot. The coffee! Why didn’t you remind me?”
The question is how far to take this. Do we now pretend that there is no coffee for the rest of the family to drink or do we say that there is enough left for a day or two until we can get to the shops again? The latter is probably a better solution!
AI’ll have to go to the supermarket on Wednesday when I’m in town again and buy some more coffee as we are a bit low. So go steady on the coffee everyone. Sally was supposed to have reminded me to get some more today, but we both forgot!”
Initially, prompts should be near to the event:
Just inside the supermarket: ASally, don’t forget to remind me
to get some coffee will you?”
The following week:
Just outside the supermarket: ASally, I need some biscuits.
Remind me will you?”
The next week:
At home, before going to the supermarket: ASally ......”
The suggestion is to engineer a situation in which a word or item which the user knows is forgotten. Use of the tip-of-the-tongue phenomenon is another effective tactic:
AWe were walking through the park and we saw whatshisname with a thingy! Oh me and my memory. What do I mean Sally?”
A further idea is to say the wrong thing (as in the cartoon)(for example, substitute an incorrect though appropriate word in the place of another - paraphasia) about something that has happened that day to allow for you to be corrected:
AWe were walking through the park and we bumped into Bert. He was taking his cat for a walk” (it should have been dog)
Obviously the person who is listening to this conversation must be in on the act or they may make a correction before the user has a chance to make a comment. They may help by prompting the user to make the correction:
AWell fancy taking a cat for a walk!”
The correct word should be contained on the user’s AAC system otherwise the exercise is pointless (although a person may be able to state there has been a mistake without being directly able to say what the mistake was).
AI know there’s something I meant to get but I can’t think what it is.”
Of course, the individual must be primed before the trip:
ASally, don’t let me forget to buy some more coffee, will you?”
However, if you ‘forget’ the coffee and Sally does not react to the above prompt, what then? Take Sally near to the aisle where the coffee is stacked and provide some verbal cues:
AI know there’s something I need. Oh dear, I wish I could remember!”
Although this should be fun, it also should be taken seriously. If Sally fails to remind you then you must leave the store without buying coffee. There is no point in remembering if you set up a situation in which you decide to forget. Sally will learn that if she says nothing you will always remember anyway. If you remember the coffee there is no consequence to Sally’s forgetting. Actions (in this case inactions) must have consequences. Go home and then remember. Tell Sally she forgot to remind you:
ASally! I know what it was I forgot. The coffee! Why didn’t you remind me?”
The question is how far to take this. Do we now pretend that there is no coffee for the rest of the family to drink or do we say that there is enough left for a day or two until we can get to the shops again? The latter is probably a better solution!
AI’ll have to go to the supermarket on Wednesday when I’m in town again and buy some more coffee as we are a bit low. So go steady on the coffee everyone. Sally was supposed to have reminded me to get some more today, but we both forgot!”
Initially, prompts should be near to the event:
Just inside the supermarket: ASally, don’t forget to remind me
to get some coffee will you?”
The following week:
Just outside the supermarket: ASally, I need some biscuits.
Remind me will you?”
The next week:
At home, before going to the supermarket: ASally ......”
The suggestion is to engineer a situation in which a word or item which the user knows is forgotten. Use of the tip-of-the-tongue phenomenon is another effective tactic:
AWe were walking through the park and we saw whatshisname with a thingy! Oh me and my memory. What do I mean Sally?”
A further idea is to say the wrong thing (as in the cartoon)(for example, substitute an incorrect though appropriate word in the place of another - paraphasia) about something that has happened that day to allow for you to be corrected:
AWe were walking through the park and we bumped into Bert. He was taking his cat for a walk” (it should have been dog)
Obviously the person who is listening to this conversation must be in on the act or they may make a correction before the user has a chance to make a comment. They may help by prompting the user to make the correction:
AWell fancy taking a cat for a walk!”
The correct word should be contained on the user’s AAC system otherwise the exercise is pointless (although a person may be able to state there has been a mistake without being directly able to say what the mistake was).
TECHNIQUES 15 - Create a CHANCE to CHAT
The idea is pretty well summed up in what is an oft-retold story about a couple and their young boy. These parents were becoming more and more uneasy as time passed and their son spoke not one word. There seemed to be no reason why he wasn’t talking: he wasn’t deaf, and he seemed to be smart enough. But by the time he had reached the age of four and still hadn’t spoken, they began to get desperate. One morning when the whole family was seated at breakfast, he shocked them by saying loudly and clearly, AI didn’t get strawberries on my cereal.” Even in the midst of her delight and relief, his mother had the presence of mind to ask, AWhy have you never spoken before?” to which her son replied, clearly annoyed, AUp till now everything has been all right.” (INGRAM J. 1992)
The cartoon makes several points:
C a person is unlikely to communicate if there is nothing to communicate about;
C a person may not feel the need to speak if everything is provided without a requirement to communicate;
C a person may not initiate conversation if others do the talking for him/her in an intrusive manner;
C a person who feels insecure about communicating may choose to remain silent;
C modification of the environment can create a communicative opportunity in which an otherwise ‘silent’ individual is more likely to request clarification or assistance;
C lack of communication does not necessarily equate with an inability to communicate.
The focus of this section is the creation of such a non-threatening environment. It will seek to explore the possible strategies used to increase the likelihood of a person initiating communication and draws heavily on the work of Helen Cockerill at the Cheyne Centre in London (COCKERILL H. & HUME S. 1990; COCKERILL H. 1991, 1992, 1994; COCKERILL H. & BARNETT S. 1994). This, in turn, can be related, at least in part, to work by others (see for example - McCARTHY D. 1954; AXLINE V. 1964, 1989; BRICKER D. 1972; STREMEL-CAMPBELL K., CANTRELL D., & HALLE J. 1977; SALISBURY C., WAMBOLD C., & WALTER G. 1978; SCHAEFFER B. 1980; DANILOFF J. & SHAFER A. 1981; KARLAN G., BRENN-WHITE B., LENTZ A., HODUR P., EGGER D., & FRANKOFF D. 1982; PINNEY R. 1983 & 1990; KOURI T. 1988; NYGARD J. & PETERS V. 1990; McMAHON L. 1992; WEST J. 1992; WILSON K., KENDRICK P., & RYAN V. 1992; NIND M. & HEWETT D. 1994).
A study by Kouri (KOURI T. 1988) demonstrated that a signed or spoken symbols could be learned in a child-directed context. Five children with varying disabilities but demonstrating very limited communicative intent where allowed to free play in a stimulating environment. At every opportunity an accompanying clinician would both speak and sign usually one or two word comments related to either the objects with which the child was playing or the activity in which the child was engaged. Unlike Cockerill’s work (op. cit.), the clinicians were allowed to ask questions in order to encourage the child to make responses or to begin playing (AWhat’s that?”, Acan you fly the air plane”) but, other than in these instances, they did not attempt to verbally or physically direct the children. On some occasions they modified the environment to maximise the possibility of a child asking for assistance:
Items were placed out of subjects’ direct reach and routine activities interfered with (e.g. a lid was screwed on too tight for subject to open) in order to elicit spoken or gestural requests which were then reinforced by the clinician’s compliance. (KOURI T. 1988)
The procedure was modelled on the work of Wilcox (WILCOX M. 1984) and involved four basic components:
C the clinician focussed on the child’s activities and waited until appropriate moments to communicate;
C the communicative system used always involved speech accompanied by sign;
C the environment could be modified to maximise the opportunities for communicative interactions between child and clinician;
C no requirements were placed upon any child to respond to the clinician’s signs.
Kouri found that not only were the children able to learn signs that they were not directly taught (as in a formal instructional setting) but also that the childrens’ spontaneous use of language and their ability to interact with others increased:
This study demonstrated that signed and/or spoken symbols can be acquired by young children with various disabilities in a child-directed treatment setting. Furthermore, such an approach can favourably affect various parameters of children’s spontaneous language and sociocommunicative interaction (KOURI T. 1988)
Cockerill’s work in non-directive communication therapy (COCKERILL H. 1991, 1992, 1994) centres around the creation of ‘special times’: times in which control over play is passed to the child for a set period of time. The facilitator’s role is to provide a running commentary without interference:
She gives an interested commentary on what the child is doing at a language level appropriate to his age and understanding (COCKERILL H. 1992)
The facilitator does not seek to:
C direct the activity;
C make suggestions;
C direct the child’s attention;
C ask questions of the child;
C use judgmental language (nice, dirty, pretty, ...);
C joins in play unless the child requests it.
This ability to remain totally non-directive may require a lot of practice, but is fundamental to the technique. It is what makes Special Times different to other techniques. (COCKERILL H. 1992)
Special times require a special place: a place where the child can play freely, will be stimulated and free from obvious dangers. Of course a child cannot be allowed to do just as he or she pleases - there has to be limits if only because of the possible dangers that are involved with some activities to the child or to other children. In these instances the facilitator is instructed to say clearly and firmly, without anger or judgement, AI’m sorry I can’t let you do that”.
If the child is an augmented communicator then augmentative communication should be incorporated into the facilitator’s commentary if appropriate:
The playroom is labelled with symbols: each toy / activity has both a Blissymbol and a Rebus symbol near by. During the commentary the therapist will show the child the appropriate symbol (COCKERILL H. 1992)
The facilitator may choose to use the aided-language stimulation technique in non-directive therapy in line with the above criteria:
Aided language stimulation is a teaching strategy in which the facilitator highlights symbols on the user’s communication display as he or she interacts and communicates verbally with the user. In this manner, the user is ensured frequent models of interactive use, considered to be vital to learning to use an augmentative communication system .... interactively. Although highlighting can be achieved by using an index finger point, a light point tends to be more salient when working with young children and does not obliterate the user’s view of the symbol. (GOOSSENS C. 1991 page 47)
Non-directive communication therapy provide a non-threatening environment for a person to begin to use communication. Passive communicators are given control and may slowly begin to communicate using their augmentative system:
Children who adopt a passive role in communication rarely initiating and often labelled as ‘unmotivated’ in school, can develop a knowledge of their own ability to communicate through Special Times. Many children with cerebral palsy show such patterns of behaviour - they are used to having needs anticipated, and may have only a limited range of communicative signals which are easily missed by carers. In Special Times they will be forced into an initiating role, and the therapist will pick up even the smallest signals. Although the realisation of their power to influence the behaviour of an adult may come after a few sessions of very little happening, the change in behaviour is often very dramatic (COCKERILL H. 1992)
Non-directive (CAUGHT NOT TAUGHT) and directive (TAUGHT NOT CAUGHT) techniques can be used in conjunction (not at the same time!) to help an individual to begin to communicate . Together they are powerful facilitative tools. The augmented communicator who works well in class and seems to be learning an AAC system but does not initiate beyond the walls of the classroom may be helped by the Special Times technique above.
Note: Those interested in finding out more about this technique should contact the Cheyne Centre, 61 Cheyne Walk, Chelsea, London, SW3 5LT (Telephone 0181 846 6488) or Helen Cockerill (who has recently moved on from the Cheyne Centre) at The Newcomen Centre, Guys Hospital, St. Thomas Street, London SE1 9RT (Telephone 0171 955 5000 ext. 3862)
The cartoon makes several points:
C a person is unlikely to communicate if there is nothing to communicate about;
C a person may not feel the need to speak if everything is provided without a requirement to communicate;
C a person may not initiate conversation if others do the talking for him/her in an intrusive manner;
C a person who feels insecure about communicating may choose to remain silent;
C modification of the environment can create a communicative opportunity in which an otherwise ‘silent’ individual is more likely to request clarification or assistance;
C lack of communication does not necessarily equate with an inability to communicate.
The focus of this section is the creation of such a non-threatening environment. It will seek to explore the possible strategies used to increase the likelihood of a person initiating communication and draws heavily on the work of Helen Cockerill at the Cheyne Centre in London (COCKERILL H. & HUME S. 1990; COCKERILL H. 1991, 1992, 1994; COCKERILL H. & BARNETT S. 1994). This, in turn, can be related, at least in part, to work by others (see for example - McCARTHY D. 1954; AXLINE V. 1964, 1989; BRICKER D. 1972; STREMEL-CAMPBELL K., CANTRELL D., & HALLE J. 1977; SALISBURY C., WAMBOLD C., & WALTER G. 1978; SCHAEFFER B. 1980; DANILOFF J. & SHAFER A. 1981; KARLAN G., BRENN-WHITE B., LENTZ A., HODUR P., EGGER D., & FRANKOFF D. 1982; PINNEY R. 1983 & 1990; KOURI T. 1988; NYGARD J. & PETERS V. 1990; McMAHON L. 1992; WEST J. 1992; WILSON K., KENDRICK P., & RYAN V. 1992; NIND M. & HEWETT D. 1994).
A study by Kouri (KOURI T. 1988) demonstrated that a signed or spoken symbols could be learned in a child-directed context. Five children with varying disabilities but demonstrating very limited communicative intent where allowed to free play in a stimulating environment. At every opportunity an accompanying clinician would both speak and sign usually one or two word comments related to either the objects with which the child was playing or the activity in which the child was engaged. Unlike Cockerill’s work (op. cit.), the clinicians were allowed to ask questions in order to encourage the child to make responses or to begin playing (AWhat’s that?”, Acan you fly the air plane”) but, other than in these instances, they did not attempt to verbally or physically direct the children. On some occasions they modified the environment to maximise the possibility of a child asking for assistance:
Items were placed out of subjects’ direct reach and routine activities interfered with (e.g. a lid was screwed on too tight for subject to open) in order to elicit spoken or gestural requests which were then reinforced by the clinician’s compliance. (KOURI T. 1988)
The procedure was modelled on the work of Wilcox (WILCOX M. 1984) and involved four basic components:
C the clinician focussed on the child’s activities and waited until appropriate moments to communicate;
C the communicative system used always involved speech accompanied by sign;
C the environment could be modified to maximise the opportunities for communicative interactions between child and clinician;
C no requirements were placed upon any child to respond to the clinician’s signs.
Kouri found that not only were the children able to learn signs that they were not directly taught (as in a formal instructional setting) but also that the childrens’ spontaneous use of language and their ability to interact with others increased:
This study demonstrated that signed and/or spoken symbols can be acquired by young children with various disabilities in a child-directed treatment setting. Furthermore, such an approach can favourably affect various parameters of children’s spontaneous language and sociocommunicative interaction (KOURI T. 1988)
Cockerill’s work in non-directive communication therapy (COCKERILL H. 1991, 1992, 1994) centres around the creation of ‘special times’: times in which control over play is passed to the child for a set period of time. The facilitator’s role is to provide a running commentary without interference:
She gives an interested commentary on what the child is doing at a language level appropriate to his age and understanding (COCKERILL H. 1992)
The facilitator does not seek to:
C direct the activity;
C make suggestions;
C direct the child’s attention;
C ask questions of the child;
C use judgmental language (nice, dirty, pretty, ...);
C joins in play unless the child requests it.
This ability to remain totally non-directive may require a lot of practice, but is fundamental to the technique. It is what makes Special Times different to other techniques. (COCKERILL H. 1992)
Special times require a special place: a place where the child can play freely, will be stimulated and free from obvious dangers. Of course a child cannot be allowed to do just as he or she pleases - there has to be limits if only because of the possible dangers that are involved with some activities to the child or to other children. In these instances the facilitator is instructed to say clearly and firmly, without anger or judgement, AI’m sorry I can’t let you do that”.
If the child is an augmented communicator then augmentative communication should be incorporated into the facilitator’s commentary if appropriate:
The playroom is labelled with symbols: each toy / activity has both a Blissymbol and a Rebus symbol near by. During the commentary the therapist will show the child the appropriate symbol (COCKERILL H. 1992)
The facilitator may choose to use the aided-language stimulation technique in non-directive therapy in line with the above criteria:
Aided language stimulation is a teaching strategy in which the facilitator highlights symbols on the user’s communication display as he or she interacts and communicates verbally with the user. In this manner, the user is ensured frequent models of interactive use, considered to be vital to learning to use an augmentative communication system .... interactively. Although highlighting can be achieved by using an index finger point, a light point tends to be more salient when working with young children and does not obliterate the user’s view of the symbol. (GOOSSENS C. 1991 page 47)
Non-directive communication therapy provide a non-threatening environment for a person to begin to use communication. Passive communicators are given control and may slowly begin to communicate using their augmentative system:
Children who adopt a passive role in communication rarely initiating and often labelled as ‘unmotivated’ in school, can develop a knowledge of their own ability to communicate through Special Times. Many children with cerebral palsy show such patterns of behaviour - they are used to having needs anticipated, and may have only a limited range of communicative signals which are easily missed by carers. In Special Times they will be forced into an initiating role, and the therapist will pick up even the smallest signals. Although the realisation of their power to influence the behaviour of an adult may come after a few sessions of very little happening, the change in behaviour is often very dramatic (COCKERILL H. 1992)
Non-directive (CAUGHT NOT TAUGHT) and directive (TAUGHT NOT CAUGHT) techniques can be used in conjunction (not at the same time!) to help an individual to begin to communicate . Together they are powerful facilitative tools. The augmented communicator who works well in class and seems to be learning an AAC system but does not initiate beyond the walls of the classroom may be helped by the Special Times technique above.
Note: Those interested in finding out more about this technique should contact the Cheyne Centre, 61 Cheyne Walk, Chelsea, London, SW3 5LT (Telephone 0181 846 6488) or Helen Cockerill (who has recently moved on from the Cheyne Centre) at The Newcomen Centre, Guys Hospital, St. Thomas Street, London SE1 9RT (Telephone 0171 955 5000 ext. 3862)
TECHNIQUES 16 - It's your responsibility
A user needs to be made responsible in order to avoid the danger of passivity and to promote the desire to communicate. Responsibility comes in all shapes and sizes and the package designed should be specifically tailored to the needs of the individual. A few simple ideas for early responsibility are given below:
C Responsibility for the AAC system. The user should have easy access to specific phrases dealing with the AAC system itself: AMy system needs cleaning”; AMy system needs charging. Will you put it on charge tonight?”; AI need some new things in my system”; AI think my system has moved could you check the position?”; AMy system is loose could you tighten the fixing bracket please?”; AWill you put my system on I will need it in lessons”; and so on.
While it is irrelevant whether the individual can clean his or her own system (for example), it should not be cleaned as a matter of course by another but only on the individual’s instruction. In this manner, the individual is given the responsibility for instructing another if not the actual physical task itself. However, the examples above relate mainly to high tech systems but the user can also be made responsible to a communication board. A sticker on a wheelchair with the word ‘board’ on it can serve to remind significant others not to forget to put a user’s communication board in their bag when (eye) pointed to by the user. The board sticker can also be used to indicate to others that a user wants his/her board getting out of their bag in order to communicate further. Users who are physically able to pack their own communication boards will not need to ask another to do it for them but are still just as responsible for its transportation and its care.
C Responsibility for a wheelchair - cleaning and charging, etc.
C Responsibility for reminding another of an event. An example of this has already been detailed (See techniques 14).
ARemind me to get some coffee we are nearly out”
C Responsibility for data collection. An example of this might involve asking a user to collect daily data on the number and types of drinks required by other members of the class. Every morning the user has to ask each pupil what they want to drink at break. It is also the user’s responsibility to pass the results to a nominated staff member by a certain time. The monitor may involve a different child each week (or each term). Further, the results of the monitors efforts could be entered into a simple database on one of the computers in the classroom:
MONDAY
JUNE 12th
DRINKS DATABASE
NAME
Milk
Apple juice
Orange
Lemonade
Absent
Robert
T
Tracy
T
Dawn
T
This could lead to some interesting numeracy work:
How many people drank milk on Tuesday?
How many bottles of milk are drunk each week?
Who drank apple juice on Monday and orange juice on Wednesday?
How many litres of apple juice are drunk each week?
How much do you drink in a week?
C Responsibility for a classroom item - The TV set or a computer for example. It is a user’s duty to make sure it is put closed down and put away properly at the end of a school day for example. This may involve environmental control options as well as communication with others.
These and other ideas for responsibilities may lead to the frequent use and practise of communicative phrases. Responsibility often tends to be ongoing and thus provides facilitators continuing opportunities for fine tuning a user’s communicative abilities. As the nature of the communication involved in the responsibility tasks is repetitive, responsibility tasks are ideal for people with cognitive and developmental disabilities.
As the cartoon suggests, there are danger areas. People should not be made responsible for feeding animals (for example) as an animal cannot be left unfed if the user forgets or does not live up to the responsibility. In this instance there is a danger that a user will learn ‘if I don’t do it someone else will do it for me’ if another performs the task. Responsibility for tasks that involve some communication are better than those that don’t. Feeding animals does not necessarily involve communicating with others although it could be modified such that it does (asking a nominated person for the food for example).
C Responsibility for the AAC system. The user should have easy access to specific phrases dealing with the AAC system itself: AMy system needs cleaning”; AMy system needs charging. Will you put it on charge tonight?”; AI need some new things in my system”; AI think my system has moved could you check the position?”; AMy system is loose could you tighten the fixing bracket please?”; AWill you put my system on I will need it in lessons”; and so on.
While it is irrelevant whether the individual can clean his or her own system (for example), it should not be cleaned as a matter of course by another but only on the individual’s instruction. In this manner, the individual is given the responsibility for instructing another if not the actual physical task itself. However, the examples above relate mainly to high tech systems but the user can also be made responsible to a communication board. A sticker on a wheelchair with the word ‘board’ on it can serve to remind significant others not to forget to put a user’s communication board in their bag when (eye) pointed to by the user. The board sticker can also be used to indicate to others that a user wants his/her board getting out of their bag in order to communicate further. Users who are physically able to pack their own communication boards will not need to ask another to do it for them but are still just as responsible for its transportation and its care.
C Responsibility for a wheelchair - cleaning and charging, etc.
C Responsibility for reminding another of an event. An example of this has already been detailed (See techniques 14).
ARemind me to get some coffee we are nearly out”
C Responsibility for data collection. An example of this might involve asking a user to collect daily data on the number and types of drinks required by other members of the class. Every morning the user has to ask each pupil what they want to drink at break. It is also the user’s responsibility to pass the results to a nominated staff member by a certain time. The monitor may involve a different child each week (or each term). Further, the results of the monitors efforts could be entered into a simple database on one of the computers in the classroom:
MONDAY
JUNE 12th
DRINKS DATABASE
NAME
Milk
Apple juice
Orange
Lemonade
Absent
Robert
T
Tracy
T
Dawn
T
This could lead to some interesting numeracy work:
How many people drank milk on Tuesday?
How many bottles of milk are drunk each week?
Who drank apple juice on Monday and orange juice on Wednesday?
How many litres of apple juice are drunk each week?
How much do you drink in a week?
C Responsibility for a classroom item - The TV set or a computer for example. It is a user’s duty to make sure it is put closed down and put away properly at the end of a school day for example. This may involve environmental control options as well as communication with others.
These and other ideas for responsibilities may lead to the frequent use and practise of communicative phrases. Responsibility often tends to be ongoing and thus provides facilitators continuing opportunities for fine tuning a user’s communicative abilities. As the nature of the communication involved in the responsibility tasks is repetitive, responsibility tasks are ideal for people with cognitive and developmental disabilities.
As the cartoon suggests, there are danger areas. People should not be made responsible for feeding animals (for example) as an animal cannot be left unfed if the user forgets or does not live up to the responsibility. In this instance there is a danger that a user will learn ‘if I don’t do it someone else will do it for me’ if another performs the task. Responsibility for tasks that involve some communication are better than those that don’t. Feeding animals does not necessarily involve communicating with others although it could be modified such that it does (asking a nominated person for the food for example).
TECHNIQUES 17 - Electronic Talker Phone home
I often wonder about the effect of these one-way conversations on those at the other end of the line. I am overwhelmed by them. How dearly I would love to be able to respond with something other than silence to these tender calls. I know that some of them find it unbearable. Sweet Florence refuses to speak to me unless I first breathe noisily into the receiver which Sandrine holds glued to my ear. ‘Are you there, Jean-Do?’ she asks anxiously over the air. And I have to admit that at tomes I do not know any more. (BAUBY J. D. 1997)
This telephone technique necessarily relates to those people who possess a Voice Output Communication Aid, although low-tech users may also be able to hold a phone conversation if another person acts as a translator.
In a recent study by Sutton (SUTTON T. 1994), a majority of users said that one of the major differences the ability to use a VOCA had made to their lives was being able to use the phone. In the cartoon, Sally is phoning her mother at home and Mum is overwhelmed by her daughter’s new found ability. The telephone is an invaluable weapon in the facilitator’s armoury. It can help to promote:
C user abilities;
C user self-esteem;
C user awareness of the needs of a communication partner;
C turn taking skills;
C a significant other’s use of waiting;
C a significant other’s awareness of potential and ability;
C a skill necessary for many jobs.
Users who rely heavily on others’ awareness of their needs and others’ interpretation of contextual cues can be helped to improve their communication techniques by making telephone calls. Initially, the phone calls may be stage-managed internal calls to other members of staff, pupils or students or significant others. Sutton’s study (op.cit.) showed that the ability to use the phone is rated highly by augmented communicators and adds greatly to their self-esteem. This motivational aspect should not be overlooked in early tuition. Many aspects of a telephone conversation can be predicted and stored into a user’s system for easy retrieval. Social conversation (AHello”), and communication initiators (AHow are you?”) and terminators (AWell, I’ve got to go now”) may be taught in this way.
The use of the telephone temporarily restricts the use of body language and contextuality in conversation. For example, the signer can no longer sign (unless it is a video phone) and unaided and unvocalised yes or no responses are no longer appropriate. The user is forced into an awareness of the needs of the other. Skills learnt in this way may be generalised and the user made more aware of the needs of a communication partner who is ignorant of idiosyncratic gestures and other unaided techniques.
Turn taking is a feature of the average telephone conversation. I speak, you speak, then I speak again. Many users beginning to learn an augmentative communication system will have poor pragmatic awareness and must be taught such skills. The phone may help to promote simple turn taking conversational abilities. It has been noted (See LIGHT J. 1985, GLENNEN S. & CALCULATOR S. 1985, VON TETZCHNER S. & MARTINSEN H. 1992)( See also INTERACT 9) that in conversation significant others may not provide adequate time for an AAC user to respond. This may lead to a person’s failure to use a system in subsequent interactions. The telephone may help the significant other to see the necessity to wait and allow time for a user to respond.
The use of a telephone also has great benefit to any significant other who is uncommitted to (or unsure about) the use of a VOCA or has limited contact with progress because of a residential situation (for example). An uncommitted significant other may be gradually won over if user ability is frequently demonstrated using the phone. A technique is for the facilitator to rehearse a phone conversation with a user in the ‘safety’ of the communication room until the conversation runs smoothly. The facilitator then phones the user at home (or wherever the significant other(s) are uncommitted) and asks to speak to the user knowing that the significant other will have to facilitate the phone call by holding the phone. The ‘rehearsed’ conversation is then held. In this way the uncommitted significant other gets to see the ability of the augmented communicator and the power of the AAC system being used. If you are concerned that this is, in some way, ‘fooling’ the significant other involved, there is no need to hide the fact that the conversation has been rehearsed because the result is still the same.
An ability to use a telephone is a vital requirement for many occupations. A lack of opportunity to develop this skill denies the user a marketable skill (See the last section on WORK).
The use of a telephone by single switch scanning is possible:
CASE STUDY: X is a student from the Glasgow area. He is a single switch scanner on a VOCA. However, he frequently rings me to chat and to ask for further information about his system. Although slower than others who are direct selectors the conversation flows and is not painfully slow. X normally prepares the main point of his telephone call beforehand. However, we generally go on to talk about unprepared topics.
There are problems however, especially with those who are unfamiliar with AAC:
CASE STUDY: Z wanted to purchase a laptop computer for his work. He had the money but had specific system requirements and therefore needed to talk to manufacturers and suppliers regarding his needs. Although he had the phrase AI am using a communication aid to talk to you. Please be patient” stored in his system, five out of six firms contacted eventually hung up the phone on him. This was the same even when a friend explained the situation to the person answering the phone before passing them on to Z. Needless to say they lost his business.
This telephone technique necessarily relates to those people who possess a Voice Output Communication Aid, although low-tech users may also be able to hold a phone conversation if another person acts as a translator.
In a recent study by Sutton (SUTTON T. 1994), a majority of users said that one of the major differences the ability to use a VOCA had made to their lives was being able to use the phone. In the cartoon, Sally is phoning her mother at home and Mum is overwhelmed by her daughter’s new found ability. The telephone is an invaluable weapon in the facilitator’s armoury. It can help to promote:
C user abilities;
C user self-esteem;
C user awareness of the needs of a communication partner;
C turn taking skills;
C a significant other’s use of waiting;
C a significant other’s awareness of potential and ability;
C a skill necessary for many jobs.
Users who rely heavily on others’ awareness of their needs and others’ interpretation of contextual cues can be helped to improve their communication techniques by making telephone calls. Initially, the phone calls may be stage-managed internal calls to other members of staff, pupils or students or significant others. Sutton’s study (op.cit.) showed that the ability to use the phone is rated highly by augmented communicators and adds greatly to their self-esteem. This motivational aspect should not be overlooked in early tuition. Many aspects of a telephone conversation can be predicted and stored into a user’s system for easy retrieval. Social conversation (AHello”), and communication initiators (AHow are you?”) and terminators (AWell, I’ve got to go now”) may be taught in this way.
The use of the telephone temporarily restricts the use of body language and contextuality in conversation. For example, the signer can no longer sign (unless it is a video phone) and unaided and unvocalised yes or no responses are no longer appropriate. The user is forced into an awareness of the needs of the other. Skills learnt in this way may be generalised and the user made more aware of the needs of a communication partner who is ignorant of idiosyncratic gestures and other unaided techniques.
Turn taking is a feature of the average telephone conversation. I speak, you speak, then I speak again. Many users beginning to learn an augmentative communication system will have poor pragmatic awareness and must be taught such skills. The phone may help to promote simple turn taking conversational abilities. It has been noted (See LIGHT J. 1985, GLENNEN S. & CALCULATOR S. 1985, VON TETZCHNER S. & MARTINSEN H. 1992)( See also INTERACT 9) that in conversation significant others may not provide adequate time for an AAC user to respond. This may lead to a person’s failure to use a system in subsequent interactions. The telephone may help the significant other to see the necessity to wait and allow time for a user to respond.
The use of a telephone also has great benefit to any significant other who is uncommitted to (or unsure about) the use of a VOCA or has limited contact with progress because of a residential situation (for example). An uncommitted significant other may be gradually won over if user ability is frequently demonstrated using the phone. A technique is for the facilitator to rehearse a phone conversation with a user in the ‘safety’ of the communication room until the conversation runs smoothly. The facilitator then phones the user at home (or wherever the significant other(s) are uncommitted) and asks to speak to the user knowing that the significant other will have to facilitate the phone call by holding the phone. The ‘rehearsed’ conversation is then held. In this way the uncommitted significant other gets to see the ability of the augmented communicator and the power of the AAC system being used. If you are concerned that this is, in some way, ‘fooling’ the significant other involved, there is no need to hide the fact that the conversation has been rehearsed because the result is still the same.
An ability to use a telephone is a vital requirement for many occupations. A lack of opportunity to develop this skill denies the user a marketable skill (See the last section on WORK).
The use of a telephone by single switch scanning is possible:
CASE STUDY: X is a student from the Glasgow area. He is a single switch scanner on a VOCA. However, he frequently rings me to chat and to ask for further information about his system. Although slower than others who are direct selectors the conversation flows and is not painfully slow. X normally prepares the main point of his telephone call beforehand. However, we generally go on to talk about unprepared topics.
There are problems however, especially with those who are unfamiliar with AAC:
CASE STUDY: Z wanted to purchase a laptop computer for his work. He had the money but had specific system requirements and therefore needed to talk to manufacturers and suppliers regarding his needs. Although he had the phrase AI am using a communication aid to talk to you. Please be patient” stored in his system, five out of six firms contacted eventually hung up the phone on him. This was the same even when a friend explained the situation to the person answering the phone before passing them on to Z. Needless to say they lost his business.
TECHNIQUES 18 - Let your fingers do the talking
Habits are the daughters of action, but then they nurse their mother, and produce daughters after her image, but far more beautiful and prosperous. (TAYLOR J. 1651)
There are many activities for which the average person has to develop habituation (See BOWER T. 1977) or automaticity (See BADMAN A. 1994a, 1994b) of skills in order to be considered proficient: walking; driving; swimming; ball games; touch typing; and literacy (See NICHOLSON R. & FAWCETT A. 1989; MIRENDA P. & LINDSAY P. 1995) all spring to mind. The act of speaking also features high in this list. If we had consciously to think about the construction of each sentence (See AITCHISON J. 1994) or the pronunciation of each word before we uttered it we would surely be, at the very least, extremely disfluent and possibly even incomprehensible.
The development of automaticity may be aided by the following techniques:
C frequent frequently used vocabulary;
We remember what we meet and what we use everyday. We are more likely to become automatic in those actions we perform daily. Thus, users of AAC systems are more likely to become automatic on core vocabulary rather than on fringe vocabulary. Work with core vocabulary!
C practice and repetition;
In the USA there is hardly a house to be found that doesn’t have a basketball hoop fixed to its wall and a child practising the necessary skills to become proficient at the game. The same is true of soccer in the U.K. We think nothing of a child spending hundreds of hours in such practice. Touch typists require approximately 200 hours of practice. Why then is practice with an augmentative system so rarely seen?
C once seen never forgotten;
Allow the user to form a Gestalt of the entire symbol overlay. This may be aided by having larger versions of the overlay in places well frequented by the user: bedroom; classrooms; toilets and bathrooms; etc. This may also be aided by playing games ......
C games;
Variations on Kim’s game (amongst others) may prove useful in spatially orienting a user’s awareness of his or her symbol system or overlay. For example, play a game of which one is missing in which one symbol from a single row or column is removed after allowing the user to view the unaltered row for a few seconds or a memory game where the user has to state which symbol is under the Blissymbol for ‘I’.
C close your eyes;
Play a game where you ask the user to close his or her eyes and locate a particular symbol or say a word or a phrase.
C working in the dark;
When is working in the dark not working in the dark? When you have acquired automaticity! Switch off all lights including any on any electronic communication aid and resume talking!
C symbol simplification;
A complex symbol, once mastered may be simplified in some systems such that all that remains of the original symbol is its essence or characteristic. Some aspects of some symbol systems may be thought to be childish and, as a child develops automaticity or, at least, a comprehension of the symbols range of reference, the symbol may be redrawn in a much simpler and more acceptable form to an adult. For example: The hand reaching to pick an apple from the branch of a tree in the Minspeak Application Program ‘Language, Learning, and Living’ (JONES A.P. 1991) may be redrawn as the stylised outline of an apple.
C single symbol suspension;
It is possible to remove single symbols, one at a time, over a period of time, such that spatial reference is still provided by the adjacent symbols. In this way the user learns not to rely on the symbolic image but its spatial location and may develop intuitive navigational skills.
C multi-symbol suspension;
As suggested above, it is possible to remove a single symbol to promote the development of automaticity. Once the user is happy with the removal of one symbol a further symbol may be deleted. Symbol suspension is only a temporary measure to aid the development of the habituation of automatic processing skills. Symbols may be replaced if the system now proves too difficult for the user or the user has mastered automaticity.
C symbol system suspension;
Some users are able to maintain a conversation without the benefit of an overlay on their VOCA (See BAKER B. 1996a). This is the ideal state because it means that the user has achieved a level of transparency with the system akin to that achieved by touch typists with the qwerty keyboard. The user should then decide whether he or she wants the original overlay, a variation on the original overlay (a simplified form), or no overlay at all!
NOTE: Some of the above techniques may be more suited to voice output communication aids and some more suited to specific voice output communication aids than others. However, all system users may benefit to some extent through practice in the techniques of automaticity.
There are many activities for which the average person has to develop habituation (See BOWER T. 1977) or automaticity (See BADMAN A. 1994a, 1994b) of skills in order to be considered proficient: walking; driving; swimming; ball games; touch typing; and literacy (See NICHOLSON R. & FAWCETT A. 1989; MIRENDA P. & LINDSAY P. 1995) all spring to mind. The act of speaking also features high in this list. If we had consciously to think about the construction of each sentence (See AITCHISON J. 1994) or the pronunciation of each word before we uttered it we would surely be, at the very least, extremely disfluent and possibly even incomprehensible.
The development of automaticity may be aided by the following techniques:
C frequent frequently used vocabulary;
We remember what we meet and what we use everyday. We are more likely to become automatic in those actions we perform daily. Thus, users of AAC systems are more likely to become automatic on core vocabulary rather than on fringe vocabulary. Work with core vocabulary!
C practice and repetition;
In the USA there is hardly a house to be found that doesn’t have a basketball hoop fixed to its wall and a child practising the necessary skills to become proficient at the game. The same is true of soccer in the U.K. We think nothing of a child spending hundreds of hours in such practice. Touch typists require approximately 200 hours of practice. Why then is practice with an augmentative system so rarely seen?
C once seen never forgotten;
Allow the user to form a Gestalt of the entire symbol overlay. This may be aided by having larger versions of the overlay in places well frequented by the user: bedroom; classrooms; toilets and bathrooms; etc. This may also be aided by playing games ......
C games;
Variations on Kim’s game (amongst others) may prove useful in spatially orienting a user’s awareness of his or her symbol system or overlay. For example, play a game of which one is missing in which one symbol from a single row or column is removed after allowing the user to view the unaltered row for a few seconds or a memory game where the user has to state which symbol is under the Blissymbol for ‘I’.
C close your eyes;
Play a game where you ask the user to close his or her eyes and locate a particular symbol or say a word or a phrase.
C working in the dark;
When is working in the dark not working in the dark? When you have acquired automaticity! Switch off all lights including any on any electronic communication aid and resume talking!
C symbol simplification;
A complex symbol, once mastered may be simplified in some systems such that all that remains of the original symbol is its essence or characteristic. Some aspects of some symbol systems may be thought to be childish and, as a child develops automaticity or, at least, a comprehension of the symbols range of reference, the symbol may be redrawn in a much simpler and more acceptable form to an adult. For example: The hand reaching to pick an apple from the branch of a tree in the Minspeak Application Program ‘Language, Learning, and Living’ (JONES A.P. 1991) may be redrawn as the stylised outline of an apple.
C single symbol suspension;
It is possible to remove single symbols, one at a time, over a period of time, such that spatial reference is still provided by the adjacent symbols. In this way the user learns not to rely on the symbolic image but its spatial location and may develop intuitive navigational skills.
C multi-symbol suspension;
As suggested above, it is possible to remove a single symbol to promote the development of automaticity. Once the user is happy with the removal of one symbol a further symbol may be deleted. Symbol suspension is only a temporary measure to aid the development of the habituation of automatic processing skills. Symbols may be replaced if the system now proves too difficult for the user or the user has mastered automaticity.
C symbol system suspension;
Some users are able to maintain a conversation without the benefit of an overlay on their VOCA (See BAKER B. 1996a). This is the ideal state because it means that the user has achieved a level of transparency with the system akin to that achieved by touch typists with the qwerty keyboard. The user should then decide whether he or she wants the original overlay, a variation on the original overlay (a simplified form), or no overlay at all!
NOTE: Some of the above techniques may be more suited to voice output communication aids and some more suited to specific voice output communication aids than others. However, all system users may benefit to some extent through practice in the techniques of automaticity.
TECHNIQUES 19 - Enforcing spontaneous communication
Do not make the learning or the teaching of communication skills a chore. Caroline Musselwhite at a conference in England (MUSSELWHITE C. 1993) told of her two minute rule:
If something takes longer than two minutes to perform people will not do it.
Not that she was criticising the people working in special education, far from it. Rather, she was stating that people are generally very busy. If you have to stop what you are doing to prepare an item for an individual then there are others left waiting. If the whole task takes less than two minutes it is more likely that it will be done. If it takes longer, it is less likely.
The Musselwhite rule rules OK?
You may attempt to force people to communicate, you may also attempt to force others to help you. However, it will probably be unpleasant for you, the user, and the significant others involved. Who wants to work in an atmosphere like that? There is no need for any aspect of learning or teaching AAC to become a chore. If it has, it is not being correctly implemented:
C keep tasks simple;
C keep objectives specific;
C use task analysis;
C do not compound the problem by adding other problems;
C delegate responsibility;
C facilitate a team effort.
Above all ...... Make it fun!
You must avoid the danger of making the game into an exercise or letting it become a chore either for you or the child. This often hinders rather than helps the child’s learning, and can be very wearing on your patience. (JEFFREE D. & McCONKEY R. 1976)
If something takes longer than two minutes to perform people will not do it.
Not that she was criticising the people working in special education, far from it. Rather, she was stating that people are generally very busy. If you have to stop what you are doing to prepare an item for an individual then there are others left waiting. If the whole task takes less than two minutes it is more likely that it will be done. If it takes longer, it is less likely.
The Musselwhite rule rules OK?
You may attempt to force people to communicate, you may also attempt to force others to help you. However, it will probably be unpleasant for you, the user, and the significant others involved. Who wants to work in an atmosphere like that? There is no need for any aspect of learning or teaching AAC to become a chore. If it has, it is not being correctly implemented:
C keep tasks simple;
C keep objectives specific;
C use task analysis;
C do not compound the problem by adding other problems;
C delegate responsibility;
C facilitate a team effort.
Above all ...... Make it fun!
You must avoid the danger of making the game into an exercise or letting it become a chore either for you or the child. This often hinders rather than helps the child’s learning, and can be very wearing on your patience. (JEFFREE D. & McCONKEY R. 1976)
TECHNIQUES 20 - Make it fun
One of Sue’s most fundamental signals, and the basis of her style of celebrating his behaviour, is that she is really having a good time. She is not pretending to have fun for his sake, she isn’t shaping and styling her behaviour purely for his benefit, she is literally, unequivocally, unashamedly having a great time and indulging her own needs for enjoyment. (NIND M. & HEWETT D. 1994 page 49)
If it is not fun for you or it is not fun for the user or for both of you, then:
C it will not be successful;
C something is wrong.
In computer-speak:
IF NOT FUN YOU OR NOT FUN USER THEN GOTO CHANGE STRATEGY
Mr. Jolly has got the balance about right. Be a little crazy, a little creative, a little over the top! Above all .....
Have fun!
Answers to cryptic crossword clues: 1) Rabbit (hidden word)
2) Tragedy (anagram)
3) Pump-kin
If it is not fun for you or it is not fun for the user or for both of you, then:
C it will not be successful;
C something is wrong.
In computer-speak:
IF NOT FUN YOU OR NOT FUN USER THEN GOTO CHANGE STRATEGY
Mr. Jolly has got the balance about right. Be a little crazy, a little creative, a little over the top! Above all .....
Have fun!
Answers to cryptic crossword clues: 1) Rabbit (hidden word)
2) Tragedy (anagram)
3) Pump-kin