A Study in Augmentative Communication in Distance Learning
JA is an eighth-grade student who is both verbal and uses augmentative communication. He is diagnosed with autism and presents with significant sensory needs and a mixed receptive-expressive language disorder. He thrives on a written schedule, visual prompts, and consistency. When his routines are altered, he can become very upset, which often leads to negative behaviors. JA is a kind and sensitive teenager who needs reassurance, consistency, and intellectual stimulation to be an effective communicator and participant in teletherapy.
His verbalizations are sufficient for basic requests and needs, but other communicative functions are difficult for him to access verbally. He uses the app Proloquo4Text to communicate in addition to his verbalizations. With this augmentative and alternative communication (AAC) app, he is able to use pre-programmed phrases, a full keyboard with word prediction, and quick phrases. Within this customized robust app, personalized messages have been programmed to allow for quick communication. He also uses the Zones of Regulation curriculum to communicate his feelings. These emotions are programmed by color in his talker for quick access.
Transition to Distance Learning:
I spoke with his mother at length about triggers that lead to negative behaviors. JA has had previous virtual sessions with other therapists that ended with negative behaviors (aggression). His mother was very apprehensive about moving forward with any more virtual sessions.
I have been working with JA for approximately two years, so I already have an established rapport with both JA and his mother. I discussed how the sessions will run differently from JA’s previous virtual sessions. The most important way that they would be different is that we needed JA’s consent. Also, he would be given choices throughout the session to improve overall motivation. If JA did not give consent to have the meeting, the clinician would work only with his mother in a parent coaching session. So far, JA has chosen to participate in each session, with his mother present.
During conversations with his mother, we reviewed motivating activities that he can do, not that he can’t do. Due to the current pandemic, JA is not allowed to go to restaurants, shop in stores, etc. He thrives on these activities and when they’re discussed, it triggers negative behaviors. These topics need to be avoided. Activities need to incorporate and target writing, expanding vocabulary and communication, while focusing on motivating activities that can be completed safely during the pandemic (e.g., baking, going to the drive-through, visiting his country house, etc.).
Learning goals
To improve overall communication via verbalizations and/or AAC communication system to access a variety of communicative functions, including:
Expressing emotions
Retelling stories
Asking questions
Clarifying communication breakdowns via AAC
Expressing actions (finish, stop, keep working)
Engage in a two- to three-turn conversation
Following directions
Sequencing
Writing and speaking in more grammatically correct sentences
Transition to distance learning
Activities
Face to Face
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Reading age-appropriate books about community activities
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Reading age-appropriate stories about hotels
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Using apps about community and vocational activities
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Playing physical games (dominoes, bingo, Uno)
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Having conversations about recent events during the day
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Checking in about emotions
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Sensory activities as breaks
At a Distance
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Using Clicker Writer software with remote control access via Zoom to create sentences about his week/weekend (sentence sets, Cloze docs)
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Using EDpuzzle with videos about restaurants with drive-throughs, cooking activities, baking activities
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Using online coloring pages for break time
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Using check-in visual available through LessonPix to check on emotional state. When he says “feel green,” the clinician continues the session (green means, happy ready to learn).
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Using screen mirror of Proloquo4Text when needed
Materials
Face to Face
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Learning to Work book (Attainment Company)
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Focus on Feelings book (Attainment Company)
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Social Success app (Attainment Company)
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Community Success app (Attainment Company)
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Uno cards
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Board games
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Swing for sensory breaks
At a Distance
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Zoom account to allow for screen share, annotation, and remote control access
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Subscription to LessonPix
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PowerPoint for links of activities and check-in visual
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Online access to a free coloring page site
Strategies
Face to Face
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Movement breaks (would walk for a break)
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Written schedule
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Sensory breaks when needed
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Check-in about emotional state
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Prompts and modeling as needed
At a Distance
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Written schedule on PowerPoint
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Coloring as a break
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Check-in with visual of Zones of Regulation
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Having Mom to support student
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Consistent positive reinforcement
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Prompts and modeling as needed
What worked well
Overall, the sessions have gone well. I think the success of the sessions was due in part to my being sensitive to JA’s needs and getting him involved in the process of being an active participant. I also think that structure, knowing technology well, and visual check-ins have helped immensely. I’m in contact with his mother twice a week before sessions to check in about what they’ve done over the past few days and to find out about any activity that has been motivating. For example, if he’d like to make cupcakes this week, we’ll work on “making cupcakes” and incorporate language goals into the activity. I’m also doing increasing check-ins with JA to make sure he’s feeling OK about continuing. He knows that he can stop if he wants to, and that makes a big difference.
I was surprised by
I was most surprised about how well we transitioned into virtual therapy. Based on his negative experience with virtual sessions in the past, I was anticipating that our sessions would be more difficult. Our sessions have been productive, and seeing him smiling on my computer while he completes the activities successfully makes me feel so happy and proud of him.
Next time I’ll try
Based on how he feels that particular day, I’ll challenge him more with repairing communication breakdowns via his AAC system. Often, when he isn’t heard, his mother will translate for him. Over time, I want him to be more independent, repairing communication with fewer prompts.
My big picture takeaways
Teletherapy can be very successful for students with complex communication needs and behavioral challenges. Being empathetic, knowing how to use technology quickly and efficiently, and having appropriate activities are key. When we can’t use technology in an efficient way, our students get frustrated. It’s important to set up your tabs and test out activities before trying them in the session. I also think collaboration with parents is absolutely necessary for success. We’re a team with the same goal!
With regard to materials and activities, I have found several private telepractice groups for speech-language pathologists that have been a wonderful resource. Join them and check out what everyone else is doing. You’ll get many good ideas and you can also share your own. I have also invested a lot of time in creating personalized materials for my students, as well as attending webinars to learn about new software programs.