What does Presuming Competence Really Mean?

Presuming competence means that we as communication partners assume that the communicator is capable of learning to communicate and build language. They may not have the capabilities now. But we believe that they can gain communication and language skills with the right support. So, we interact with them as we would with any other individual of similar age. 

What Assumptions are We Making?

Maybe I’ll hand him/her a simple AAC system because they may not do well with a robust system

When Professor Anne Donnellan in 1984 introduced the concept of presuming competence, she talked about making the least dangerous assumptions about individuals with disabilities when we don’t have enough data. 

This is why we provide an user with a robust AAC system. And model appropriate language without expectation.This is considered to be the best and safe approach

The alternative to this will be to provide a simple system with fewer vocabulary. Assuming that a robust system is considered too complex for the user holds back their communication and language development. This is detrimental to the user’s progress.

No Prerequisites, No Proof 

It’s common practice to expect the user to demonstrate some prerequisite skills. Interventionists can look for a good understanding of language, communicative intent, attention, and motivation to communicate before handing a robust AAC. 

But can a communicator really demonstrate their potential when they lack the means to do so?

Expecting individuals to prove their skills and earn their right to a robust AAC system is unreasonable.

Mary-Louise Bertram , a special educator, argued that if we provide the same learning environment and opportunities and experiences that typical kids require to develop language, and if we provide quality instruction and create access to appropriate technology, kids having complex communication needs can access language.

Putting Presume Competence into Practice

Here are a few simple ways in which we can practise presuming competence with our communicators –

1. Make AAC Available 

Let’s presume that the child has a lot to say and will communicate when they have a means to do it. 

Develop new habits such as  always having  the AAC device close by. Have the app in another device(like your phone, if possible) and have low tech versions of their vocabulary  ready so that they have multiple modes to communicate. 

2. Don’t Infantilize AAC Users

Let’s presume that they are capable of comprehending new concepts. 

Choose language and communication activities and materials that are age appropriate. Be age respectful. Remember that the activities should also fit in with their interests.

3. Pause and be Patient

Let’s presume they are going to respond and let’s pause expectantly.

Let’s presume that if we are persistent and patient, we can see progress.

Communication is hard work for many AAC users. Let’s make it easier for them by

• Giving extra time to process the information you say
• Giving them adequate time to respond.
• Taking time everyday to practise AAC. 
• Never trying to interpret what they are trying to tell us 

4. Know When to Step In and Step Back

Let’s presume that they are capable of doing better with the right support. 

As and when needed, especially for an emergent user, try simple short sentences initially. Most users are strong visual learners. So, provide visual supports if necessary to help them learn. 

Let’s presume they can communicate autonomously.

Emergent communicators may need other prompts and cues when they are beginning to learn a new skill. Follow the prompt hierarchy and be discreet about the help you are giving. Make sure your support does not come in their way of communication autonomy.

5. Acknowledge the AAC User

Let’s’ presume that the AAC user can respond to you and have a social exchange. 

Talk directly to the user rather than talking through someone else. This will make them want to participate in conversations and boosts their self confidence. Let them know what they say matters

Abundant language models,appropriate tools, your support and faith in their abilities helps them in achieving their communication potential. When we assume competence we show that we trust in their abilities. We try and this motivates the user to try too. No matter how complex their needs are, they are definitely tuned in when we show that we believe in them.

WRITTEN BY

Niveditha Ryali
Speech – Language – Swallowing Therapist

I have 16 years of learning experience that comes from working in NHS(UK), special schools, hospitals and private practice. I am passionate about working on improving Speech, Language and Swallowing skills in children and adults. I also strive to facilitate early communication in children with complex communication needs, thereby improving parent-child bonding.

References:

https://i-asc.org/ten-ways-to-pres unume-competence-in-nonspeaking-kids-and-adults/?fbclid=IwAR3SY8vkpQN4SFuOxvyBMlLRYCu6tJNesQJzK2SJ1hUoK4PwXpxk_MxCSmA

https://praacticalaac.org/strategy/strategy-of-the-month-engaging-the-learner/

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An AAC user’s device must show off their personality. This is easier done when communicators themselves are involved  in the process of customisation. Our role in tailoring an AAC system to a communicator’s needs is to observe. We investigate. We talk to all the stakeholders in the communicator’s life and include elements that they can identify with. Then we observe more as they continue to use the device and customise more. 

The Vocabulary 

AAC Vocabulary that has not been personalized for a communicator limits their potential for learning. Most robust systems come with core vocabulary and a set of fringe words already programmed into them. Personalizing the vocabulary for a communicator should more be an imperative step rather than an optional activity. 

When communicators have easy access to core words, it allows language building. Include all the fringe words that are relevant to the communicator’s life such as

1. Their name and names of family members
2. Places they often visit
3. Items of high interest such as their favorite stuffed animal or book
4. Food 
5. Activities
6. Quick phrases such as ‘I need a break’, ‘I need help’

Personalizing your AAC device is easy with Avaz. You can add multiple items effortlessly and have all the vocabulary ready for the communicator in no time. This is particularly useful wen you want to quickly add a set of words related to a communicator’s new-found interest such as the upcoming Lego movie.

The Pictures

For picture-based AAC systems, symbols and images play a crucial role. When there is an extensive collection of symbols to choose from, it makes the customisation easy. ( Avaz AAC has over 15,000 Symbolstix pictures).

It’s best to include photos of the communicator and family members & friends in their About Me Folder.

 With Avaz AAC, you can add photo using the following methods:

1. Use the device’s camera to take photos
2. Upload existing photos stored in the device gallery/photos

In addition, you can also add it from the internet. Say, you want to discuss the SpaceX launch for the communicator interested in space, you can search for it from within the app and add it.

Zoom and High Contrast

The Picture zoom is also a great feature that provides visual stimulus to communicators.

Here’s a post shared on instagram that illustrates how there was communication with the Zoom feature in Avaz and a tactile screen protector.

High contrast mode allows users with vision impairments to read text better. Avaz’s high-contrast mode make it easier to read and navigate the app.

The Voice

AAC devices typically have different voice settings. It’s important to get the AAC user’s inputs while picking a voice that they like. 

Some words may be pronounced wrong in AAC devices. In such cases, you can use phonetic spelling in Avaz AAC to fix the pronunciation. Avaz AAC allows you to record a communication partner’s voice too. (We’ve seen that some AAC users prefer having a sibling’s or parent’s voice for certain words)

The Keyboard 

For text-based AAC users too, there are several features that need customisation. 

1. Keyboard Layout

It’s important to see which keyboard layout communicators are comfortable with. Avaz AAC offers a choice of Qwerty/ABC layout.

2. Phrase Prediction

For emergent communicators, we may want prediction turned ON so as to facilitate quick communication

3. Spell Check

For communicators with spelling awareness, we can turn this feature OFF while emergent communicators may find this feature useful.

4. Picture Prediction in Keyboard

For a communicator transitioning from picture to keyboard, Avaz AAC has a handy feature which shows images in the prediction bar along with text. As the communicator gains confidence with typing, we can fade this picture prompt or delay the prediction.

There are more than you can customise such as picture sizes, color code, page navigation options and more. A fancy device case and cool stickers can also make the device feel like their own for some communicators.

The post Customisation in AAC: Making it Just Right for the Communicator appeared first on Avaz Inc..

Avaz Inc. presents ‘Insights with Avaz’, a free webinar series all through October to celebrate AAC Awareness Month. Register for these informative sessions by the best AAC experts and learn AAC strategies, implementation ideas, and more. The recorded webinars will be available to watch on this page within a week after the Live webinar.

Date: Sep 30, 2021

THU, 5 – 6 PM IST
7:30 – 8:30 AM EST/EDT
4:30 – 5:30 AM PST/PDT

Critical Role of Family in the Child’s Communication Journey

Communication is a continuous process and the role of communication partner is as crucial as communication opportunities and demands. The session would look at these three important areas in transforming an emergent communicator to an independent communicator.

About Kalpana Rao

Principal of the Day Center and Head of the Communication Department at Vidya Sagar, Chennai. She is an expert in AAC with over 20 years experience and has conducted various training programs on AAC in Vietnam, Srilanka and Oman. She has presented many papers in International Conferences on AAC. She has been the secretary of ISAAC(International Society for Augmentative and Alternative Communication), India chapter, and has been a faculty for AAC for the Certificate course in Assistive Technology solutions held by NISH. Her dream is to have a world where no one is left behind for want of a mode of communication.”

Register Now!

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Date: Oct 7, 2021

THU, 5 – 6 PM IST
7:30 – 8:30 AM EST/EDT
4:30 – 5:30 AM PST/PDT

Common AAC Implementation Pitfalls and Helpful Strategies to Correct Them

Parents often face challenges while introducing AAC to their children. There are several common pitfalls that can (unintentionally) limit the motivation and progress of AAC learners. In this webinar, we will explore a set of common pitfalls as well as effective strategies that can replace those pitfalls.

About Lauren S Enders

Lauren S. Enders, MA, CCC-SLP is an Augmentative and Alternative Communication (AAC) and Assistive Technology (AT) Consultant working for the Bucks County, Pennsylvania, USA. She has more than 25 years of experience and is passionate about providing access to communication, and empowering parents and caregivers! She presents at leading national and international conferences, and has 10k followers on Facebook and 34K followers on Pinterest!

Register Now!

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Date: Oct 14, 2021

THU, 5 – 6 PM IST
7:30 – 8:30 AM EST/EDT
4:30 – 5:30 AM PST/PDT

AAC through the day – ideas for implementing AAC at home

Home is where the heart of AAC implementation is and parents know their child best! This webinar will guide you on how you can make use of your daily routines and home schedules to teach language to your child using AAC. This includes easy to implement tips, activity ideas and implementation examples.

About Anjana Sathyabodha

Anjana Sathyabodha is an RCI certified Speech-Language Pathologist specialized in Autism and Augmentative & Alternative Communication (AAC). With over 10 years of experience, including 5 years in the UK, she now works as an independent practitioner in Bangalore, India providing tele-therapy services to families in need of AAC intervention. She works closely with organisations to offer an ongoing coaching support to implement AAC for students in need and is involved in creating courses and training programmes related to AAC. She is passionate about advocating for AAC and facilitating communication using a multimodal communication approach.” 

Register Now!

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Date: Oct 21, 2021

THU, 5 – 6 PM IST
7:30 – 8:30 AM EST/EDT
4:30 – 5:30 AM PST/PDT

Strategies for Helping Children Express and Deal with Emotions using AAC

Individuals with complex communication needs often struggle to communicate their emotions and feelings, sometimes resulting in challenging behaviors. This webinar will guide you with strategies to help them use AAC to:

• become aware of their feelings and emotions and express them  

• deal with difficult feelings like anger and frustration
• learn coping mechanisms to deal with these feelings 

About Akila Vaidyanathan

Akila Vaidyanathan holds a Masters in Psychology and has extensive experience working with children and Adults with Autism. She  is the Founder-Director, AMAZE Charitable Trust (Coimbatore), an NGO focused on helping families navigate the disability maze through skill training programs and capacity building. She is the Vice President South, Founding Member, Autism Society of India. Mother to Nishant, an adult with Autism, she is a great advocate for the use of AAC and has helped many individuals, families and institutions  across India implement AAC and AT solutions/programs  successfully. She has conducted several training programs related to Behaviour management , Emotional Awareness and coping strategies as well.

Register Now!

The post AAC Awareness Webinars – Insights with Avaz 2021 appeared first on Avaz Inc..

October is AAC Awareness Month! We want to honor this month by giving away Avaz AAC app to a few lucky winners. Robust vocabulary and ease-of-use aside, this is just another great reason for you to try our app. Just click that download button now to get started. Good luck! .

What you Get

How to Get?

1. Download the free trial version of Avaz AAC app and explore its awesome features for 2 weeks ( Communication Partner training module, low tech printing, predictive keyboard – there’s a lot to look at)

2. Like, Follow, and Subscribe to Avaz Inc’s social media channels – Facebook, Instagram, Twitter, or YouTube.

3. Fill the form below.

Please Note:

The giveaway will be open until 12:00am IST on Nov 1, 2021.

The winner will be chosen at random – they will be contacted via email or phone.

The winner will be asked to provide the app registration details so that we can offer them free lifetime subscription.

One person is not eligible for more than one free app.

By entering this giveaway, an entrant allows Avaz Inc. to use their images and videos for marketing purposes.

This giveaway is in no way sponsored, endorsed or administered by, or associated with, Facebook, Instagram, or Twitter.

The post Avaz AAC App Giveaway- October 2021! appeared first on Avaz Inc..

AAC Awareness Month is here! As always, we are looking forward to seize this opportunity to amplify our efforts to empower people through communication.  We’ve seen in the past year the pivotal role assistive technology and AAC has played in connecting people.

So, we are delighted to announce a FLAT 50% discount on all our apps from October 1st to 15th, 2021.

The Discount:

50% off on:

Avaz AAC : An award-winning communication app for users with speech difficulties arising from ASD, Cerebral Palsy, Downs Syndrome, aphasia, apraxia, strokes & more

MDA Avaz Reader : Education app that enables struggling readers become independent readers using research backed strategies.

Avaz FreeSpeech : An education app that makes learning English Grammar fun & easy for children with special needs

Date:

October 1 to 15, 2021

Help us Spread the Word

Share this news with loved ones who have been waiting to buy one of our products. Tell that teacher friend of yours who has been eyeing our products for her school.

Queries?

Our Support team is here to assist! Reach us 24×7 at support@avazapp.com

Learn more about our assistive technology products that empowers users through communication and learning:

Avaz AAC MDA Avaz Reader Avaz FreeSpeech

The post AAC Awareness Month Discount 2021 appeared first on Avaz Inc..

Visual Calendars and Schedules

When children know what to expect, they are generally less anxious. Create a school year calendar to explain to children about when school opens and the days they need to be at school. Put the calendar where the child can see it such as in their bedroom or in the classroom. Use pictures or symbols to represent school days and visually prepare them in advance.

You can also help children visualize the countdown for back to school by using a paper chain. Use construction paper strips to make a paper chain with the number of days still school opens. Ask the child to remove one link every day until they reach the beginning day of the school year.

Visual schedules are another excellent tool that can show children what tasks/activities they will be doing at school. Visual schedules help children understand what is expected of them. This predictability helps them be prepared for the activities and tasks.

Sneak Peek of The School

Taking children on a school tour before they begin the new school year can help them get accustomed to the setting. Meeting their teachers and getting to experience their classroom ahead of time can also help them be prepared. This also gives an opportunity to explain classroom rules such as where to put their bags so that they have enough time to process the instructions in less distracting environment.

Make Getting Ready Fun

Superhero backpacks, Dinosaur erasers, Disney lunch bags – Get children involved in the planning for their new school year. Getting a say in picking school supplies can get children excited for school. Make a list of all the supplies needed and ensure that children can find them in their backpacks.

For children using communication devices, make sure that the device is charged and ready to use. Similarly, make sure they have all the vocabulary they might need in a classroom setting. Encourage them to ask for help or request for a break if they are overwhelmed. Avaz AAC has a Quick Folder with which communicators can have quick access to phrases. You can add more phrases according to the communicator’s requirements.

Practice at Home

Depending on what COVID mandates you have in place, practice masking, social distancing, and hygiene requirements at home. This will help the child understand expected behaviours at school. In case your child is expected to wear a mask at school, it’s best to have them practice wearing a mask for longer periods. Talk to the child about how to wear their mask properly and how to take them off during lunch/snack. Make sure children have spare masks in their backpacks.

Hope you found these tips for back to school useful. Please share your feedback and suggestions in the comment section below.

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Stimming and AAC

AAC learners can sometimes use their communication devices for stimming. They may seem to be hitting buttons out of context. It might be frustrating for the parent who expects them to use it meaningfully. Sometimes, the repeated auditory output can be disruptive too. 

What do we do? Do we just take the device away from them?

Definitely NO!! 

We cannot take away a child’s mode of communication. It’s their voice.

Let’s see what we can do to manage their stimming behaviours instead.

What do Do When a Child is Hitting Seemingly Random Buttons

Here are a few things to do when you see a child make repeated utterances on their AAC devices

1. Observe, Observe, Observe- Why does Stimming Happen?

Because of the environment – too noisy/bright/crowded?

How they are feeling – tired / anxious?

In response to some outside trigger-the friend taking away their favourite toy?

Is it because they have the device in front of them but don’t know what to do with it -no functional activity on hand?

They may be stimming to express their frustration or to calm down or block out the sensory overload. Some children also do it so that they could get your attention!!

Try finding out if there are specific triggers and see if the causative factor could be modified.

2. It Maybe AAC Babble

When starting to use an AAC device, it is not uncommon for a child to hit random buttons on the device. They are exploring the device and want to see what they can do with it, how it looks and sounds. This is called AAC Babble. It’s very much like neurotypical children babbling as they learn to speak.  Babbling is necessary and AAC learners need to hear the auditory feedback. 

Even though it may look like the AAC learner is pushing a random button and uttering out of context, assume it to be a meaningful utterance and respond appropriately. By doing so we help the child in understanding that what he says is meaningful, while simultaneously showing them the right way to use the word!!

 For example, if the child taps ‘pizza’ when playing outside, you can say, “Oh maybe you want to play the pizza delivery game?” and see if they are interested in the game.

3. Designated Time

If we know that the child is stimming for auditory or visual stimulation, we could mark a time slot in their visual schedule and a safe space where they could stim without interruption.

While stimming may not stop, it definitely makes it more manageable. (Besides, our goal is to facilitate communication, not stopping/blocking stimming unless it’s harmful)When the child starts using the device meaningfully, this time could be reduced gradually.

4. Another Tool for Stimming

If you feel that the child is using the device for stimulation, we can try offering another device instead, for satisfying their curiosity/ need for stimulation. By doing so we are sending them a strong message that the device is best used  for COMMUNICATION PURPOSES 

5. Stimming or Communication?

Sometimes a communicator might be repeating a word in the environment they are in.

For example, during book reading,  they may say “apple, apple apple”. They may have seen an apple in the book and they are excited to talk about their favourite fruit( commenting). Or they may want their mother to get one for them (requesting). Make sure not to miss out on that!

Stimming in AAC – Observations from Therapy

Here are a few observations from my Avaz teletherapy sessions that illustrate how communication can be facilitated when you see stimming behaviours –

K( 6 years, Autism) was fond of chocolate and the minute his Avaz AAC device was open, he would go for that word and tap it several times. We decided to try using this as a reinforcement. We had a customised folder for favourite food and encouraged him to make the sentence ‘I WANT CHOCOLATE’. After modelling the sentence a few times, to our surprise, he did make the sentence and got his chocolate too!! He continues to occasionally tap his favourite word repeatedly but he has also learned to meaningfully communicate with the word. This has also led to him learning to use complete sentences to request other things. ( I WANT ANIMAL PUZZLES/GIRAFFE BOOK) 

S(22 years, Autism ) was tapping buttons repeatedly on his AAC device. Suggestions from his OT to work on ‘soft touch” has helped him to successfully use single touch for selecting the target word.

Stimming may be happening randomly and look like it has no purpose. But on looking closer, you may be able to find patterns in repetitive behaviours. Careful observation can help us in supporting AAC learners to manage their stimming behaviours better. This can lead to more meaningful communication opportunities and a ton of learning.

WRITTEN BY

Niveditha Ryali
Speech – Language – Swallowing Therapist

I have 16 years of learning experience that comes from working in NHS(UK), special schools, hospitals and private practice. I’m passionate about working on improving Speech, Language and Swallowing skills in children and adults. I also strive to facilitate early communication in children with complex communication needs, thereby improving parent-child bonding.

References 

Laura Haynes- stimming or not stimming

http://praacticalaac.org/praactical/stimming-or-learning-considerations-for-kids-who-repeat-themselves-with-aac/

The post Understanding Stimming in AAC Learners appeared first on Avaz Inc..

One of our goals in therapy was for her to practice conversations. This primary goal had other secondary goals which were: 

• Understanding the ‘back and forth’ aspect of communication or ‘two-way’ communication
• Understanding and following the different rules of conversations
• Learning that everyone gets to ‘lead’ a conversation
• To practice asking questions in a conversation 

Generalisation of these skills in teletherapy seemed daunting initially, but as a team, collaborating with the family, we found success with some activities. I hope to share ideas of activities that we tried and those that I hope to try, with the aim that it would be helpful for your AAC user. 

Continuing Conversation Practice at Home

Conversations are how we connect with others and build bonds. I wanted the AAC learner to be able to have conversations beyond the therapy sessions. One of the activities we did for this was to have conversations through email.

The conversation topics were different depending on the activity. We often read a short news item and then had a discussion about it, or we chose generic conversation topics based on a video she watched or a message she read.

For example, after watching a video, we decided to chat about an idea that was new to her – volunteering.

 I described the concept and sent her a video to watch for better understanding. I then asked her to email her thoughts on it over the weekend. 

This is what she had typed in her Avaz AAC and emailed – 

“Volunteering Means Willingly Caring And Helping Other For A Cause.”

These email conversations turned out to be an excellent way for the AAC learner to spontaneously share her ideas whenever she wanted to without being bound by ‘therapy time’

Changing the Setting of the Conversations 

My client is a big movie buff. She enjoys watching Bollywood movies and can tell you and sing for you the songs of most 90s Bollywood movies. So, I moved the conversations to the TV room where we watched a movie and then talked about it. Needless to say, she was excited about this activity and had lots to say.

Due to the time constraints of the sessions, we usually watched short films. After the movie, we had discussions about the movie, the story, and shared our comments about the same. 

This was her response to the short film, Mr Indifferent on YouTube :

“I Can Cry Because Most People are Indifferent”. 

Moving conversations to different rooms within the house gradually gave the AAC learner the confidence to independently communicate using her AAC system in different settings.

Conversations with Different Communication Partners

As she became more confident in her conversations with me, the next step was to support her to have similar conversations with her friends and family. We encouraged family members – her cousin, or her dad to get involved in the teletherapy session. So instead of the three of us – the AAC learner, her mom, and me in the virtual meeting, there were now four of us. I facilitated the conversation, but mostly the AAC learner practiced her conversations independently. She made introductions to the new members in the meeting, led conversations and enjoyed the entire experience as she was thrilled to have her favourite people join the chat. 

Here’s how the conversation went in one of the sessions. 

The AAC learner was talking about planning a holiday with the family and she was responding to her parents’ questions.

She was encouraged to ask questions to elicit use of different communicative functions during a conversation.

AAC Learner – Is resort expensive?

Father – Yes, it’s expensive.

The AAC learner was encouraged to comment and to maintain the conversation.

AAC Learner – Then we can stay in resort for two days

The family reported that the AAC learner was beginning to have longer conversations than she normally would, with her father and other family members. 

Conversations without Therapist Support 

The family chat sessions were also carried over at home without my support. The family set up a video call or organized a time to practice within the home. Sometimes, we prepared the questions to ask beforehand so that she was less anxious about the chat. 

The practice sessions were simple everyday things such as what food to order or her favourite topic such as where to go on holiday next. 

These independent home practice sessions sounded something like this:

AAC Learner- I want to eat from restaurant please order

Parent- What do we order and how much for all?

AAC Learner- Chicken lollipop 2 plates Spring Roll 3 plates Manchurian 2 plates Fried rice

The important takeaway from this conversation was that the AAC practice does not need to be a complex activity. Instead, it can be something as simple as ordering food on a lazy Friday night. 

Some other activities that I hope to set up for the AAC Learner are to have conversations with her friends, other teachers or therapists and then slowly move to the people in the community. 

Given that she is a young adult, other activities to try are conversations with her peers through messaging applications and on social media platforms. 

Teaching generalisation of AAC skills in teletherapy may pose its own challenges. Since the number of places that we can visit is restricted due to the pandemic, we may have to rely on the internet to encourage communication in different settings. We may need to get a bit creative using technology. But with a little bit of planning and collaborative effort from families, communicators can learn to generalise their AAC skills and use them to freely express themselves. 

WRITTEN BY

Nayantara Nambiar, MSP, BASLP
Speech Language Pathologist

Trained in India and Australia, I am passionate about supporting people with communication and swallowing difficulties. Equipped with experience in Rehabilitation, School and Early Intervention settings, I strive to provide a holistic intervention approach tailor-made for my clients and their families.

References:

The post Generalisation: AAC outside the therapy room appeared first on Avaz Inc..

Teletherapy, however, is not without its limitations. Dependence on technology, dependence on the facilitator, the challenge in holding the communicator’s attention for a long time, and more screen time might are all some of its downsides. 

Definitions of Terms and Requirements 

Tele-AAC is the use of telepractice specifically for individuals using or working with those using AAC. Tele-AAC is a “unique cross-disciplinary clinical service delivery model that requires expertise in both telepractice and augmentative and alternative communication (AAC) systems” (Anderson, et al., 2012, p. 80). 

The basic requirements for a Teletherapy session are:

• A computer(IPad/tablet/phone) one each with the client and professional – that is used to connect
• Clinician, client and one communication partner 
• Secure software system for video conferencing
• AAC system one each with the client and the clinician( for modelling)
• A second camera(optional) for sharing the AAC system( the clinician can listen to the auditory feedback from the Speech Generating Devices (SGD) or communication partners can speak out the message in case it is a light tech AAC device)
• Hi-speed broadband connection

Choosing the Right Method of Service Delivery 

This depends on the client, their attention span, and their sensory-motor needs

Service delivery models could be Broadly classified as —Synchronous, Asynchronous and Hybrid.

• Synchronous-Clinician engages in an audiovisual live interaction with the client
• Asynchronous -Lessons are forwarded to the communication partner who works with the child and sends back video clippings for the clinician to analyse and give feedback
• Hybrid- is a combination of Synchronous, Asynchronous and in person sessions

Another way to classify Teletherapy sessions

Direct: (similar to the Synchronous  method)

This is similar to an in-person session you might have with a child 

Jess(name changed) is a 17-year-old girl with Autism whose parents signed up for Teletherapy. After the initial session, we decided to try direct Teletherapy. Jess struggled initially. She found sitting down for a 45 min duration session on-screen quite difficult. But with time, she settled down once she knew what to expect. Jess has been having successful therapy for the last 10 months and has been showing consistent progress.

Consultative:  

This involves talking with parents, brainstorming, troubleshooting and planning target skills/vocabularies.

The client’s presence during the session is not required 

Parents/caregivers put forth their problem areas, concerns and requirements. The therapist shares ideas based on their clinical knowledge on what could be done. Parent and professional mutually agree on goals and strategies. The parent works on the same at home, discusses with the professional and gets feedback during the session.

Ben (name changed)  is a 12-year-old boy with autism. He had his routine go for a toss since lockdown ( like many other children). He had been exhibiting anxiety and sensory issues. Parents signed up for teletherapy a year after the pandemic set in and by then he was averse to online classes and would refuse to even sit in front of the computer.

His mother was clear that he was not a candidate for direct Teletherapy and preferred to take the lesson plan from the therapist and work at home. She found it difficult to take a video of him using the device as he immediately stopped working if he sensed that someone was filming him.

With direct and coaching methods not being a choice for Ben, we decided to use the consultative method 

 Coaching: 

This involves giving parents specific feedback (in real-time or after-the-fact with video) Here, children may be present for the whole/ part of the session or may not be present at all.

This is similar to the consultative method but the difference is in the method of feedback. Parents capture the child working on the goal as a video and they play the same during the session. The clinician then provides specific feedback.

Sometimes we can also do Parent Implemented Intervention (PII) where the parent works on a goal that has been targeted in real-time during the session. The clinician provides relevant feedback and guides the session

Bala (name changed) is a 4.5-year-old boy with Autism. We started direct teletherapy with him. It was soon obvious that he could not take instructions from the screen. We tried Parent Implemented Intervention but he was growing restless by the day. So we chose to go with the mother videotaping his  AAC use and playing the video during the session followed by discussion.

Hybrid:  

As the name implies, this is a combination of the above delivery methods. 

John (name changed) is a twelve-year-old with Autism. When we were certain after few sessions that we could not do direct therapy and it was not possible for the mother to capture videos every single time, we used the Hybrid method. So, there was PII when he was cooperative followed by specific feedback ( coaching method). Sometimes, when he refused to sit down, his mother put across her concerns and we discussed how to work towards addressing them (consultative method.)

It’s a Team Effort

We also had Jack (name changed), an 11-year-old with Autism. He had severe sensory and behavioural issues that could be due to the pandemic and routine change, and change in medication. Through consultative method, we realized he was not responding to parental modelling (got irritated and indulged in injuring self/others). We have referred him back to consult his doctor and sensory therapist to initiate rehabilitation. We are hopeful of restarting his communication therapy soon with inputs from his doctor and sensory therapist. 

Online therapy is for all. Each communicator has unique needs and abilities and we choose a service delivery model that caters to their specific needs. We have found that with consistent, persistent and committed work from the team, success in communication intervention is just ahead!!

WRITTEN BY

Niveditha Ryali
Speech – Language – Swallowing Therapist

I have 16 years of learning experience that comes from working in NHS(UK), special schools, hospitals and private practice. I am passionate about working on improving Speech, Language and Swallowing skills in children and adults. I also strive to facilitate early communication in children with complex communication needs, thereby improving parent-child bonding.

References

https://rachelmadelslp.thinkific.com/courses/AAC-ally

https://www.communicarelearning.com/handouts

https://praacticalaac.org/praactical/aac-learning-at-a-distance/

The post Online Therapy for All – Communication Intervention for AAC Users appeared first on Avaz Inc..

Vanshita has speech difficulties which sometimes come in the way of her expressing what she thinks or how she feels. But since she learned to use Avaz AAC, she has begun to freely convey her ideas and thoughts with those around her.  Read more about how Vanshita’s communication skills progressed through her teletherapy sessions here.

Here’s what Vanshita says about Avaz AAC app:

 “i know challenge of communication has destroyed my life.Life changed in many ways.these frustrations bring sadness. Using Avaz has helped tremendously.I can express my feelings and thoughts. Having Avaz is blessing.”

Conversations Using The Avaz Keyboard 

Vanshita types on the Avaz keyboard to communicate her thoughts and feelings to those around her.

“i like writing thoughts for expression since i speak limited.”

Initially, she needed help in understanding the ‘back and forth’ aspect of communication or ‘two-way’ communication. In her teletherapy sessions, she got to practise how to initiate and lead conversations. The therapist also helped her to maintain a conversation, thus allowing her to have longer and more nuanced conversations. 

Speaking Her Mind

Once Vanshita became comfortable  with her conversation skills, she gained the confidence to express her opinions of matters, both big and small.

‘Holiday’ is one of her favourite topics. 

Here’s how Vanshita planned a holiday with her family using Avaz AAC app. Initially, she was responding to her parents’ questions by typing the answers in the app 

She was then encouraged to ask questions to elicit use of different communicative functions during a conversation.

Vanshita – Is resort expensive?

Father – Yes, it’s expensive.

She was encouraged to comment and to maintain the conversation.

Vanshita – Then we can stay in resort for two days

The family was glad to hear her logical thoughts that go into planning a holiday such as expenses and accomodation. 

Conversations Beyond the Therapy Room

After observing how keen Vanshita was to talk about her favorite topics, the therapist encouraged her to continue the conversations at home. She is a movie buff and loves Bollywood movies. So, she likes talking about movies and the songs that she enjoys listening to. Moreover, she gets to participate in everyday decision making such as what food to order online for dinner.

She also typed messages in the Avaz AAC app which sent through email to her therapist. 

The Role of Family Support 

Vanshita is a great example of how collaborative effort of the family and professionals can impact a communicator’s progress. Her family was keen on providing a positive communication environment for her. The first and one of the pivotal steps to see that up is presuming competence.

Vanshita’s parents believed that she had lots more to say than what she managed to convey through verbal speech. They understood how Avaz AAC app was allowing their daughter to open up and connect more with others. Her family members including her cousin and friends often participated in the teletherapy sessions and supported her AAC conversations. This support played a key role in Vanshita learning to become a confident communicator.

Read more Avaz AAC user stories here.

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