Intro to LAMP Basic Concepts - Assistive Technology of Alaska

AAC and Autism

An Introduction to LAMP :

Language Acquisition through Motor

Planning

Margaret Perkins M.A. CCC-SLP, ATP

Communication without Limitations

What LAMP and AAC is NOT







Augmentative

Alternative

Communication



Device used along side other approaches

– ABA, PECS, Floor time, etc.

Adapted from ‘LAMP: Language Acquisition through Motor Planning’ authored by

John Halloran, MS, CCC-SLP and Mia Emerson, MS, CCC-SLP

Prentke Romich Company

“…I think that it is not okay to get it wrong for even one person; when we talk about communication, we are talking about peoples’ lives, no less than that…..If we get it wrong, if we miss the boat – people drown.”

Pat Mirenda from ‘A Back Door Approach to

Autism and AAC’ September 2008




Desired Outcomes



(1) that the children will become more proficient communicators, utilizing a variety of communication modes which may include AAC, speech production, or a combination of the two;



(2) that language comprehension and expression will develop so that the children can communicate beyond the one word level; and



(3) that the children will develop an increased understanding of the power of communication.




LAMP approach




Communication Goal



Same as for all AAC users

–

–

–

–

S: Spontaneous

N: Novel

U: Utterance

G: Generation i.e. expressive, generative communication




Sensory Processing and ASD



Sensory processing disorders in those individuals with autism are well documented in the basic science and literature and in first-person accounts of those living with autism. These children and adolescents respond differently to sensory experiences than do their peers without disabilities.

Tomchek & Dunn, AJOT Vol. 61, Number 2 p. 190




AAC & Autism:

Sensory Processing



Sensory processing refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response.

-Foundation for Knowledge in Development



In contrast, sensory processing dysfunction is a disorder in which sensory input is not integrated or organized appropriately in the brain and may produce varying degrees of problems in development, information processing, and behavior.

-Cindy Hatch-Rasmussen, M.A., OTR/L www.autism.org/si




Typical Sensory Difficulties



Difficulty modulating sensory information may be involved with:

– Auditory Processing

 Also Auditory filtering & auditory hyper & hyposensitivity

– Visual Responding

 Avoidance of eye contact & inefficient use of eye gaze

 Atypical use of peripheral vision

– Tactile hypersensitivity

 Possibly interconnected with inflexible behaviors & repetitive verbalizations




Considerations for AAC & Autism



Most likely have Sensory Processing Impairment



Focus on coordinating three sensory systems for language acquisition

– Motor movement (proprioceptive system)

– Auditory (hearing)

– Visual



Should also be aware of

– Tactile and vestibular




ASD Learning Characteristics











Likely have gifted Visual memory (rote)

Excellent visual spatial pattern recognition

Strength in rule-based learning

Gestalt learner (chunked learning)

– ‘the whole is greater than the sum of its parts”

Frequently hyperlexic




LAMP approach









LAMP: Consistent & Unique Motor

Patterns

Each Word has it’s own unique Motor Pattern

– Focus on Pattern, not icon



Language connections made through:

– Initiating a unique motor pattern and hearing a word

– Experiencing other’s reaction to the word

– repetition of the Motor

Pattern & experience with words




How to Model Vocabulary to Achieve

Motor Automaticity



The goal is that the child will press the correct icon or icon sequence spontaneously and independently. However, to get to that end, you may have to help the child through the movement initially. You want to back off the amount of cuing that you are giving as soon as possible so that the child does not become cue dependent. Remember, it is a lot easier to remember how to get somewhere if you were the driver last time rather than the passenger.











Levels of motor assistance:

Hand over hand

Point to icon

Point to general area of icon

Point to device

Wait for child to activate






Fitts and Posner (1967) proposed a three stage model of motor learning. The first stage is the cognitive stage in which the learner has to attend to the process of learning a motor action. This stage is marked by highly variable performance. The learner may or may not know what they are doing wrong or how to correct their performance and will need guidance to assist them. In the associative stage, he works on refining his skill and is able to detect and correct their errors. The autonomous stage is the result of a lot of practice. At this stage, the learner does not have to concentrate on the movement and can attend to other aspects of the activity.




Motor Planning and AAC




Automaticity: The Great Equalizer



Natural Language

– Cognitive activity: Formulation of thoughts

– Motor activity: Speech & Gesture (automatic)



AAC Language

– Cognitive activity: Formulation of thoughts

– Motor activity: Device activation (automatic???)








"In the practiced automatic movements of daily life attention is directed to the sense impression and not to the movement. So, in piano playing, the beginner may attend to his fingers but the practiced player attends only to the notes or to the melody. In speaking, writing and reading aloud, and in games and manual work, attention is always directed to the goal, never to the movement. In fact, as soon as attention is directed to the movement, this becomes less automatic and less dependable."

Cattell, J.M.

1893




Fundamentals of Motor Planning in

AAC



Stop Looking

– Meaning of each location must be unique and consistent

– Focus more on patterns, less on picture interpretation

 Location label (icon/picture/word) becomes ‘placeholder’



Stop Thinking

– Predictable next movement

– Teach patterns




Motor Planning and AAC



“Using Motor Planning for language acquisition requires more than simply keeping icons in stable locations. It requires an understanding of where the system is headed years down the line, and teaching the motor patterns accordingly. The motor patterns must not change, rather they build upon themselves as vocabulary increases and language skills develop.”




Physiology Matters



Law of Neural Habit (1890s)

– Repetition of a neuromotor pathway eventually requires less energy & enhances performance



Pathways are physiological, chemical processes



The same physiology that makes a movement strong also makes it hard to change




Consistent and Unique Motor Patterns



LAMP was developed with two “levels” of motor planning. Level 1 requires a single movement before the word is spoken by the device.



Level 2 requires two movements before a word is spoken.



Unity® vocabularies were used because they support consistent motor patterns that builds in a systematic fashion.




LAMP approach




Auditory Processing and ASD



“Autistic children typically have problems processing auditory information. One auditory processing problem occurs when a person hears speech sounds but does not perceive the meaning of the sounds.

Sometimes the lack of speech comprehension is interpreted by others as an unwillingness to comply. However, the person may not be able to retrieve the meaning of the sound at that particular time.” Stephen M. Edelson, Ph.D, “Auditory Processing

Problems in Autism”










Auditory Filtering

“Sensory Processing in Children With and Without Autism”

Compared 281 children 3-6 y.o. with ASD to age-matched peers who were typically developing.

Items

– Is distracted or has trouble functioning if there is a lot noise around

 58% ASD compared to 2.9%

– Appears to not hear what you say


– Can’t work with background noise

 12.5% ASD compared to 2.9%

– Has difficulty paying attention






Auditory Signals





Keep language models short, simple, natural

Focus on words ‘spoken’ by child with AAC device

– And their natural consequences



Little to NO verbal prompts initially

– Limit auditory input that child needs to process

– Avoid ‘cluttering’ interaction with verbal prompting

 May not be understood

 Could encourage verbal prompt dependency and ‘key pushers’




Auditory Signals



“Input from the vestibular, proprioceptive, and auditory systems is critical for the development of speech and language (1989, Windeck & Laurel)



Children need to experience words, not just repeat them

– In LAMP each unique motor pattern = specific auditory signal

 a specific word



Needs to be immediate (both signal and response)

– Engagement and attention likely short-lived for student with ASD




Language Connections





The AAC device is a tool that allows the child to “babble” and learn about language. For example, after saying

“more” to get bubbles, the child might think that pressing the key for “more” means “bubbles.” A beginning talker might make the same conclusion.

However, in another instance what the auditory signal means when the child says “more” and gets more juice, the meaning of “more” is revised by the child.

As the child learns with the AAC device, he/she is learning consistent motor patterns that result in an auditory signal. Depending on the natural consequence triggered by the auditory signal, the child may modify his/her perception of what the auditory signal means.




LAMP Language Consideration:

Single Words



“ Communication is based on the use of the individual words of our language. True communication is spontaneous and novel. Therefore, communication systems cannot be based significantly on pre-stored sentences. Communication requires access to a vocabulary of individual words suitable to our needs that are multiple and subject to change. These words must be selected to form the sentences that we wish to say.”

ASHA’s AAC Glossary












Language Development

Questions

Is there research establishing a process for normal language acquisition?

Is normal language acquisition a simple or complex process?

Have you seen research that establishes how children with developmental disabilities acquire language?

In the absence of this research, on what do you base your intervention for helping children with disabilities acquire language?




From ASHA Leader

“To integrate AAC systems with the curriculum, we must consider several issues. First, language develops and expands in an orderly fashion. Our devices and systems must allow for this development from the beginning. Typically, children acquire spoken language by progressing from one-word utterances to two-word utterances to simple sentences and so on. Language form, function, and use proceed in a fairly predictable pattern. AAC intervention should begin early, and clinicians should provide support for the way we know language typically develops rather than use devices that generate complete sentences at the onset.”

Julie Schers and Pamela Hart, Wichita State University

The ASHA Leader Vol. 7 No. 16 Sept. 10, 2002




Words vs. Phrases for Autism



Individuals with ASD tend to be ‘Gestalt Learners’



Tendency to take in chunks of info

– Phrase “I want spin toy” is learned as 1 entity

– Even the simple phrase “I want”



Phrases = participation, don’t build language skills

– Individual words are the building blocks of language

– We can have participators AND communicators



Two words can be something new

– Two phrases can only be two phrases




LAMP approach




Natural Consequences



No Mistakes: Respond to all communication



Respond Naturally & with

Animation

– Ex. Loud crunching when pretending to ‘eat’



Use Natural responses to build language




Natural, Visual Consequences



Emphasize words with a natural visual reaction

– “Interestingly, those individuals who do not have auditory processing problems are often ‘auditory learners.’ These children do very well using the ABA approach, whereas those who are visual learners do not do as well…given this, one might suspect that many visual learners have auditory processing problems and that visual learners will do well with a visual communication/instruction approach.”

Stephen M. Edelson, Ph.D, “Auditory Processing Problems in Autism”




Core Words & Natural

Consequences



‘go’ has a natural consequence that child can see

 How would you respond to ‘Wednesday’ in a meaningful way?



‘more’ would have a similar visual consequence

 “What color is this?” facilitates response ‘red’



Conveniently, core words are the most powerful

 Can be used in virtually any activity




Core Defined



Words that are common to peers of a similar age. They are common words used across all communication environments…which include structure words (e.g. want, more) that provide a framework for functional language use.

(Banajee et.al., 2003)




Evidence Based Practice

Despite evidence that nouns are not among core vocabulary used by preschoolers…clinicians typically select nouns representing foods and objects as first symbols when designing AAC systems.

(Banajee, et. al., 2003)




333 Most Frequently Occurring Preschool Words: The Marvin Sampling

Compared with Banajee Sampling: all words present as at away baby back bad bad ball bathroom be bean because before being bet better big bird birds a about after again all almost already also an and another ant any are aren't around car catch cause chair come comes cookie corn could couldn't cup cut day did didn't different do does doctor bite black blue both box boy bugs but buy by bye call came can can't candy fall find finger fire first five fixed fly foot for from found get gets getting girl girls give go doesn't dog doing don't done door down drink duck eat eating else even everybody everything face her head hear hello help here here's hi high hill him his hold home horse hot house how huh goes going gonna good great green guys had hair hand hands has have haven't he he's name named need never new next nice no not of off oh other ok old on one only open maybe me mean messy middle mine mom mommy more most move much must my myself

Name kind know last leaves let let's lift like little long look looking lot lunch made make man many may hum

I

I'll

I'm if in inside is isn't it it's juice jump jumped jumping just really red remember ride right room run said same saw say see she she's show shut side sit so or our ours out over paint people pet name pick piece play please push put ready their them then there there's there's these they they'll they're thing things this those three threw through time to still some somebody someone something sometimes somewhere stop stuff swing tape tell than that that's the

Christine A. Marvin, today together too top toys trees try trying turn turtles two um up us use used very wait want wanted was wasn't watch water way we we'll

David R. Beukelman,

Denise Bilyeu we're well went were what what's when where where's which while who who whole why with won't would ya yes yet you you'll you're your yours




AAC, Vol. 10, Dec.,

1994

Toddler Vocabulary Arranged by Frequency

I

Words

No

Yes/yea my the want is it that a go mine you what on in here more out off some help all done/finished

Percentage

9.5

8.5

7.6

5.8

5.2

5.0

4.9

4.9

4.9

4.6

4.4

3.8

3.2

3.1

2.8

2.7

2.7

2.6

2.4

2.3

2.3

2.1

1.0

26 core words shown at left comprise 96.3 percent of the total words used by toddlers in this study

96.3%



Banajee et al.

LAMP Language Consideration:

Core Words



Essential for expressive communication



Children with ASD tend not to spontaneously generalize concepts



Core words can be used in multiple contexts with varied meanings



Essential for ASD student to make language connections

– Used to build flexibility with language meaning




Core Vocabulary has few

Picture Producers



Fewer than 5 percent of all words used by toddlers are picture producers

(Banajee, Dicarlo & Stricklin, AAC , 2003)



Concrete graphics can only be made for picture producers



More than 90 percent of core vocabulary words are not picture producers

(Hill, Dissertation, Establishment of Performance Indices, 2001)




LAMP approach




Readiness to Learn



In preparation for learning child may need:

– Calming:

 rocking, brushing, massage, push/pull, oral motor (chewing, sucking), quiet sounds

– Alerting:

 swinging, rolling, dancing, oral motor (sour, crunchy).




Shared Focus



“Sensory modulation impairments represent a mismatch between the external contextual demands of the child’s environment and his or her internal characteristics (e.g. attention, emotion, sensory processing) and can impair the ability of the child with autism to sustain engagement with people or in activities.”





Shared Focus



Vary activities to find motivator

– Use that motivator for language learning



Follow your student’s lead, give up control

– Can be flexible and still meet goals





Keep student challenged by building on activity

Attend to their every move

– Treat everything as intentional and purposeful



Be prepared to move




Shared Focus



Capture attention by doing surprising and novel things



Avoid predictability



Don’t be afraid to be

Goofy



Goal is to engage student

– Then teach language




Shared Focus





Use isolated interests as opportunity to teach language

PASSION Not OBSESSION

Compliance vs.

Communication



Stop asking “What” start asking “Which”



Stop Testing

Start Teaching




Taking advantage of Expected

Behaviors



Mis-hits offer a profound learning opportunity

– if met with natural consequences



Device exploration is OKAY

– Will depend upon reinforcement




Strategies




Strategies




Strategies: Vocabulary Builder

Hide Show



Hide keys temporarily if behavior is roadblock

– Hide keys as needed during activity

 Adjust vocabulary based on child-directed activity

– Show keys (vocabulary) for specific activity

 Remember goal: learn motor patterns for individual words

 Use of AAC device mimics speech in that it’s a motor movement that produces a consistent sensory feedback

– Remember: Include keys for ‘mishit’ learning opportunities

– Try showing all keys when child is engaged in motivating activity




Why High Tech



Auditory signals



Technology bridges the cognitive gap

 Keep same system as language grows



Dynamic display allows for quick programming to keep up with student.



Example of Vocabulary Builder Tool




Strategy: Device Introduction



During the initial stages of intervention, it may be necessary to limit use of the AAC device to a controlled setting. If possible, plan for one to five intensive therapy sessions before introducing the device in other settings, such as a classroom or home. As the child is gaining success in use of the device, introduce more use of the device in less controlled settings. The introduction of the device into these settings will be dependent on a wide range of variables, including the skills and attitudes of the communication partners and the degree of simulation in the environment.




“The reason children fail with their communication systems is because they’re too easy.”

John Halloran, M.S., CCC-SLP

Arkansas




Prentke Romich Company

Communication without limitations

Margaret Perkins, MA CCC-SLP, ATP

Office: (760) 431– 8875

Toll Free: 1-800-262-1984 ext 420

Email: mcp.cons@prentrom.com

www.prentrom.com




Intro to LAMP Basic Concepts - Assistive Technology of Alaska

AAC and Autism

What LAMP and AAC is NOT

“…I think that it is not okay to get it wrong for even one person; when we talk about communication, we are talking about peoples’ lives, no less than that…..If we get it wrong, if we miss the boat – people drown.”

Desired Outcomes

LAMP approach

Communication Goal

Sensory Processing and ASD

AAC & Autism:

Sensory Processing

Typical Sensory Difficulties

Considerations for AAC & Autism

ASD Learning Characteristics

LAMP approach

LAMP: Consistent & Unique Motor

Patterns

How to Model Vocabulary to Achieve

Motor Automaticity

Motor Planning and AAC

Automaticity: The Great Equalizer

Fundamentals of Motor Planning in

AAC

Motor Planning and AAC

Physiology Matters

Consistent and Unique Motor Patterns

LAMP approach

Auditory Processing and ASD

Auditory Filtering

Auditory Signals

Auditory Signals

Language Connections

LAMP Language Consideration:

Single Words

Language Development

Questions

Words vs. Phrases for Autism

LAMP approach

Natural Consequences

Natural, Visual Consequences

Core Words & Natural

Consequences

Core Defined

Evidence Based Practice

LAMP Language Consideration:

Core Words

Core Vocabulary has few

Picture Producers

LAMP approach

Readiness to Learn

Shared Focus

Shared Focus

Shared Focus

Shared Focus

Taking advantage of Expected

Behaviors

Strategies

Strategies

Strategies: Vocabulary Builder

Hide Show

Why High Tech

Strategy: Device Introduction

“The reason children fail with their communication systems is because they’re too easy.”

Prentke Romich Company

Communication without limitations

Related documents

Add this document to collection(s)

Add this document to saved

Suggest us how to improve StudyLib