“Your child is too young for assistive
technology” . . .
and other myths about communication
in early childhood
Molly Heck, BS-SLPA
Deanna Hughes, PhD, CCC-SLP
Larissa LaPine Ferill, MA, CCC-SLP
April 11, 2012
San Diego Infant Development Association
Introduction
Assistive Technology (AT) vs.
Augmentative Alternative
Communication (AAC)
Assistive Technology: an umbrella term
referring to adaptive and rehabilitative devices for
people with disabilities and the process for
selecting and implementing

Augmentative Alternative Communication: a
subset of assistive technology designed to replace
or supplement verbal language

Maintaining a Perspective
Technology Should Never Replace Play,
Engagement & Interaction
Stages of Early Communication
(Ingersoll & Dvortcsak, 2010)
Pre
intentional
Pre linguistic
Intent
First Words
Two Word
Combinations
Smiling
Communicative
Intent
One word can have Rapidly expanding
varied meaning
vocabulary
Crying
Non verbal
Varies rhythm of
speech
Increased awareness
of listener
Gazing
Point
Requests,
responds, protests
Talks about concrete
topics
Grasping
Show item to
adult
Labels, greets
Repairs
communication
breakdowns
Stages of Early Communication
(Ingersoll & Dvortcsak, 2010; Searcy, 2011)
Preintentional
Prelinguistic
Intentional
First
Words
TwoWord
Combos
Early
SyntacticSemantic
Later
SyntacticSemantic
Communicative
Competence
Early Stages of Play
(Ingersoll & Dvortcsak, 2010)
Exploratory
Combinatorial
Touches
Cause &
Effect
Functional
Self
Directed
Pretend
Other
directed
pretend
Symbolic
Nests objects Pop up
toys
Pushes
Car
Pretends
to eat
Feeds
parent
play
food is
“yummy
”
Mouths
Puts objects
in containers
Catches
ball
Pretends Dresses
to talk on doll
phone
Pretend
s blocks
are cars
Smells
Lines up toys Wind up Puts
toys
people in
cars
Pretends
to sleep
Makes
dolls
walk
Musical
toys
Puts
bear to
sleep
Functions of Communication








Request objects and items
Continue an action
Stop an action
Request social interaction
Express a feeling
Make a choice
Initiate and terminate an interaction
Request assistance
Assessment
Consider Profile of Individual Child

Receptive/Expressive Communication

Cognitive Skills

Motor Skills

Visual Skills

Auditory Skills

Physical Health
Other AAC Considerations

Ability of typical communication partners

Settings where the communication is used

Child preferences

Family and caregiver preferences

Durability and Portability

Potential for growth

Projected rate of growth
Even More Considerations

Amount of training for families and caregivers

Implementation: consistent use across settings

Low-tech vs. high-tech

Permanency of the disability

Age of the user and caregivers

Existence of prior knowledge vs. new learning

Cost effectiveness
Selecting a Device
The question is not "Can my child use AT?"
but "What AT can my child use?"
 Given the breadth of assistive technology available,
much can be adapted for very young children
 Developmental stage of child must be considered
before including some features (e.g., symbols versus
pictures to represent language)
 Children and infants are often already exposed to
abstract forms of assistive technology (e.g., prenatal sound
machines and cause:effect toys)
Children Need to Have Good Motor
Skills to Access AT
Both a challenge and liberty of AT is that can be
continuously adapted to meet the needs of
specific individuals, including:





Language skills and needs
Visual/hearing complications
Sensory integration
Portability
Access (can be activated by feet, fingers, whole
hand, eye gaze, head, etc.)
Rapidly Changing Technology Offers More
Options
 With increased experience, it becomes easier to
creatively adapt AT so that it can be accessed
appropriately
 Teachers and therapists can use household
objects to adapt AT (e.g., utility belt to enable a child
to carry an AAC device)
Common Myths
An iPad Will Help All Children
iPads can offer financially reasonable solutions to
families, but it is important to consider all options
 specific skills are necessary to use iPad applications
(ability to isolate and activate buttons, scroll, categorize,
access "home" and/or "back" button)
 although many apps target language and pre-literacy
skills but pre-requisite abilities must be considered
 adults can provide live adaptations to enable
interaction with a device
example: if child taps his hand on the floor, adult
can push a button to activate preferred, animated
response (on iPad or computer)
Verbal Children Will Not Benefit From AT
 If a child is not effectively able to use verbal
language, another communication modality must be
identified
 Teaching children with (or without) language delay to
augment communication with adapted sign language or
AAC, frustration can be decreased, while enabling the
development and use of communication
Similar to 'baby sign', AAC may increase verbalization,
and provide a concrete and consistent
verbal model
Communication Devices and Applications
are too Complicated
for Most Parents to Edit
 While editing applications and AAC devices can be
difficult to learn, they tend to be similar and can
become familiar overtime
Once the "lingo" and concepts for one device are
acquired, it becomes easier to problem solve, program
other devices, and communicate to others using them
Most companies offer live tech support that can help
with any issues
There is no funding for AT
With an assessment completed by a Speech
Language Pathologist,
funding for AT is available through:

Insurance Companies

School Districts

MediCare and MediCal
Goals for young children should target
successful transition to Kindergarten
Focus of ALL therapy should be:

Engagement and play skills

Interaction with adults and others

Language development within the activity
Some children are too
"low functioning" for AT
Despite language and/or cognitive abilities
all children will benefit from activities which
are engaging and promote language
development
An AAC device will stigmatize a child
 AAC devices have changed
dramatically in recent year
 Many AAC devices look just like the
iPads and iPhones that all children use
AAC will prevent my child from learning
and using verbal language
 AAC provides a bridge for functional
communication by reducing frustration and
sparking language development
Current research reveals increased
verbal skills in children who are exposed
to symbolic language, such as icons,
gestures and pictures
AAC
Do’s and Don’ts
Technology Do’s
 Have a plan: how and why technology will be used
in your intervention
 Be able to articulate your rationale with families:
why are you getting paid to play with your iPad?
 Acknowledge that families may have more
technology savvy than you or none at all: collaborate
with families
 Use technology as a concrete support for parents
that may require minimal training: help parents find a
way to play successfully with their children
Technology Do’s (continued)
 Be prepared: be sure that equipment is charged;
have knowledge of applications and programs before
introducing them
 Incorporate other, more familiar tools: visual timers,
alerts, camera, video, and alarms in addition to
applications
 Understand and appreciate how technology is
typically used in the family’s home: (e.g., distracter;
entertainment for the child; reinforcer)
 Know professional standards: American Academy of
Pediatricians and ASHA
Technology Don’ts
 Never use technology as a substitute for good
therapy: it must enhance interaction, not replace it
 Technology must never be used as a time-filler or
distracter: use it for functional communication
requests and to provide visual representation of
language
 Block access to self-stimulating activities on the
device: e.g., limit scrolling and access to repetitive
videos
 Maintain control of the device: avoid tug-of-war
 Never assume one technology is right for every
child
Technology Don’ts (continued)
 Never narrow your choices to one specific type of
technology
 Avoid assumption that technology will hold the
child’s interest
 Never minimize the importance of face-to-face
interaction
 Never exclude use of natural gestures and
modified sign
 Never forget the power of engagement, and the
role it plays in communication and
interaction
iPad Applications for Communication
Advance March 19, 2012
AAC
LANGUAGE
Categories Learning Center
Proloquo2Go
Conversation Builder
Touch Chat HD
Easy Concepts
Tap to Talk
Fun and Functional
Custom Boards
Fun with Directions
Grace
Image Spinner
Aunt Maggie’s Recipes Language Builder
ACT Spell
Story Line
RJ Cooper’s Rad Sounds
Communication and Learning
Cookie Doodle
Go Away Big Green Monster
Icebox Doodle
Music Colors
Toca Hair Salon and Toca Tea Party
Sound Touch
The Social Express
Cinderella by Nosy Crow
NoodleWords