Speech Generating Devices
Overview
Many individuals with autism spectrum disorders (ASD) have difficulty developing and
using verbal speech to communicate with others. Augmentative and alternative
communication (AAC) is "a set of procedures and processes by which an individual's
communication skills (i.e., production as well as comprehension) can be maximized for
functional and effective communication" (Augmentative and Alternative Communication:
Knowledge and Skills for Service Delivery, 2002). AAC systems include those that are
unaided (i.e., do not require an external aid or device) such as sign language, and
those that are aided (i.e., do require an external aide or device). SGDs, sometimes
referred to as voice output communication aids (VOCA), are considered an aided
technique. SGDs offer the advantage of spoken language for individuals who use them.
With ongoing advances in technology, the range of available SGDs is increasing, and
the cost of many types of SGD is becoming much more affordable. The complexity of
SGDs ranges from simple single-message communicators to those that have large
memory capacity and include other features such as word processing, MP3 players,
and the ability to interface with other electronic devices. In summary, SGDs are
electronic devices that are portable and can produce either synthetic or digital speech
for the user. SGD may be used with graphic symbols, text, and/or alphabet keys.
While AAC software is available that can be installed on a personal computer, this
module will focus only on devices that are used solely for communication. Steps for
implementing each of these procedures is provided as well as how SGDs can be used
across the age range with learners with ASD.
Pre-Assessment
Pre-Assessment
Decisions regarding appropriate augmentative and alternative communication (AAC)
techniques for a specific individual are based on
Select an answer for question 599
Speech Generating Devices (SGD) are only for individuals who have previous
experience using AAC devices.
Select an answer for question 601
An SGD should not be used with individuals who use sign language or other AAC
systems.
Select an answer for question 602
When introducing an SGD to a learner, how many symbols should initially be
presented?
Select an answer for question 603
An SGD can be used in which environments?
Select an answer for question 604
SGD use should be discontinued if the learner starts using verbal language.
Select an answer for question 605
AAC and SGD: Selection and
Preparation
As with other evidence-based practices, selection and preparation of augmentative and
alternative communication (AAC) and speech generating devices (SGD) requires
specific steps. This section of the module will address:
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What Are SGDs?
Why Use SGDs?
Who Can Use SGDs and Where Can They Be Used?
With What Ages Are SGDs Most Effective?
Which Assessments Should be Completed Before Using an SGD?
What Other Factors Should be Considered before Using an SGD?, and
How Do I Teach Learners to Use an SGD?
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What are Speech Generating
Devices?
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Speech-generating devices are portable electronic devices that provide speech
output, either synthetic (i.e., computer-generated speech) or digitized (i.e.,
recorded human speech). The devices use a variety of graphic symbols, text,
and/or pictures to represent personalized messages for individuals who use their
hands, fingers, or some other means (e.g., switch, eye gaze) to activate the
device. SGDs are considered a higher-tech aided AAC system than the Picture
Exchange Communication System (PECS; Frost & Bondy, 2002), which is
considered a low-tech aided AAC system. For more information on PECS, please
visit the autism internet module on the Picture Exchange Communication System
(PECS).
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SGDs are designed to be durable, turned on and off frequently, carried from
place to place, and used in areas in which people work or play. While considered
high-tech, SGDs range from simple single-message units that have one
prerecorded phrase (e.g., "Hello, my name is __________," "Please help me,"
"Bathroom, please") to those that have a nearly infinite set of messages activated
by multiple buttons or switches. Voice-output applications for smart phones are
also becoming increasingly available. Messages expressed via an SGD may be
generic such as those listed above, or they can be individualized for the person
who uses the device. SGDs range in price from 20 dollars to thousands of
dollars. Some SGD manufacturers and distributors are listed in the resources
section of this module. In addition, the following website serves as an AAC
device search engine and may be useful as professionals and families consider
options for learners: http://www.ace-north.org.uk/userStatus/vocapages/main.asp
Why Use Speech Generating Devices?
Impairment in communication skills is a core feature of ASD (American Psychiatric
Association, 2000). For example, some learners with ASD do not use words the way
most typically developing children do. Furthermore, some learners with ASD do not use
eye contact, vocalizations of any type, or gestures to meaningfully communicate with
others. Instead, learners with ASD sometimes learn to use nonconventional means to
gain the attention of people around them and to obtain desired objects/outcomes (e.g.,
grunting, pulling adult's hand to desired object). Prolonged use of these
nonconventional communication strategies may result in the development and
maintenance of inappropriate and interfering behaviors (e.g., disruptive, repetitive).
Early intervention with learners with ASD is a well-established and supported practice
that helps address these nonconventional forms of communication before they become
problematic (Romski et al., 2009; Thompson, 2007). It is imperative that learners with
ASD develop communication skills as early as possible as a means of getting their
needs met. For learners who do not develop typical verbal and nonverbal
communication skills, learning to express wants and needs can prove to be challenging.
Delays in developing these expressive communication skills can cause frustration for the
child and caregivers and can sometimes lead to behavioral challenges as well.
SGDs are one example of an AAC system designed to help learners with limited speech
communicate and interact within a social context. SGDs are particularly helpful during
these exchanges because they (a) allow communication exchanges across any number
of trained or untrained partners, (b) require only simple motor responses from users,
and (c) vary from very complex (with nearly unlimited messages) to very simple (with
only one or two messages). The most compelling reason to use an SGD is that they
give learners with ASD a "voice," thus facilitating their ability to communicate effectively
with communication partners (Quill, 2000).
Who Can Use SGDs and Where Can
They Be Used?
Initial SGD training and support is often provided by a speech-language pathologist;
however, other professionals, parents, or caregivers must support the ongoing use of
the device by learners with ASD to facilitate generalization and maintenance of skills.
Research has shown that SGDs are effective not only in supporting communication
skills (e.g., Parsons & La Sorte, 1993; Schepis, Reid, Behrmann, & Sutton, 1998;
Sigafoos, et al., 2004), but also in helping learners develop academic skills (Schlosser &
Blischak, 2001). Because SGDs are portable, learners may be taught how to use them
in school, at home, or in community settings.
Which Assessments Should be
Completed Before Using an SGD?
If you are considering using an SGD with a learner with ASD, some assessments have
probably already been completed. Such assessments often consist of formal
intelligence tests and tests of adaptive behavior/functioning, including social interactions
and communication skills. When used with learners with ASD, standardized testing
frequently results in an underestimation of the learner's functional level. This, in turn,
may lead to inappropriate educational planning and provide a roadblock to SGD
acquisition (Koegel, Koegel, & Smith, 1997). Therefore, it is important to include
observations and knowledge of how learners acquire skills and their interests during the
assessment process. Having a speech-language pathologist who is experienced with
ASD and AAC is pivotal to the success of the plan. Teachers/practitioners and
caregivers should consider finding a specialist who is willing to work with the team on at
least a consultative basis. Depending on the learner, an occupational therapist may
need to be consulted as well to determine how the learner will use the device (e.g.,
pushing buttons, positioning).
The following questions may be helpful when choosing the type of SGD or other AAC
system to use with an individual learner with ASD (adapted from Quill, 2000):
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What motivates the learner to communicate?
What is the learner's current most-frequently used means of communication (formal
or informal)?
What other AAC systems has the learner used or attempted to use in the past? If
the system was unsuccessful, identify teaching methods and/or other factors that
were problematic.
Does the learner show an interest in using graphic symbols or pictures? If learners
are able to read, use of text may be more meaningful and/or motivating for them.
What motoric and/or cognitive challenges does the learner have that must be
addressed while teaching use of the device?
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What seems to be the easiest AAC system for the learner to use?
What seems to be the most functional means of communication for the learner?
What are the AAC preferences of the learner's family?
What are the AAC preferences of the learner's teachers and school support staff? If
developmentally appropriate, what are the preferences of the learner?
Who are the learner's current communication partners? Who else might he or she
communicate with through an SGD?
Does the learner engage in interfering behaviors (e.g., disruptive, repetitive,
stereotypical) that should be considered when selecting a device? For example,
some learners engage in self-stimulatory behaviors with pictures or icons (e.g.,
flicking/flapping card), and an SGD may circumvent that problem. Other learners
habitually fling objects, so the device may need to be attached to a desk with Velcro
or some other means.
Based on the answers to these questions, the long-term goals from the individualized
education program (IEP) or individualized family service plan (IFSP), and the
preferences and needs of the learner, teachers/practitioners, caregivers and other team
members can identify the basic type of SGD device that may be effective with an
individual learner with ASD. Teachers/practitioners and caregivers also may consider
having individual learners interact with a few devices to identify the specific device that
might be most effective. Before purchasing the SGD, teachers/practitioners and
caregivers should allow the individual learner to use it on a trial basis (even up to a
month may be necessary to establish that it is a good match). It may be possible to
borrow a device from a school, clinic, university, or educational resource library during
this trial period. Because funding sources, such as Medicaid, frequently are only
available to purchase a single high-end device, it is very important that the SGD
selected is a good fit for the learner.
What Other Factors Should Be
Considered Before Using an SGD?
Additional factors also should be considered prior to selecting and purchasing an SGD
including the following:
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how information will be displayed for the user,
how vocabulary will be selected by the user,
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how portable the device needs to be,
the type of support available from the device manufacturer and/or professionals in
your area, and
what types of financing are available.
Displaying Information
Before choosing an SGD, teachers/practitioners and caregivers should decide how to
display the information on the device in a way that is age- and developmentally
appropriate for the individual learner. This can be crucial to the successful use of the
device.
Static screen devices use an overlay that has pictures, symbols, or words to identify the
chosen message. The number of pictures, symbols, and words is limited so that the
screen always looks the same unless someone physically changes the overlay or
reprograms the device. Dynamic screen devices allow the learner to access a virtually
limitless vocabulary. The electronic display changes as the user selects different
categories and functions (similar to a menu option on a computer), which may be
represented by pictures, symbols, or words that are relevant and useful for the person
using the device. Some dynamic screen devices use specific icon systems (e.g.,
BoardmakerTM pictures www.mayer-johnson.com); others are more flexible. Some
newer devices even include digital cameras, which allow teachers/practitioners and
caregivers to take a photo of an object or person, record a message, and play the word
or phrase within minutes. Typically, less expensive SGDs use static screens, while the
more costly ones have dynamic screens.
Accessing Vocabulary
Another important factor to consider is how learners will access vocabulary, taking into
account the learner's fine- and gross-motor skills. Frequently, learners use their fingers
to activate buttons or icons on SGDs. However, accommodations can be made if
motoric issues interfere with the ability to activate the device, including use of a
trackball, a headmouse, or key guards. Motoric challenges can also be addressed by
learning to use scanning techniques (e.g., the learner listens to options and then
activates a switch to indicate his/her choice).
In addition, different SGDs allow for different numbers of choices in a field (e.g., a
BIGmack allows for a single message, a GoTalk4 allows four messages at a time, and a
VantageTM allows up to 84 icons at a time). Consideration of how many symbols
learners can currently scan, as well as their potential abilities, is important. Although a
device may be able to display a certain number of icons, it may be introduced with fewer
icons, which would then be increased as the learner's skill level increases. Further,
some complex SGDs require users to sequence symbols to find a specific word
(Minspeak, retrieved May 7, 2008, from Frequently Asked Questions,
www.minspeak.com). The following example illustrates how a learner would need to
select two words or symbols to create one word.
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select rainbow + select heart = "red,"
select rainbow + select umbrella = "rain"
While this device may be ideal for some learners, this kind of icon sequencing requires
higher cognitive ability and/or more training than a device that relies on single-symbol
selection.
Portability of the Device
Portability of the device is another important consideration when selecting an SGD.
Ideally, these devices will go wherever the user goes. If they are too big, the learner
may find them cumbersome. If the devices are too small, they may be misplaced.
Consideration of where the device will be used (now and in the future) as well as who
will be responsible it is also important. Always consider the learner's preferences since
the SGD will essentially be an extension of the learner.
Training and Support
Another crucial factor to consider before purchasing a device is the amount and
availability of training and support from the manufacturer. Many manufacturers offer
initial training for those who support learners using their devices. They may also offer
follow-up training as well as technical support. This is important to know prior to
purchase as there may be extra costs associated with long-term support. Similarly,
warranties and repair services should be investigated before purchase to identify what
is available and at what cost.
Beyond support from the manufacturer, it may also be possible to identify AAC
specialists in your region who can provide additional technical assistance and support.
University programs, the local education agency (LEA), and individual school districts
frequently have professionals on staff who have specific expertise in SGDs.
Funding Sources
Because SGDs can be expensive, funding sources should be explored. More complex
SGDs are typically purchased by a third party, such as Medicaid, private insurance, or
individual special education/early intervention programs. Funding sources usually will
require data on the learner's need for the device. Common requests include the
learner's current expressive communication abilities as well as how the device will be
used. This module will not cover specific information related to funding the purchase of
an SGD, since that information varies from state to state and changes over time.
How Do I Teach Learners to Use an
SGD?
The use of an SGD (i.e., how to operate it) is most frequently taught using naturalistic
intervention (see AIM module on this topic authored by the NPDC on ASD) and,
sometimes, graduated guidance (see AIM modules on prompting authored by the
NPDC on ASD). Naturalistic intervention allows teachers/practitioners to utilize
behavioral strategies, such as modeling and modified time delay, within the learner's
daily routines and activities to elicit a target skill. With the graduated guidance
procedure, teachers/practitioners apply the amount and types of prompts needed to
help the learner with ASD complete the target skill/behavior, and they immediately fade
(reduce) the prompts needed as the learner begins to acquire the skill.
Regardless of the instructional strategy or prompting system used, learners should be
taught to use the SGD within the context of natural communication opportunities, with a
variety of communicative partners, and with repeated trials in multiple, natural settings
across the day to promote generalization and maintenance of skills (Mirenda, 2003).
For more information on naturalistic teaching strategies please refer to the AIM module
on Naturalistic Intervention. Additional information on graduated guidance may by found
in the AIM module entitled Prompting.
Prior to selecting vocabulary, the format for representing the vocabulary must be
determined. Representation may vary from concrete objects to abstractsymbols. For
example, concrete learners may need an actual empty juice box placed on a BIGmack
switch. To move toward more abstract representations, a photo of the juice box may be
used, then a colored drawing, a black-and-white line drawing, and finally the word
"juice." Decisions on how to represent vocabulary will be based on learners' cognitive
abilities and their interest in and experience with symbols. Computer programs such as
Boardmaker (TM) can be used to produce symbols which make finding symbols and
creating overlays more efficient.Templates of boards are available through software and
on the Internet.
Vocabulary: Selection and Organization
Once the SGD has been obtained, it must be individualized and introduced to the
learner. Thoughtful decisions regarding the number of symbols to introduce, the words
to use, and communication partners will help make the use of the device smooth and
successful.
A critical first step before teaching SGD use to the learner is the selection of highly
motivating vocabulary for the device. For some simple SGDs, one or two messages
may be recorded on the device and changed frequently based on the routines in which
the learner is engaged. For example, a learner could use a BIGmack to participate in a
choral reading activity and then use it to request "more" at snack time. Other devices
can store more words. Static screen devices require that you develop overlays (i.e.,
boards) with pictures and then record messages to match each one. It is important for
the vocabulary on each overlay to be appropriate for specific situations or
communicative functions (i.e., boards for snack, art class, current science experiment,
specific picture book). At the same time, a core vocabulary with basic words may be
included on each overlay. The core vocabulary will depend on the learner, but may
include words like no, yes, all done, and more. However, it may be important to consider
that learners may already have learned appropriate ways to express some core
vocabulary without an SGD.
For beginners or individuals with limited capability, it may be preferable to have a single
symbol to represent an entire phrase. For example, when a symbol of a swing is
pushed, the device says, "I want to swing" (see Example 1 to the right). To increase the
complexity, a device may have an "I want" button and then several different choices to
push after it (see Example 2 below). Finally, a device may have different icons with
individual words, such as I, want, see, and don't. Increasing the level of complexity
allows a learner to create more novel utterances. The examples below and to the right
show how boards can be customized to meet the needs of learners with differing
communication abilities.
There are more complex devices available as well. More complex, dynamic screen
devices typically come loaded with vocabulary that is already organized (e.g., Minspeak,
InterAACT ), but require icon sequencing. While these devices can be loaded with
personal vocabulary, such as familiar names, favorite foods, classroom vocabulary, and
local slang, it is generally recommended that the vocabulary or the layout not be
changed substantially. The organization of the symbols is designed to promote quick,
logical access to vocabulary. Certain pictures can be hidden when the learner is first
being taught how to use the system and then reintroduced as the learner becomes
more comfortable using the device.
When setting up a device, teachers/practitioners should choose vocabulary and
recorded voices that make the device sound as much like the learner as possible. That
is, they should use words that are age appropriate (e.g., potty rather than toilet for a 3year-old, "That's cool!" rather than "I like that." for a teenager). When recording
messages, it is helpful to have a child or adolescent of the same age and gender who
speaks in the learner's home dialect make the recording; for example, an 11-year-old
boy's SGD should sound like an 11-year-old boy. Devices with synthetic speech
frequently have options for different voices.
To update the vocabulary, teachers/practitioners identify who will design new boards
and/or personalize the device. This may be the speech-language pathologist, but it may
be more appropriate and more efficient for an educational assistant or teacher to
assume the role. With some devices, overlays can be quickly developed to meet the
needs of a particular lesson or activity. Regardless of who is responsible for the device,
regular meetings or checkins are useful for discussing the use of the SGD and whether
or not it needs to be altered.
Identification of vocabulary specific to an activity requires that teachers/practitioners
also identify the communicative functions that they want to elicit. For example, during a
preschool painting activity, instead of only having the materials be icons (brush, paper,
water) that are useful for requesting, a teacher/practitioner may want to use icons that
would represent more typical communication, such as "Hey, look at my picture!,"
(commenting) "That's pretty." (commenting) or "Can I hang it on the wall?" (requesting).
Communicative functions may include requesting (materials or help), protesting,
commenting, greeting, or asking (requests for information).
It is also important to consider how the learner will use the SGD in environments outside
of school. Therefore, teachers and other practitioners need to confer with parents about
vocabulary. For example, the learner may participate in Boy Scout meetings and want
vocabulary specific to his Pinewood Derby car or an upcoming camping trip. Or,
teachers/practitioners may want to program questions that a learner can ask on a family
trip to Disney World or the beach.
Step-by-Step Instructions
Implementing an SGD is not a step-by-step, sequential process. Unlike intervention
methods derived from applied behavior analysis, there are no real rules along the lines
of "If X happens, do Y." Nevertheless, the following guidelines provide a plan for
introducing and implementing an SGD. To be successful, this process also will require
the use of professional wisdom and skills.
For learners with ASD, it is important to have the team, including family members, identify
priority goals based on the IEP or IFSP. While it may not be reasonable to assume that a learner
will quickly learn to create novel sentences for numerous communicative functions as the initial
goal with an SGD, the team may consider the ability to spontaneously request desired items to be
meaningful. The ability to express a single, novel thought may also be considered an important
goal.
It is important to preface these steps with a reminder that lower-tech options are
available, such as static devices or easily accessed recordable devices, such as
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Key chains recorded with a single message like, "I need a break" or
Picture frames holding a photo of a book, with the message, "Will you read to me?"
These lower-tech devices can be explored prior to purchasing a more costly device.
These same steps can be used with both lower-tech and high-end devices, and
experimentation with different devices prior to a major purchase is recommended.
Step 1. Identifying and Setting up the
Device
In Step 1, teachers/practitioners and caregivers focus on identifying an appropriate SGD
device for the learner with ASD by taking into account a number of factors, including
learner needs and characteristics, and available training and technical assistance.
Teachers/practitioners and caregivers select an appropriate device, taking into account
how the information is displayed, the learner's present and potential abilities (e.g.,
attention span, experience with symbols, ability to establish joint attention), portability of
the device, available training and technical assistance, and funding sources.
Teachers/practitioners and caregivers also choose a number of symbols in the visual field
that the learner will be able to discriminate easily by considering the learner's attention
span, experience with symbols, and ability to establish joint attention (Ogletree & Harn,
2001).
Teachers/practitioners introduce the device to the learner by having a device with few
symbols and/or buttons with nothing on them. To begin, teachers/practitioners introduce
a single symbol and have buttons with nothing on them to introduce the idea that the
symbol, not the button, is the important factor.
Teachers/practitioners include desirable and undesirable symbols to facilitate the learner's
ability to discriminate. When a desired symbol is paired with an undesirable symbol, or
a somewhat aversive object symbol, the learner may more efficiently attend to the
symbol and discriminate between symbol choices.
Step 2. Introducing Direct Support
Persons to the Device
In Step 2, teachers/practitioners identify direct support persons and train them on how
to use the identified SGD.
Team members, including family members, are identified and trained in how to program
and use the device.
Persons who will be using and/or supporting the device participate in training offered by
the manufacturer.
One or two key members of the team are identified as primary contacts regarding use of
the device.
One team member may be designated as the primary contact with the manufacturer
and as the go-to person when the device is not working properly.
Step 3. Identifying Environments Where
the Device Will Initially Be Used and with
which Communication Partners
The device is introduced during familiar routines that allow for frequent communicative
attempts (e.g., circle time, English class, snack, lunch, free play).
Initial environments should involve routines that provide opportunities for frequent
communicative attempts and that are generally positive for the learner. For example,
snack and free-choice time provide opportunities for practicing requests with a SGD.
Show and tell, circle time, and functional jobs (e.g., mail delivery) provide opportunities
to practice social greetings or comments.
Step 4. Identifying Vocabulary
Appropriate to the Learner and the
Environments
In Step 4, teachers/practitioners focus on identifying age- and developmentally
appropriate vocabulary that can be used in the identified environments.
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Words and phrases are age-appropriate.
Words and phrases are meaningful and motivating for the learner.
Words and phrases serve an identifiable communicative function (e.g., greeting,
requesting).
Identified words should be age-appropriate and meaningful to learners and their
communicative partners, and should serve an identified communicative function (e.g.,
requesting, greeting, protesting). Vocabulary should be motivating to learners and
applicable to their daily lives (e.g., vocabulary related to daily routines, curriculum,
and/or activities outside of school). The entire team, including parents, should be
involved in the selection of vocabulary. For example, a classroom teacher might
suggest that color and animal words would be appropriate for an Eric Carle author unit
(so that the child can participate in a choral reading of Brown Bear, Brown Bear), or a
parent might request words specific to a worship service in which the family participates
(e.g., greeting others in the pew). Teachers/practitioners and caregivers should refer to
their speech-language pathologists and/or assistive technology specialists for more
information on how to choose vocabulary specifically for certain learners and/or specific
devices.
Step 5. Allowing the Learner to Explore
the Device
In Step 5, teachers/practitioners and caregivers provide opportunities and sufficient time
for learners to explore and become familiar with the device.
Teachers/practitioners give the learner an opportunity to independently explore the device.
Step 6. Setting up Communicative
Opportunities
While SGD use should take place in natural environments, some level of individualized
instruction is required to introduce the device. For requesting, options depend on the
skills of the learner. Some learners need the actual objects displayed (e.g., crackers,
apple slices, juice on a tray out of the student's reach), while others may already be
aware of options by virtue of the location or the time of day.
Teachers/practitioners thoughtfully arrange opportunities within naturally occurring
environments that provide cues and motivation necessary for the learner's success (e.g.,
takes into account materials needed and needs of individual learners, places out of reach).
It can be helpful to think of this step as a form of environmental "sabotage;" that is,
interfering with a desired outcome so that the learner is motivated to communicate. For
example, desired snacks may be placed on a high shelf or the computer mouse may be
missing when the learner tries to play a video game. Teachers/practitioners and
caregivers must challenge learners to communicate, while not frustrating them to the
point that they shut down.
Teachers/practitioners and caregivers use frequent questioning to facilitate communicative
exchanges during routines and activities.
Frequent questioning also can be used to encourage communication if symbols are
available for the learner to respond to the questions. The following example illustrates
how numerous communicative opportunities may be provided with a single activity.
Teacher: "What do you want to do?"
Learner (via SGD): "Ball."
Teacher: "What do you want to do on the ball?"
Learner: "Bounce."
Teacher: "How many times do you want to bounce?"
Learner: "Five."
Teachers/practitioners instruct peers in how to respond to learners' SGD use (e.g.,
responding to learner rather than teacher). Some peers made need instruction or
encouragement on how to initiate with an individual who has a SGD.
For social interactions, classmates need to be introduced to the device before it is used.
Classmates and staff also need instruction regarding how to respond to the learner's
SGD (e.g., respond to the learner rather than to the teacher or assistant).
Step 7. Providing Only as Many Prompts
as the Learner Requires
Teachers/practitioners and caregivers begin the communicative exchange by using only
prompts that the learner needs (e.g.,hand-over-hand assistance when a more subtle prompt
would suffice).
Providing prompts from least to most restrictive prevents the teacher from providing
more support than the learner needs. For example, some learners may need the
teacher to point directly at the appropriate icon, while others may need the teacher to
point to the device. Still other learners just need to be asked, "What do you want?" After
a few trials, teachers/practitioners should try using less restrictive prompts.
Teachers/practitioners and caregivers allow wait time (i.e., approximately 4-5 seconds)
before using a prompt, depending on the needs of the learner.
Some learners with ASD, while not yet able to initiate SGD use, eventually respond to
cues as subtle as a communicative partner glancing at the device. Adequate wait time
(e.g., 5-10 seconds) should be provided, allowing the learner time to scan the pictures
and choose the one that is appropriate.
Teachers/practitioners and caregivers should be mindful that for some learners, it is
best to avoid physical touch. Cues, such as hovering a hand over the desired symbol
and/or shining a flashlight on the desired symbol, may prevent a "Here's my hand, tell
me what I want" dilemma.
Step 8. Honoring the Communication
After the learner has communicated a request, teachers/practitioners immediately grant
the request even if it is not a desired item, object, or action.
Initially, when learners make a request, the request should always be granted. For
some learners, it may be necessary to remove or hide pictures of activities or objects
that are inappropriate at certain times. If a child initiates a different kind of
communicative function, teachers/practitioners and caregivers should respond to the
learner's communication as if it were intentional and purposeful, even if it is suspected
that the communication was not intentional.
After the learner fluently uses the SGD, teachers/practitioners and caregivers can
introduce the concept that sometimes a choice is no longer an option.
As learners become more familiar with the SGD, it may be appropriate, even necessary,
to say, "We're all done with ____. Make another choice." Or to encourage interactions
with a variety of activities, a statement, such as, "It is time to select another choice" may
be used. At the same time, remember that the overall goal is communication.
Teachers/practitioners and caregivers give learners choices during routines/activities and
follow their lead when appropriate communication is used (e.g., staying on playground to
swing, playing on computer during reading time).
It may be more important to have students independently make choices and control
their environments than participating in their regular routines. For example, if a learner
requests, "More swing" when the rest of the class is heading inside, you may want to
consider letting her stay on the playground for a few more minutes.
If learners become frustrated because their choices do not match the intended request,
teachers/practitioners and caregivers should use their best judgment to determine the
appropriate course of action. Frequently, this is a prime opportunity for learning. By
simply giving the learner the requested item (even if the request did not match the
learner's intention), it may quickly become clear that certain icons can be used to obtain
highly desired objects or activities. At other times, learners may become so frustrated
that they cannot learn. When this happens, it may be best to use cues or modeling to
correct the error to help them secure the desired item. These introductory lessons help
develop meaningful choice-making, rather than simply pushing icons because the
student understands that this is the expectation.
Step 9. Reducing Prompts as Soon as
Possible
Spontaneous use of the SGD can be particularly challenging for learners with ASD
because they may become dependent on the prompts, or cues, teachers and other
practitioners use to facilitate their use of the device. The most natural prompts are
verbalizations directed at the learner, such as, "What do you want?" or "What did you
bring to show us today?"
After a few successful trials, teachers/practitioners use a less-restrictive prompt and
provide pause time (i.e., 4-5 seconds) in which the learner may activate the SGD.
Allowing sufficient wait time for learners to respond is extremely important. Learners
must be given opportunities to activate the SGD independently.
Teachers/practitioners are aware of learners' attention, frustration, and motivation and
adjust demands during routines/activities accordingly (e.g., more/less intensive prompts,
more/less wait time).
Professionals should use their best judgment to determine the length of the wait time by
considering learners' attention spans, motor planning abilities, and temperaments (Light,
Roberts, Dimarco, & Greiner, 1998). Although it can be difficult, quietly waiting is an
enormously valuable teaching tool. If after waiting an appropriate amount of time,
learners do not initiate use of the SGD, professionals may provide a high-level prompt
(i.e., less restrictive), such as asking a question or gesturing toward the options (e.g.,
pointing at the snacks available). Again, teachers/practitioners should wait to see if
learners activate the SGD independently. If not, a more direct prompt (i.e., more
restrictive) should be provided, such as pointing to the device or giving a verbal
direction (e.g., "Use your VantageTM and tell me what you want"). After the second
prompt, teachers/practitioners and caregivers should wait again. If learners still do not
activate the SGD, teachers/practitioners and caregivers should be even more direct by
providing a more restrictive prompt (e.g., pointing to the desired symbol).
Modeling is another way to encourage SGD use. Learners may be grouped with peers
who have been taught to use the SGD or peers who are successful with their own SGD.
For example, learners may all take turns requesting snack. If learners with ASD observe
peers using the SGD independently, they may be more apt to do so.
Please refer to the AIM module on Prompting for more information on this topic.
Step 10. Increasing the Number of
Environments Where SGD is Used
Teachers/practitioners and caregivers provide opportunities for the learner to use the SGD
in environments around the school, at home, and/or in the community.
As the learner becomes more comfortable with the SGD, its use in other activities and
settings should be encouraged to promote generalization. Environments may include
different classrooms, work places, home, or community settings (e.g., restaurants,
stores, bowling alleys, movie theaters).
Teachers/practitioners encourage the use of the SGD with multiple communicative
partners.
Learners should also be encouraged to use their SGD with multiple conversational
partners. In some instances, learners may become too comfortable using their SGD
with a single communicative partner (e.g., assistant, speech-language pathologist) and
may have difficulty generalizing SGD use to different people.
Step 11: Increasing Vocabulary
Teachers/practitioners and caregivers increase the number of symbols in a single field as
the learner becomes more proficient with the device.
Teachers/practitioners and caregivers increase the number of overlays as the learner
becomes more proficient with the device.
Depending on the device, this may be accomplished by adding novel overlays and/or
adding vocabulary to an existing overlay (i.e., increasing the field). Another strategy for
increasing expressive vocabulary is to encourage the use of modifiers by offering items
that differ by only one attribute (e.g., "Do you want the big cookie or the little cookie?"
"Do you want the red Lego or the blue Lego?"). The ability to use descriptive words
allows learners to create utterances that are novel, flexible, and more specific.
Increasing vocabulary may require that a new device be obtained and taught to the
learner. For example, if the learner has demonstrated the ability to use the maximum
number of icons on a static device, acquiring a more dynamic device may be
appropriate.
Teachers/practitioners and caregivers obtain a new device as the learner's need requires.
After learners are able to use their device efficiently, teachers/practitioners should
consider upgrading to a more complex device. For example, if learners are using all four
overlays on a GoTalk4 and their team believes they could use more pictures, new
devices (perhaps one with a dynamic screen) should be considered. Some of the more
complex devices have considerable capacity. Therefore, the team must constantly
update vocabulary and make certain that the learner understands how to access it.
If learners can successfully push single buttons to activate a phrase, sentence buildingoptions should be considered. With this skill, learners push separate buttons or icons for
I, want, and juice. To teach these skills, teachers/ practitioners and caregivers may
need to initially use cues such as hovering over an icon or pointing. To start,
teachers/practitioners may need to provide learners with a few basic sentences that
require only two buttons: "I want" / ____, "More" / ____, "I see" / ____. Different devices
(e.g., one with more icons) may be required to teach this skill.
Case Study Examples
The authors have provided two examples that discuss use of speech generating
devices. Charlie, a 7-year-old first grader uses a SGD to protest and to greet. Tasha, a
14-year-old high school student wtih PDD-NOS, is verbal, but does not like speaking to
unfamiliar adults, and therefore the team is considering SGDs for her.
Charlie
Case Study: Charlie
Charlie is a 7-year-old first grader with ASD. He was diagnosed at age 3, and has
received speech therapy, occupational therapy, and special education services since
that time. He is presently included in a general education first-grade classroom but
frequently leaves the room for breaks and some therapies. A special education
assistant in his classroom provides support for Charlie and another student with
disabilities. Charlie is nonverbal, but he uses an SGD to protest and to greet. He points
and/or leads an adult by the hand to request. Charlie sometimes imitates signs and
inconsistently uses "more," "swing," and "eat" spontaneously. However, it can be
difficult to discriminate these signs from his extraneous hand movements, and his
teachers have struggled to get Charlie to use more signs independently. Charlie has
used a BIGmack switch occasionally in his preschool and kindergarten classrooms to
make requests at snack and to participate in circle time. He usually needs an initial
prompt to use it by having a teacher or an assistant point at the device. Charlie uses a
picture schedule (with photographs) during the day and responds well to the pictures.
Charlie's parents hope that he can learn to make specific requests, especially when he
gets home from school and is hungry for a snack. Finally, Charlie's first-grade teacher,
Mr. P, is excited to have peers read to Charlie during DEAR (Drop Everything and
Read) time (i.e., free reading time) and has wondered if there is any way to support
Charlie's participation more in this activity.
Charlie's speech-language pathologist, Ms. K, decides that a more complex SGD may
help increase Charlie's expressive language. She knows that he has had some success
with the BIGmack and that he is motivated to make requests. He responds well to the
pictures on his daily schedule, and Ms. K. wonders if he would respond as well to line
drawings from Boardmaker(TM). She asks his assistant to find out if Charlie can match
line drawings of snack items to actual snack foods by presenting the line drawing to
Charlie and asking him to put it next to the matching food item (with four items on the
table). After just a few trials, Charlie is successful with very familiar foods, such as
cookies, chips, and a juice box. Ms. K decides that she will try a GoTalk4 with Charlie
because it is portable (can be used at school and at home) and affordable. The district
already owns one of these devices, so Charlie can try it out for a while to see if indeed it
is a good fit.
The GoTalk4 stores four overlays with four messages on each. In preparing for the new
SGD, Ms. K reviews Charlie's day and talks with his parents and teachers about when
they think he may use the device. She decides to start with two overlays: one for snack
choices and one for DEAR time. She uses BoardmakerTM to make a snack board with
the following messages: "I want chips," "I want a cookie," "I want apple slices," and "I
want popcorn." The DEAR board contains these messages: "Will you read me a book?"
"Read more, please." "I'm all done reading." and "Thank you!"
During snack time at school, Charlie's assistant ensures that all of the choices are
available. Ms. K introduces the device by setting it on the table in front of Charlie. She
waits for him to explore the device. After a minute or so, she asks, "Charlie, what do you
want?" and points to the device. Charlie points to the chip and activates the voice
output. Ms. K gives Charlie a chip, and he is quite pleased. He touches the GoTalk4
again, this time activating the apple selection. Ms. K gives Charlie an apple slice, and
he protests by pushing it off the table and vocalizing. Ms. K decides to play dumb and
simply says, "You said you wanted apple slices. What do you want?" while pointing to
the device. Charlie looks at the pictures and pushes the chip. This continues for the
duration of snack. Charlie does not select apple slices again, but does ask for a cookie.
Charlie continues to use the GoTalk4 during snack time at school and at home. At this
time, the GoTalk4 is introduced to Charlie's classmate. They learn how Charlie
communicates with the device and how to respond to him. They learn that talking with a
peers who has a communication device is very similar to talking to any classmate.
During DEAR, Charlie's assistant helps him use the GoTalk4 to ask a peer to read to
him by leading him over to a pre-selected peer and using hand-over-hand to push the
"Will you read to me?" button. The peer agrees, and they go to the corner to read. At
the end of the book, Charlie gets up to walk away. The assistant says, "Charlie, do you
want another book or are you all done?" and points to the "all done" and "more reading"
pictures. Charlie pushes "All done" (with questionable purposefulness). The assistant
says, "OK ... we're all done. Tell Brian, "Thank you!" She takes Charlie's hand to push
"Thank you" before he walks away.
Charlie's team continues to use the overlays for snack and DEAR. Charlie quickly
becomes independent in requesting snack choices. He requires a physical prompt to
use the DEAR overlay, although he does request, "Will you read to me?" with a simple
verbal cue. Ms. K decides to make another snack overlay to give Charlie more choices.
She also makes an overlay for break choices, including "I want to swing." "I want to
jump." "I want to go for a walk." and "I want to do a puzzle." As with the snack requests,
Charlie quickly learns these choices and uses the board purposefully.
Charlie and his team continue with the GoTalk4 consistently for six months. Because
most of Charlie's highly motivating choices are already represented, the team agrees
that the GoTalk4 has met his needs. However, Ms. K wants to increase his field of
options. She is able to obtain a GoTalk9+ for Charlie, allowing him to have all of his
snack choices available at the same time. It also has room for five overlays, and Ms. K
develops a new overlay Charlie can use during one of his new jobs: delivering mail to
staff in the afternoon. She puts several messages on the board, any of which would be
an appropriate greeting when Charlie hands over the mail, like "Catch ya later!" "Have a
great day!" and "See ya!" Charlie is pleased to activate these buttons after his assistant
provides a visual prompt by pointing at the device. He also enjoys the smiles and verbal
replies he gets from staff members.
Charlie's parents also have been using the GoTalk9+ at home for snack. Previously,
Charlie arrived home tired and hungry, and he quickly became frustrated when his mom
gave him the wrong snack. The GoTalk9+ has allowed their after-school time to be
much more pleasant. His mother also reports that they have occasionally taken the
GoTalk9+ to church and that they have used the "mail delivery" page to say goodbye to
friends and teachers at Sunday school.
The team decides that the GoTalk9+ meets Charlie's current needs and has capacity to
build on his skills in the future. He uses the GoTalk9+ independently to make choices
for snack and breaks and for social greetings during a routine part of his afternoon. In
addition, Charlie uses it for interactions with peers during DEAR time. He has begun
generalizing its use to home and the community. Although the level of prompting
required for each communicative function varies, the SGD allows Charlie to verbally
participate throughout his day. Because a fifth overlay is available and not all nine
buttons have pictures on all the overlays, Ms. K feels that there are opportunities to
increase both vocabulary and environments in which the SGD can be used.
Tasha
Case Study: Tasha
Tasha is a 14-year-old high school student with pervasive developmental disorder-not
otherwise specified (PDD-NOS). She is included with her general education peers
during physical education, music, and art classes. She participates in a reading group
with other special education students that focuses primarily on functional reading skills.
She likes this group of students and considers two of them her friends. Tasha enjoys
younger children, and she works as an assistant in the district's early childhood
classroom once a week. Tasha is verbal, but she does not like speaking to unfamiliar
adults and can be difficult to understand when utterances are out of context. She uses
two- to four-word utterances to make requests, protest, call attention, and greet. She
understands language at a level that falls just below the average range for her age. She
has tried a variety of the district's SGDs in the past, but was easily discouraged and
preferred using her limited verbal language instead.
Tasha's case manager, Miss V, recognizes Tasha's potential for work and recreation in
the community; however, she wishes that Tasha could verbally participate with peers,
teachers, and community members. She wonders if Tasha would be able to use a
dynamic screen SGD, and if having access to a larger vocabulary and the opportunity to
create novel sentences might be motivating to her.
Miss V calls Tasha's mother to talk about her ideas and to let her know that they can
borrow a device from state agencies if they decide to move forward with the SGD.
Tasha's mother is confused and does not understand why Tasha needs a machine to
talk for her when she can talk for herself. When Miss V explains that she thinks that the
device would be especially useful when Tasha interacts with less familiar people, her
mother agrees that the SGD might be beneficial.
After Miss V acquires a VantageTM system from a state educational agency, she shows
it to Tasha. She tells her that the device is like a computer that she can take anywhere.
Together, they download some of Tasha's favorite music onto the device's MP3 player.
Miss V introduces Tasha to the home screen and shows her how to use the device to
make requests and get attention. They sit together and develop an "introduction page"
with Tasha's name, the names of her pets, and some of her favorite things. They take
the device to her reading group where she practices introducing herself. Her classmates
think the device is cool, and Tasha is happy to show it off. Miss V allows Tasha to tinker
with the device much of the week so that she begins to figure out the layout. When
Tasha has time with an assistant or the speech therapist, they work with the device
together - finding vocabulary and practicing how to use it with unfamiliar people through
role play. For example, they found pictures of clothing and then used them to
compliment each other and some peers with the phrases "Nice shirt!" and "Cool shoes!"
Miss V decides that it would be good for Tasha to use the Vantage TM during her job at a
preschool where Tasha's tasks are usually nonverbal: passing out paintbrushes,
organizing the block shelf, and wiping tables. The preschool teacher and Miss V decide
to let Tasha call the children to line up after circle time. Miss V and Tasha practice in the
resource room and then bring the VantageTM to the classroom. Initially, Miss V cues
Tasha to call a child; however, Tasha catches on quickly and continues through the
class: "Line up, Eric. Line up, Chrissa. Line up, Juan." The children are thrilled and love
to be called on by Tasha. Miss V hopes that as Tasha's comfort with the Vantage TM
increases, she will be able to call on learners based on attributes, as their teacher does
(e.g., "Line up if you are wearing red"). The preschool teacher and Miss V identify other
jobs where Tasha could use the SGD, such as reading simple books to a small group,
and asking a group question at circle time and then calling on individual children to
answer it.
Back at school, Tasha's reading group often goes on community outings where they
have opportunities to read functional material like menus and environmental signs.
Tasha begins bringing the VantageTM on these outings and becomes more comfortable
ordering food from and asking questions of unfamiliar people. If she cannot find the
appropriate word on her VantageTM, she says it out loud to the accompanying adult who
usually understands and can help her locate the word on the device (since she is
familiar with Tasha). These community-based learning opportunities help Tasha
generalize use of the VantageTM to environments outside of school.
Tasha also brings the VantageTM home occasionally, but her mother reports that she
does not always use it because she and Tasha understand each other without the
device. However, her mother has been able to meet Tasha for lunch in the community
and has been delighted to see Tasha order her food independently.
Tasha's team has been so pleased to see her use more verbal exchanges with the
SGD. She is able to use the VantageTM in the workplace, in her classroom, and in the
community. She uses it to request items, information, and actions, as well as to
describe objects and activities and use social greetings. Because Tasha was already
verbal, Miss V identified ways to make using the device meaningful. By letting her
download music, show it off to her friends, and call it a laptop, Miss V made the device
work for Tasha. Rather than seeing it as something to slow her down, it became a cool
way for Tasha to expand her communicative abilities.
Summary
According to evidence-based studies, SGDs are effective in increasing expressive
language for learners with ASD who struggle with verbal speech. To ensure that SGDs
are used successfully, professionals must consider many factors, such as vocabulary
that is motivating to learners and how many symbols learners are able to discriminate at
one time. Environments where the device will be used should include familiar routines
and activities that are arranged to encourage communicative opportunities. The device
should be used across multiple environments and with different communicative partners
to encourage generalization and maintenance of skills. When teaching learners to use
an SGD, cues and other prompting strategies should be as subtle as possible so that
learners do not become dependent upon teachers and other practitioners during
communicative exchanges.
Frequently Asked Questions (FAQs)
Q. Won't the use of an augmentative and alternative communication (AAC) device such as
an SGD interfere with verbal development?
A. This is a common concern; however, the available research indicates that AAC, such
as an SGD, facilitates verbal language by improving interaction or providing a model for
speech (Cress, 1997; Romski et al., in press). Learners will likely use the most effective
and efficient means of communication available to them.
Q. Does a learner need to be at a certain cognitive stage before an SGD is tried?
A. In the past, many educators felt that learners needed to have certain cognitive
prerequisites before they were considered candidates for AAC such as an SGD.
However, this is no longer a common assumption. Early AAC intervention builds on a
learner's current behaviors/actions/gestures, which are then shaped into skills for
communication. AAC training does not depend on the ability to understand abstract
symbols or use complex devices. Clearly, the learner's cognitive abilities will influence
decision-making about which device is most appropriate.
Q. If a learner appears to have no interest in communicating, should an SGD still be used?
A. When deciding whether to use an SGD, teachers/practitioners closely examine
learners' communicative styles and try to find out what motivates them. Sometimes it is
difficult to identify those interests. SGD intervention can be very powerful when
teachers/practitioners identify an appropriate device and situations where the learner is
motivated to communicate. When an SGD is used, teachers/practitioners should adapt
the environment, modify activities, and alter routines to create learning opportunities
that are motivating for a given learner. For some learners with ASD, giving them
opportunities to request activities that are sometimes discouraged (e.g., self-stimulatory
behaviors like fiddling with beads or jumping) may be particularly powerful.
Q. What should we do if a learner isn't using his SGD? Should a different device be
purchased?
A. It is easy to become distracted by costly equipment and technology and forget that
people teach communication, not technology. A device will not provide motivation if it is
not part of highly motivating communication opportunities. Therefore, poor use of a
device is more likely due to the vocabulary that is selected and whether the individual
uses it to initiate requests and comments rather than merely respond to questions.
Discussion Questions
[ Export PDF with Answers | Export PDF without Answers ]
1. Why are SGDs a good communicative option for many
individuals with ASD?
A correct answer will include the following:
o
Deficits in communication skills are a defining feature of autism.
o
o
SGDs provide a way for individuals with ASD to express wants and
needs, and, for some, more sophisticated communicative functions.
SGDs provide an intelligible means of communication for learners with
ASD to engage in give and take interactions with individuals who may not
be familiar with the characteristics of ASD.
o
SGDs allow learners to be independent communicators.
2. Why is it sometimes a good idea to teach SGD use with a
learner who is verbal?
A correct answer will include the following:
o
o
o
o
SGDs may be useful for learners who have reduced intelligibility or whose
use of another alternative communication system, such as signing, is
imprecise or inconsistent.
The use of an SGD allows learners with ASD to be easily understood by
those who do not know them and may reduce frustration associated with
unsuccessful communicative attempts.
Learners with ASD may be more comfortable using an SGD than their
verbal speech.
The use of an SGD may increase generalized communication across a
variety of familiar and novel partners and settings.
3. Who is involved in SGD training? Also, are there any
special skills required to teach SGD use?
A correct answer will include the following:
o
o
o
A speech-language pathologist working directly with the learner may best
implement initial training.
It is ideal to find an AAC/SGD specialist who can introduce the device.
Other team members, including professionals, parents, caregivers, family
members, and/or peers should also be involved in the training and use of
the device so that it can be used functionally across a variety of
environments.
4. Why is it important to do some homework prior to choosing
a particular SGD device?
A correct answer will include the following:
o
o
o
o
Information about the type of display to use on the device (i.e., static vs.
dynamic), how the learner will access vocabulary, and how many options
will be available to the learner should be gathered before using an SGD.
Additional decisions on the portability of the device should be made prior
to choosing a particular system. The learner's skills and preferences will
determine the appropriate size and weight of the device and the variety of
communication options.
Before purchasing a device, contact the manufacturer to find out about
training and technical support. Some offer it as part of the purchase price;
others charge an additional fee. This is an important consideration to
ensure that a device that is both affordable and functional is chosen for a
learner.
Be aware of funding sources for SGDs. These may include monies
available through the school, via third parties such as private insurance or
Medicaid, or through grants.
5.
Post-Assessment
7. Post-Assessment
8. Decisions regarding appropriate augmentative and alternative communication
(AAC) techniques for a specific individual are based on
9. Select an answer for question 606
10. Speech Generating Devices (SGD) are only for individuals who have previous
experience using AAC devices.
11. Select an answer for question 607
12. An SGD should not be used with individuals who use sign language or other AAC
systems.
13. Select an answer for question 608
14. When introducing an SGD to a learner, how many symbols should initially be
presented?
15. Select an answer for question 609
16. An SGD can be used in which environments?
17. Select an answer for question 610
18. SGD use should be discontinued if the learner starts using verbal language.
19. Select an answer for question 611