Narratives of Children who Need AAC: Assessment and Intervention Considerations
Dr. Gloria Soto Department of Special Education and Communication Disorders San Francisco State University
Acknowledgements
• • • • • • • • • • Elizabeth Hartmann, UCB and SFSU Solana Henneberry, SFSU Emily Mintz, UCB and SFSU Betty Yu, UCB and SFSU Jennifer Morton, SFSU Michele Caputo, SFSU Elena Dukhovny, UCB and SFSU Patti Solomon-Rice, UCB and SFSU Dr. David Wilkins, Center for Aphasia, VA Dr. Nicola Grove, City College, London
What is Narrative?
• A form of extended discourse, which minimally requires the expression of two different events in a way that clearly presents the relationship between them (be it causal, temporal, elaborative or some other) (Ninio & Snow, 1996). A form of discourse that allows the speaker to give interpretative meaning to a sequence of events (Labov, 1972). Implicit in all forms of narrative is the unfolding of events through time (Nelson, 1996).
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Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Narrative Structure
• Affected by age, culture, gender and context • Affected by genre: personal (often conversational) fictional (often monologic) • In its full form, fictional narrative includes orientation (setting, participants), initiating event, internal response by the protagonists, consequence, eventual resolution and evaluation
Implications for Development
• • • • • Cognitive (event schemas) Emotional (socialization and psyque) Memory Social (identity and friendships) Academic: – literacy
Implications for Literacy Development
• Readers depend on background knowledge to comprehend the story:
– Make simple inferences: implicit why? – Establish causal connections: explicit why? – Predict and generate plans: what will happen next? – Track participants' goals, thoughts, feelings – Recognize thematic relationships between individuals and society – Employ beliefs about the world in understanding – Access and utilize raw facts
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Narrative Development
The ability to produce full narratives emerges developmentally out of more basic interactional discourses (e.g., conversations, play, sharedbook reading) in which the child and supporting adults increasingly engage in true conversation about topics in the here and now, in the real but not present and in the fantasy world.
Implications for AAC
• Children who use AAC may be at risk of impaired narrative ability: – Limited expressive vocabulary – Limited access to authentic autonomous conversations – Limited opportunities for story telling – Limited opportunities for fantasy play – Lack of explicit instruction – Problems with their devices
Narrative Assessment
• AAC users have been found to produce shorter narratives characterized by fewer complete episodes, single-word utterances, short sentences, weak cohesion, and many communication breakdowns in the form of repairs and partner co-construction (Soto & Hartmann, 2006; Grove & Tucker, 2003) • We have also identified problems with poor vocabulary, story grammar, referencing, and elaboration.
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Assessment Considerations
• • • • What to assess? Personal/ Fictional How to assess? Elicitation Task What to transcribe? Paralinguistic modalities How to analyze the sample? What framework?
– Structural : high point analysis, story grammar constituents, stanza/cluster analysis – Discourse coherence and cohesiveness
Narrative Assessment Profile (Bliss, McCabe & Miranda, 1998)
• Topic maintenance: are all utterances related to a central topic? • Event sequencing: are the events presented in chronological order? • Explicitness: is the narrative sufficiently elaborated? • Referencing: are individuals, locations and events appropriately identified? • Conjunctive cohesion: are events linked using coordination, temporal links, causality, enabling, disjuncture or pragmatic links? • Fluency: is the production fluent?
Narrative Assessment Profile Study
• Purpose: to describe the use of narratives by four (4) children who experience severe speech and physical impairments and use augmentative communication systems. • Our subjects (a) use an AAC system to communicate; (b) are between the ages of 6 and 12; (c) have normal hearing and vision; (d) have a severe dysarthria affecting communication such that speech was not sufficient for advanced conversation; and (e) have no diagnosis of cognitive impairment.
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Heidi
• 9 year old • Muscular Atrophy • Dynavox which she accesses with a toggle switch
Sophie
• 11 year old • Cerebral Palsy • Dynavox which she accesses directly with her left hand
Anna
• 9 year old • Muscular dystrophy • Dynamite with Dynawrite which she accesses with her right hand
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Dave
• 5:6 year old • Cerebral palsy • Picture Board which he accesses with right hand
Elicitation Tasks
• • • • • Photo Description Shared Book Reading Conversational Narrative Story Stem Wordless Picture Books
Results
• Problems with coherence – “music”, “guitar”, “friends”, “eight”, “pretty”, “flower”, “white”, “one”, “blue”,“picture”, “doll”, “my little pony”, “book”, “cupcake”
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Results
Problems with fluency:
Results
Problems with connectives:
Results- NAP
• Topic maintenance: clear strength • Event sequencing: mostly single word utterances; no temporal devices. • Explicitness: differences by age. Younger subjects produced incomplete and incoherent narratives. • Referencing: differences by age. Younger subjects used no pronouns. Poor use of available vocabulary. • Conjunctive cohesion: “and” was the only linking device used. • Fluency: over reliance on yes/no questions and coconstruction
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Narrative Intervention
• Each dimension of NAP becomes an area of immediate concern • Narrative intervention needs to be multifaceted: – provision of a wide range of narrative opportunities and experiences, – appropriate listener responses, – support for the children’s own recruitment of a range of linguistic and communicative resources to structure and elaborate information
Pilot Intervention Study
• Heidi and Sophie • 6 weeks intensive • Everyday a narrative intervention activity: – Reading and retelling – Personal narrative – Fictional narrative
Our intervention
I. storybook reading and retelling assisted by the use of a story map targeting main story elements
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Our intervention
II. Personal storytelling supported by commercially available fill in the blank stories
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Our intervention
III.Fictional storytelling supported by the use of story elements provided by the clinician – Actions- What happened? – Settings- Where? – Characters- Who? – Causes- Why? – Modals- How?
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Our intervention
IV. Throughout each session, use of contingent queries and verbal redirection by the clinician to indicate that a narrative is not explicit enough:
• “Tell me more about” • “Tell me why you went to grandma’s house” • “How did you feel when she said that?”
Our intervention
V. Throughout each session, modeling by the teacher/clinician of the use of an overlay with strategic vocabulary to assist our subjects to convey meaning when a desired symbol is not available
Strategic Vocabulary
• “What I want to say is not on my device”:
– What I want to say starts with – What I want to say is similar to – What I want to say is opposite of – What I want to say sounds like – What I want to say is the action of – What I want to say is the noun of
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Our intervention
VI. Throughout each session, the teacher/clinician wrote everything our subjects were saying on a large board to assist them with story recall.
Results-Heidi
• Every three sessions, Heidi participated in a generalization probe: She had to “read” a novel picture story. • The last three generalization probes, we asked her to generate a story from a verbal story prompt, e.g., Imagine that your favorite cartoon character came to visit….
Results Heidi-Probe 1
“cat” “going” “fishing” “get” “a fish” “fire” “make” “fish” “cat” “dinner”
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Results Heidi-Probe 3
“he” “is” “sleeping” “and” “daydream” (no) “nightmare” (no) “what I want to say is not on my device”, “What I want to say is similar to” “daydream” “about” “a” “girl” “What I want to say is not on my device” “get up”
Results Heidi-Probe 6
• When asked to imagine a trip to the zoo: “Think”…“I” “went” “to” “the” “zoo” “minute” “A” “Lion” “what I want to say starts with r (run)” “away” “I” “go” “home” “I” “think” “about” “the” “lion” “I” “go” “to” “the” “forest” “for” “a” “walk” “Tree” “I” “sit” “near” “it” “I” “hear” “a” “lion” “I” “look” “on” “rock” “I” “see” “the” “lion” “sleep” “I” “think”..
Results -Sophie-Baseline
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Results-Probe 4-Sophie
• Imagine you’re left home alone, during a bad storm! Tell me what happened. “It” “was” “tornados. ” “ I” “ was” “ very” “scared.” “But” “ my” “ family” “ came”. “They” “ help” “ me.” “Then” “ you” “ help” “me. ” “ I” “ felt” “ very” “excited”.
Results- Last Probe-Sophie
Remember a time you went to the mall. Tell us about it. “I” “have” “money” “billion” “dollars” “I” “like” “buying” “clothes” “at” “the” “mall” “and” “jewelry” “too” “outside” “I” “felt” “so” “excited.” “I” “am” “done.”
Yet, when supported…
• Once upon a time a doctor bought flies and spiders at the pet store. She wanted to eat them. But a scientist thought it was yuck. He gave money to her for food. She felt excited because she wanted money for clothes. So she gave flies and spiders to the scientist. She tricked him. She bought clothes not food. She felt happy. The end
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Sophie’s Data Personal
Sophie’s Data Fictional
Discussion
• We are not able to draw conclusions regarding the relative contributions of the various treatment components. • Yet, it is clear that our subjects’ participation in an intensive 6 week intervention (18 sessions total) resulted in a dramatic increase in their ability to narrate independently. • Their narratives are still developing. • Must pay attention to personal event narratives. • Much work remains to be done on the use of specific intervention strategies to support the development of narrative skills in children who use AAC.
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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Guidelines for Intervention
• Parents, clinicians and educators serving children with AAC needs should create supported opportunities for the children to engage in authentic conversations about the nonpresent, fantasy, and past and future events. • Initially the child needs support to provide at least two events in a narrative (McCabe & Bliss, 2003). • Adult needs information to co-narrate (e.g. daily exchange notebook from home) that is, facilitate without overtaking the communication. The clinician serves as a conversational partner.
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Adult needs to indicate that the narrative is not complete/coherent by asking contingent queries and using verbal redirection. Children need vocabulary specific to the narrative, including answer to wh questions – What happened – Where – Why – Who – How Adult needs to highlight/elicit the emotional content of the event the child is narrating (Soto et al., in progress).
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• Experience in a broad range of communicative exchanges seems to be crucial for later autonomous narrative production. Some examples are:
– – – – – – Photo description: e.g. what happened here Retelling of favorite story book Video clip retelling Wordless books: e.g., “the Frog story”, “Good dog Carl” Conversational narrative: find your own daily time Journal writing with graphic scaffold
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Contact Gloria Soto at gsoto@sfsu.edu for bibliography
Soto, G. (2006). Narratives of Children who Need AAC: Assessment and Intervention Considerations. ASHA Convention. Miami.
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