Communication Interventions for

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					       Communication
     Interventions for
Students with Complex
 Communication Needs
Judith L. Page, Ph.D., CCC-SLP, ASHA-F, ATP
               Associate Professor & Director
        Division of Communication Disorders
                       University of Kentucky
What does the
research tell us about
developing
communication?
•   Students with the most significant
    cognitive disabilities can acquire
    generalized use of objects (or object
    selection) to communicate preferences
    (Hetzroni, Rubin, Konkol, 2002).




Research
   Language learners must use symbols
    repeatedly, interactively, and generatively
    during meaningful and ongoing activities
    in language-rich environments
    (Goossens’, Crain, & Elder, 1992; Cafiero,
    1998; Goossens’ et al., 1992; Romiski &
    Sevcik, 1996; Miller & Eller-Miller, 2002;
    Mirenda, 2003).




Research
   Competent use of language for multiple
    purposes, audiences, and contexts
    facilitates the meta-linguistic skills
    required for reading comprehension
    (Rankin, Harwood, & Mirenda, 1994).




Research
   The distribution of students with
    significant cognitive disabilities across
    grades does not appear to indicate
    ◦ Increasing communicative competence
    ◦ Reading skill development beyond sight words
    ◦ Math skill development beyond using a
      calculator
       (Kearns, Towles-Reeves, Kleinert, Kleinert,
         Thomas, in press)




Research
Did you know that
 No research-based studies supported the
  implementation “functional curriculum” prior to its
  implementation in the 1980’s?
 Over 200 research based studies exist for teaching
  academic content.
 No published research studies exist that suggest that
  learning content is harmful.
 The research says that embedding life-skills into
  naturally occurring routines promotes acquisition.
 The foundation for accessing grade-specific academic
  content is in using ecological approaches similar to
  those used in a functional curriculum.
 There is no confirmed or research based curriculum
  progression.
 What        We Know
   Most                                    What        We Know
    Vocabulary                              Least
     acquisition                              Phonemic
    Reading fluency                           awareness
    Reading                                  Phonics
     comprehension                            Algebra
    Numeracy                                 Geometry
    Measurement                              Spatial awareness
    Operations                               Most of Science
    Personal safety
    Weather* not
      included in formal
      studies


Academic Domains in the
Research Literature
Browder, D.M., Wakeman, S., Spooner, F., Ahlgrim-Delzell, L., & Algozzine, B (manuscript
submitted for publication). Research on reading for students with significant cognitive
disabilities. Exceptional Children.
   Students in the Alternate Assessment

   What are their characteristics

   Used the Learning Characteristics
    Inventory

   Results for over 13,000 students in 6
    states across the country


What Do We Know About Students
with Significant Disabilities?
   Learner Characteristics (all on a
    continuum of skills):
   (Kearns, Towels-Reeves, Kleinert, H., & Kleinert, J., 2007)
    Expressive Language
    Receptive Language
    Vision
    Hearing
    Motor
    Engagement
    Health Issues/Attendance
    Reading
    Mathematics
    Use of an Augmentative Communication
     System (dichotomous variable- questions re:
     both form and function)
Learner Characteristics Inventory
          Results of the LCI in the areas of
   Expressive Communication
   Receptive Communication
   Engagement
   AAC usage




Communication Findings
   61-79% of students across the states used true
    “language” in some form to communicate

   Between 13-26% used understandable modes
    such as gestures, point, objects, etc., to
    express intents (illocutionary/emergent
    symbolic)

   7-17% used cries, facial expressions, change in
    muscle tone, etc., to communicate, but no
    regularized gestures, pictures, etc.


    Expressive Communication
   37-56% responded to 1-2 step directions via
    spoken, signed, or printed words without
    additional cues

   34-51% required additional cues to respond to
    directions

   7-13% alerted to sensory input from others, but
    required physical assistance to follow directions

   Across states, approximately 2-3% displayed an
    uncertain response to sensory stimuli

Receptive Language
   Close to 90% of students in the LCI either
    initiated and sustained social interactions
    or at least responded to social interaction.

   6-11% only alerted to other people.

   Less than 2% of students did not alert to
    other people.



Engagement
Use of Augmentative
Communication Systems

   Does your student use an augmentative
    communication system in addition to or
    in place of oral speech?
     Yes
     No
Approximately only 50% of the
 students in the emerging or pre-
 symbolic levels in a seven state
 sample used AAC as part of their
 educational programs.
Fewer than 10% at the symbolic
 level used AAC

AAC Findings
So I Guess
Communication Skills
Increase Across the
Grade Span?
 Elementary School Grade-                Middle School Grade-Band
 Band Expressive Language                  Expressive Language

         12.60%                                    7.90%
                         Presymbolic                           Presymbolic
            20.20%                                    17.60%
                         Emerging                              Emerging
67.20%                                  74.20%
                         Symbolic                              Symbolic
                         Symbolic                              Symbolic




                      High School Grade-Band
                       Expressive Language
                               9.50%
                                       13.20%    Presymbolic

                                                 Emerging
                     76.40%                      Symbolic
                                                 Symbolic
   Expressive Communication at pre and emerging
    symbolic levels across the Grade Bands:
     ◦ Elementary School: 32.8%
        20.3% “emerging symbolic”
        12.6% “pre-symbolic”
     ◦ Middle School: 25.5%
        17.6% “emerging symbolic”
        7.9% “pre-symbolic”)
     ◦ High School: 22.7%
        13.2% “emerging symbolic”
        9.5% “pre-symbolic”)


Change Across the Grade Bands
◦Very few students appear
 to be progressing from
 emerging/pre-symbolic to
 symbolic communication,
 despite a large percentage
 at an emergent level.

Findings of Concern
Differences in Expressive
Communication: Use of
Symbolic Language
   While there were decreases in the number
    or percentage of students labeled as being
    pre-symbolic from elementary to high
    school in some states, were these changes
    statistically significant?
Did Any States Show Significant
Positive Changes from Elementary
to High School (Across the Grade
Band)
 No significant improvement (decrease in number
  or percent) of students who were labeled as
  being pre-symbolic across the grade band for any
  state EXCEPT for State 6.
 The number of students who were labeled “pre-
  symbolic in State 6 dropped from 17% to 4% of
  students in the AA from elementary to high
  school, which was significant at <.0001.
 WHY??
  Percentage of Students Using AAC by Expressive
  Language Levels

80.00%
70.00%
60.00%                                      Symbolic
50.00%
40.00%
30.00%                                      Emerging
20.00%                                      Symbolic
10.00%                                      Presymbolic
 0.00%




Use of Augmentative
Communication Systems
   State 6 had the highest rate of AAC use
    with students at a pre-symbolic level, and

   The lowest percentage of students labeled
    as pre-symbolic by high school, and

   The highest percentage of students labeled
    as symbolic by high school




What Does This Tell Us???
   Without AAC, students may appear to be “pre-symbolic”
    OR will not progress due to lack of use of AAC.

   Students have no way of displaying their actual level of
    cognitive and communication competence if no AAC has
    been offered or established.

   IF the use of AAC is not offered to these students, they are
    less likely to learn and evidence symbolic behaviors.

   IF the use of AAC is offered to these students, with
    appropriate supports and instruction, they have the
    opportunity to LEARN and DEVELOP symbolic
    communication.

Implications of Not Providing Students
with a Symbolic Form of
Communication
   Perhaps there is no more fundamental outcome
    of education than the right and the ability to
    communicate.

   Lack of communication competence is highly
    predictive of poor post-school outcomes (Kleinert
    et al., 2002).

   Academic content is by definition symbolic
    content – access to the general curriculum is
    only meaningful if one can understand and
    express that content.
Let’s Talk About
Communication
Communication
 Bill of Rights
Communication




  Reciprocity
               Communication Modes



Nonverbal             Verbal
• Body language       • Speech
• Facial expression   • Written language
• Gestures/pointing   • Email/texting
• Sign
• Tactile
• Symbols
   DEFINE AND IDENTIFY
    COMMUNICATION – AS A TEAM
    ◦Receptive Communication
    ◦Expressive Communication
    ◦Engagement
    ◦Augmentative/Alternative
     Communication (AAC)

A Problem: HOW DO YOU…
  ◦ Intent = function or thought
  ◦ Topic = content

  ◦ Form/Mode (Type of initiation or response) = form or
    mode of communicative output

  ◦ Expected Response/Reception = communication partner’s
    reaction (dependent upon the understandability of the
    output mode used)




Successful Communication Involves …
             Communication Definition Terms



I/C/F           M/F         ER            LCI
                                          Level
Intent or       Mode or     Expected
Content or      Form        Response
Function                    (Reception)

                                          I

                                          II

                                          III
The Equation
      Successful Communication =

   Intent + Mode of Initiation or
    Response + Listener Comprehension

   BOTH Expressive AND Receptive
    Communication are involved here.
   What do you think?




Must One Communicate With
Real Words???
   Level I: Perlocution (we interpret the “speaker” as
    meaningful), even if there is not clear intent, and so we
    respond to the student/child and thus reinforce their output.
    Non-symbolic, e.g., change in muscle tone, cry, grimace, etc.)

   Level II: Illocution (student is clearly intentional, consistently
    uses a non-standardized, but easily understandable output,
    e.g., gestures, facial expressions, points, etc.)

   Level III: Locution (True language level - true symbolic,
    representational, rule-governed output such as: speech, sign,
    print, Braille, etc.)

How Does this Work for Expressive
Communication ?
 Language – implies standardization, rules, and
  symbols; implying mutual understanding by the
  individuals who share knowledge of the language
  system
 Communication – implies a much broader set of
  output behaviors and combinations of output
  behaviors which may or may not be of a
  standardized form, but which convey intent and are
  understood and “readable” by the listener



Communication vs. Language
   How do I determine that a student is at a
    “symbolic” level? What constitutes “symbolic”?
   How do I determine if the student is
    “intentional”?
   Can the student be “symbolic” in receptive
    communication but not expressive
    communication? This is a question of GREAT
    IMPORTANCE AND CAUSES MUCH
    CONFUSION
   Can a student be “non-symbolic” in both
    receptive and expressive communication?
   If so, is the student still communicative?
Now, Let’s Tackle Some Of Those Messy
Questions
Astudent can have symbolic
understanding/RECEPTIVE
COMMUNICATION, but not
use symbolic communication
EXPRESSIVELY



REMEMBER
Let’s See If We Agree
Content-Intent-   Mode or Form   Desired
Function                         Response???
Intent
 Watch each tape
 Answer the questions on the next slide
  for each student
 Stop and discuss your observations


   (Use the form on the slide following the
    questions to help you answer the
    questions about the students)




Now, Let’s Meet Some Students
   Does this student UNDERSTAND language?
   At what level?
   How does the student communicate?
   What intents are communicated?
   At what level?
   Does this student need an AAC system?
   Suggestions on answering these questions




Student Example:1
Receptive Communication          Expressive Communication            Engagement              AAC needs


Understands real words and       Uses real words or language         Readily engages with    Does not need AAC
sentences, follows directions    (spoken, print, sign, computer,     others
(language level)                 etc.) (language level)


Understands words or follows     Uses gestures, points, real         Needs more              Already has AAC
directions with cues             objects, a few pictures, clear      stimulation to engage   Changes needed?
                                 facial expressions, head nods,      with others
                                 etc. to communicate and is
                                 easily understood by others
                                 (Emerging symbolic)




Needs physical assistance to     Expresses self by facial            Does not readily        Needs AAC
follow directions                expressions, cries, position        respond to others
                                 changes, muscle tone changes,
                                 etc. and listener may not be sure
                                 what the individual is
                                 communicating
                                 (Pre-symbolic)




Alerts and engages with others


Does not respond to others
Student 1
 Comprehension
 Expression/Output
 Does the student need AAC
 What are some challenges she faces to
  integration into the curriculum?




Discussion
   Does this student UNDERSTAND language?
   At what level?
   How does the student communicate?
   What intents are communicated?
   At what level?
   Does this student need an AAC system?
   Suggestions on answering these questions




Student Example 2
Student 2
 Comprehension-Understanding of
  Language
 Expressive Communication
 Use of AAC
 What would be your goals for this
  student?




Discussion
   Does this student UNDERSTAND language?
   At what level?
   How does the student communicate?
   What intents are communicated?
   At what level?
   Does this student need an AAC system?




Student 3
   Insert Movie Here




Student 3
 Comprehension of Language
 Expressive Communication
 Need for AAC




Discussion
   Does this student UNDERSTAND language?
   At what level?
   How does the student communicate?
   What intents are communicated?
   At what level?
   Does this student need an AAC system?
   Suggestions on answering these questions




Student 4
Student 4
 Comprehension of language
 Expressive communication and language
 Use of AAC




Discussion
   Does this student UNDERSTAND language?
   At what level?
   How does the student communicate?
   What intents are communicated?
   At what level?
   Does this student need an AAC system?
   Suggestions on answering these questions




Student 5
            Jessica




Student 5
 Comprehension of language
 Expressive communication and language
 Use of AAC




Discussion
What strategies do we
use to assess these
students?
Assessment of the Student
   At what level is the student communicating?
    ◦   Focus on what the student CAN do.
    ◦   Each unit of observable behavior is an event.
    ◦   Where and when do these events occur?
    ◦   Consider assessment types to be used.
    ◦   Consider who can help us know the student.
   Where is all this leading?
    ◦ Use more than organized observations
    ◦ Assess in varying locations
    ◦ Use a trans-disciplinary team approach
   Considerations
    ◦   Every student has potential and all behavior communicates
    ◦   Many students already have a form of communication
    ◦   We must be competent listeners and focus on what the student can do
    ◦   Look at the student’s current assets as building blocks
 Physical/motor challenges
 Sensory challenges: hearing, vision, etc.
 Cognitive challenges
 Emotional/behavioral challenges




Interfering Factors to Consider
The Learner Characteristics Inventory
Kearns, J., Kleinert, H., Kleinert, J., & Towles-Reeves, E. (2006)
   Learner Characteristics (all on a
    continuum of skills):
   (Kearns, Towles-Reeves, Kleinert, H., & Kleinert, J., 2007)
    Expressive Language
    Receptive Language
    Vision
    Hearing
    Motor
    Engagement
    Health Issues/Attendance
    Reading
    Mathematics
    Use of an Augmentative Communication
     System (dichotomous variable- questions re:
     both form and function)

Learner Characteristics Inventory
LCI: Expressive Communication
   Expressive Communication (check one answer that best
    describes your student)
    Uses symbolic language to communicate: Student uses verbal or written
     words, signs, Braille, or language-based augmentative systems to request,
     initiate, and respond to questions, describe things or events, and express
     refusal.
     Uses intentional communication, but not at a symbolic language level:
     Student uses understandable communication through such modes as
     gestures, pictures, objects/textures, points, etc., to clearly express a
     variety of intentions.
     Student communicates primarily through cries, facial expressions,
     change in muscle tone, etc., but no clear use of objects/textures,
     regularized gestures, pictures, signs, etc., to communicate.
Receptive Communication
   Receptive Language
    Independently follows 1-2 step directions presented through words (e.g.,
     words may be spoken, signed, printed, or any combination) and does NOT
     need additional cues.

    Requires additional cues (e.g., gestures, pictures, objects, or
     demonstrations/models) to follow 1-2 step directions.

    Alerts to sensory input from another person (auditory, visual, touch,
     movement) BUT requires actual physical assistance to follow simple
     directions.

     Uncertain response to sensory stimuli (e.g., sound/voice; sight/gesture;
      touch; movement; smell).
The Communication Matrix
Charity Rowland
Evaluating Communication
Functioning
 • Evaluate to determine exactly how an individual is
   communicating and to provide a framework for
   determining logical communication goals.

 • The Communication Matrix (Rowland)
     • Online resource
     • Appropriate for individuals of all ages who are
       at the earliest stages of communication
     • Range of communication skills matrix covers
       would occur between 0 and 24 months of age in
       typically developing child.
                             Rowland, C.
                             www.communicationmatrix.org/Default.aspx
   Seven Levels of Communication
Level I: Pre-Intentional Behavior
   •Pre-intentional or reflexive behavior
    that expresses state of subject

   •State (e.g. hungry, wet) is interpreted
    by observer

   •0 to 3 months of age in typically developing
    children
Level II: Intentional Behavior

  •Behavior is intentional, but is
   not intentionally communicative

  •Behavior (communicative)
   functions to affect observer’s
   behavior, since observer infers
   intent

  •3 to 8 months of age in typically
   developing children
Level III: Unconventional Communication
•Intentional Communication begins
 here

•Pre-symbolic, nonconventional
 gestures are used
   •Body movement
   •Vocalizations
   •Facial expressions
   •Simple gestures

•Communication with intent of
 affecting observer’s behavior

•6 to 12 months of age in typically
 developing children
Level IV: Conventional Communication
  •Pre-symbolic, conventional
   (socially acceptable) gestures are
   used with communication intent of
   affecting observer’s behavior

  •Meaning of gestures may be
   culture-specific

  •Behaviors include pointing,
   nodding or shaking head, waving,
   hugging, looking

  •12 to 18 months of age in typically
   developing children
Level V: Concrete Symbols
 •Symbolic communication begins here

 • Limited use of concrete (iconic) symbols to
   represent environmental entities

 • 1 to 1 correspondence between symbol and
   referent

 • Most skip this stage and go directly to Level VI

 • Typically developing children use concrete
   symbols in conjunction with gestures and words
   between 12 and 24 months of age, but not as a
   separate stage
Level VI: Abstract Symbols

 • Limited use of abstract (arbitrary)
   symbols to represent
   environmental entities
     • Speech
     • Signs
     • Brailled or printed words

 • Symbols are used singly

 • 12 and 24 months of age in
   typically developing children
Level VII: Language
  • Rule-bound use of arbitrary
    symbol system

  • Ordered combinations of two or
    more symbols according to
    syntactic rules

  • Understands that order
    determines meaning

  • Begins around 24 months of age
    in typically developing children
Purposes of Communication
•Refuse things not wanted

•Obtain desired things

•Engage in social interaction

•Provide or seek information


                                Charity Rowland
Reasons by Level

       Level       Refuse                         Obtain                       Social                        Information


                                                                               Expresses interest in other
       I           Expresses discomfort           Expresses comfort
                                                                               people



                                                  Continues an action
       II          Protests                                                    Attracts attention
                                                  Obtains more of something


       III


                                                  Requests more of an action
                                                                               Greets people
                                                  Requests a new action
                                                                               Offers things or shares
                                                  Requests more of an object
                                                                               Directs someone's attention
       IV
                                                                               to something
                                                  Makes choices
                                                                               Uses polite social forms
                                                  Requests a new object

                   Refuses or rejects something



                                                                                                             Answers "Yes" and "No"
                                                                                                             Questions
       V
                                                                                                             Asks questions
                                                  Requests objects that are
                                                  absent
       VI
                                                                                                             Names things or people

                                                                                                             Makes comments
Nine Categories of Communicative Behavior


      Body Movements
                           Conventional Gestures & Vocalizations



      Early Sounds
                              Concrete Symbols


      Facial Expressions
                               Abstract Symbols

        Visual
                                Language

      Simple Gestures
Communication Matrix
   Let’s go look at this program:
    http://www.communicationmatrix.org/
The SETT Framework
Zabala, J. (1995)
                                                        SETT Framework
      Consider:
                •Student

                •Environment

                 •Tasks

                 •Tools

Zabala, J. (1995, October). The SETT Framework: Critical Areas to Consider When Making Informed Assistive
Technology Decisions. Paper presented at Closing the Gap Conference, Minneapolis, MN.
The STUDENT
•What does the student need to do to
 actively communication in the
 classroom?

•What are the student’s special
 communication needs?

• What are the student’s current
 communication abilities?
The ENVIRONMENT
• What materials and equipment are currently
  available to support communication?
• What is the physical arrangement?
• What is the instructional arrangement?
• What supports are available to the student?
• What resources are available to the people
  supporting the student?
The TASKS
• What naturally occurring communicative interactions
  take place in the environment?

• What is everyone else doing to communicate?

• What activities support the student’s curricular goals?

• What are the critical elements of the activities?

• How might the activities be modified to accommodate
  the student’s special needs?

• How might technology support the student’s active
  participation in those activities?
The TOOLS
• What no tech, low tech, and high tech AT options
  should be considered when developing a system
  for a student with these needs and abilities doing
  these tasks in these environments?

• What strategies might be used to invite increased
  student performance?

• How might these tools be tried out with the student
  in the classroom in which they will be used?
Communication Environment Checklist
Rainforth & York-Barr (1997). Collaborative Teams for Students with
Severe Disabilities, 2nd Edition. Baltimore: Paul Brookes
  I. OPPORTUNITIES: Something To
  Communicate About
  1. Consistent routines are present to allow students to learn natural
  cues.

  2. Communication opportunities are integrated into daily routines.


  3. Multiple opportunities to communicate are provided within
  activities that have multiple or repetitive parts (e.g., turntaking)

  4. Natural opportunities to communicate are not eliminated by others
  in the environment (I.e., by guessing the student’s wants and needs
  before they can be expressed).
  5. Additional opportunities to communicate are created by delaying
  action on wants/needs and by interrupting daily routines.

Rating Scale:
1 = Not provided in current environment; needs intensive intervention.
2 = Provided on a limited basis; needs expansion and refinement
3 = Generally provided; needs some refinement
4 = Provided consistently; needs no intervention
II. MOTIVATION: The Desire To
Communicate
6. Instructional routines and activities utilized have a high
reinforcer value for the student, especially at first.

7. Instruction ensures the student is reinforced by natural
consequences of communication acts.

8. Reinforcement is of high frequency and/or duration in
order to provide success.

  Rating Scale:
  1 = Not provided in current environment; needs intensive intervention.
  2 = Provided on a limited basis; needs expansion and refinement
  3 = Generally provided; needs some refinement
  4 = Provided consistently; needs no intervention
III. MEANS: Partners and Tools for
Conveying Messages
9. Communication partners who are familiar with the
student’s means of communication are accessible at all
times as listeners, conversation partners and models.
10. There are many opportunities for communication with
same-age peers in the environment.

11. Others in the environment recognize and respond
to/reinforce alternate forms of communication used by the
student (especially nonverbal).
12. If an augmentative means of communication is used
by the student, it is accessible at all times.
  Rating Scale:
  1 = Not provided in current environment; needs intensive intervention.
  2 = Provided on a limited basis; needs expansion and refinement
  3 = Generally provided; needs some refinement
  4 = Provided consistently; needs no intervention
IV. MAINTENANCE, GENERALIZATION AND
SPONTANEITY: Varying Contexts and Fading
Cues
13. Spontaneous, initiated communication is agreed upon as
the ultimate goal of communication.

14. Opportunities for practice of specific communication skills
continue to be available even after skills are “mastered”.

15. Cues and prompts are individualized and faded to “natural”
cues as soon as possible.

16. Communication partners are familiar with the hierarchy of
cues and prompts for an individual student and know the
student’s current level.
17. Partners use directives and questions sparingly to increase
initiation, independence, and problem-solving.

18. Opportunities are available for practicing communication
skills in a variety of environments and with a variety of people.
Ground Rules for
Communication in
Classrooms
 All individuals communicate regardless of age or level of
  disability
 All output can be communicative
 Decisions re: communication systems and goals are made
  WITH
    ◦ Individuals and families
    ◦ Considering all support needs

   We need entire team trained and involved because of
   Physical/motor challenges
   Sensory challenges: hearing, vision, etc.
   Cognitive challenges
   Emotional/behavioral challenges

       Basic Assumptions and Philosophies Regarding
                     Communication:
                    Our Ground Rules
◦   Communication is a basic right and need
    of all individuals.
   Communication at some level is possible and identifiable for all
    students regardless of functional “level”.

   Every step toward improved communication, attending and
    interaction with others and the environment, no matter how small,
    leads to some increased quality of life and “independence: for a
    student, regardless of his/her disability.

   Communication programming goals should enhance students’
    opportunities for increased integration and interactions with peers
    and the community in general.

   Students with the most significant disabilities can gain from the
    interactions with typical peers (via contagion, alertness/awareness
    activities, etc.)


Things to Remember
   View students having multiple and severe disabilities in a way that
    emphasizes abilities and not disabilities.
   Recognize communication attempts which are evidenced in a non-
    standard way
   Develop strategies which increase the student’s social interactions in a
    variety of settings (e.g., peer groups, home, school, community, etc.)
    and across major life domains (educational, community, domestic,
    recreation/leisure, and vocational).
   Become aware of the variety of innovative strategies and systems
    available to increase communication in students with severe
    disabilities
   Develop communication skills within students that will facilitate
    participation in integrated home, school, and community settings.
Determining Classroom
Communication
Strategies
   Effective Teaching Behaviors
    ◦ High levels of engagement
    ◦ Frequent opportunities to
      respond
    ◦ High levels of success
    ◦ Systematic Presentation
    ◦ Immediate Feedback
What promotes achievement for students
with significant cognitive disabilities?
 Collaborative  Teaching
 Grouping Arrangements
 Addressing multiple intelligences
 Positive behavioral supports
 Facilitating social relationships
 Interesting stuff to talk about


What contributes to a supportive
communication environment?
 Content  which supports
 communicative competence is
 essential for
 ◦ Social interactions beyond “hello”
 ◦ Development of concepts and skills
 ◦ Social validity – what other kids are
   talking about…

We must get past hello…
 ◦Tools for identifying
  communication opportunities
  Content Catalog
  Classroom Activity Analysis
  IEP Analysis
  Student preferences


Looking for Opportunities to
Practice Communication
 Develop an “Ecological Inventory” of the
  students favorite things, greatest needs,
  etc. INVOLVING FAMILY INPUT!!!!!
 Display a Daily Schedule for each student
 Identify what adaptions the student may
  need in order to participate in the
  classroom/curriculum
 Develop a matrix of the students day
  which includes how he/she will participate
  in each class and what means of
  communication he/she will utilize


NEXT WE…
Case Study Examples
            Kevin and Corey
Activity
What and When to Teach….
   Swamp Loggers on      Crowds
    TV                    Changes in routine
   Coke                  New situations
   Video/computer        exercise
    games                 fast-paced activity
   Basketball
   “Cars” the movie




Cory’s Likes & Dislikes
Student Preferences
 Read  signs, cooking terms, calendar
  words, names or family & friends
 Write personal data & types w/
  model
 Add/subtract with number line
 Use next dollar to make purchases
 Work independently with
  personalized directions
 Follow a schedule

Cory Can….
   Greet Others
   Describe events, objects, interactions
   Ask questions of others
   Sustain communication with others.
   Read to get information and/or follow
    instructions
   Increase physical activity
   Improve handwriting
   Use telephone


Cory’s Annual Goals
   Keep a science journal
   Conduct experiments in cooperative group
   Develop science vocabulary
   Develop own experiment for science fair
   Monitor the class weather station for 1 wk
   View Earth science video write a report
   Conduct internet search on earth science
    topic



    Earth Science Expectations
Classroom Routine/                     Appropriate for the Student?             What Adaptations?   Alternative Activities
Activity/ expectations


                           AS IS       Materials   Goals         Personal
Activity                                                         Support


                           Y       N    Y     N      Y      N         Y     N


Keep a science journal

Conduct experiments with
group

Develop vocabulary


Formulate inquiry for
science fair


Write a report about an
earth science video

Monitor the Weather
Station


Conduct internet search
with key vocabulary




Classroom Activity Analysis
General Class       Language Arts   Physical    Earth     Computer   Read    Math   Science
Activities                          Education   Science   Workshop   Aloud          Social
IEP Goals                                                                           Studies

Greet others
                          X            X            X          X       X      X       X
Describe events,          X                         X          X       X      X       X
objects etc.

Ask questions             X            X            X          X       X      X       X

Sustain                   X                         X          X                      X
communication

Read for
information               X                         X          X       X      X       X
Follow directions
procedures                X            X            X          X       X      X       X

Solve problems            X            X            X          X              X       X



 IEP Matrix
    (X=opportunity to teach)
  Kevin (Kindergarten)
Likes                       Dislikes

     TV                   Crowds
     Playing outside      Most candy
     Cracker snacks       Drastic changes
     Computer time        New situations
     Swing                Strenuous exercise
     Circle time          Fast-paced activity
Kevin’s Goals
o Smooth transitions          Kevin’s Schedule

 Increase
  communication
    ◦ Receptive /expressive
      language
 Increase social
  interactions
 Hand washing
 Observe time limits
 Improve fine motor
Classroom                           Appropriate for the Student?            What Adaptations?   Alternative Activities
Routine/
Activity/
expectations
                        AS IS       Materials   Goals          Personal
Activity                                                       Support
                        Y       N    Y      N    Y       N       Y      N

Free Play/Parent Talk

Snack

Circle Time

Theme

Small Groups /Centers

Outside Play

Story Time/Lunch Prep

Lunch

Nap

Quiet Play /Personal
Care


Free Play/Outside




Classroom Activity Analysis
General Class
Activities              Morning    Snack   Circle   Outdoor Play or   Theme    Lunch   Story Time
IEP Goals               Greeting                    Gross Motor       Work
                                                                      Groups

Increase social
greetings, farewells

Use words to
request/refuse

Increase concept
vocabulary

Sustain communication

Hand washing

Improve fine motor

Transition between
activities smoothly




IEP Analysis
Using Content Standards
                                                 Reading Grade Three – Dimension A

Standard #               Core Content for Assessment 4.1                     Required Measurable/Observable Skill for the
                                                                                         Assessment Probe

             RD-EP-1.0.3 Students will know that some words have       (condition statement) student will select the correct
             multiple meanings and identify the correct meaning as     meaning of a word using context cues by (demonstrator)
    1
             the word is used. DOK 2

             RD-EP-1.0.5 Students will identify the purpose of         (condition statement) after listening to a sentence or
             capitalization, punctuation, boldface type, italics, or   passage, the student will identify the correct punctuation
    2
             indentations to make meaning of the text. DOK 1           to place at the end of the sentence by (demonstrator)

             RD-EP-2.0.2 Students will describe characters, plot,      (condition statement) student will identify character, plot,
    3        setting, or problem/solution of a passage. DOK 3          or setting from a grade level book by (demonstrator)

             RD-EP-2.0.5Students will identify the correct sequence.   (condition statement) student will sequence the events of
    4        DOK 1                                                     a passage by (demonstrator)

             RD-EP-3.0.4Students will identify main ideas or details   (condition statement) student will match details to main
    5        that support them. DOK 3                                  idea(s) by (demonstrator)




        Reading Content Standards for AA-
        AAAS – Grade 3
Reading Standards / Activity Matrix




   General Class
   Activities                   Sentence Piecing Writing Self-       Teacher   Edmark Early     Other   Other
   Content Standards            Dictation cut up   Sentence Selected Read      Reading Literacy
                                          sentence          Reading Aloud      Program Story-
                                                            W Peer                     based


   Students will know that
   some words have multiple
   meanings and identify the
   correct meaning as the
   word is used.

   Students will identify the
   purpose of capitalization,
   punctuation, boldface
   type, italics, or
   indentations to make
   meaning of the text.

   Students will describe
   characters, plot, setting,
   or problem/solution of a
   passage.

   Students will identify the
   correct sequence.


   Students will identify
   main ideas or details that
   support them
   Description of the student’s present
    communication

   Listing of ALL student’s output abilities




Steps and Materials:
What will Jack do:
 To use his communication during
  Academic Content
 AND HOW




An Example
What does Jack say and how does he “say” it??
          Refusal (no)          Pleasure/Affirmation       Getting Attention   Sharing wants and needs


        Pulls hand away           Laughs                 Smiles                Making sounds

        Drops items               Smiles                 Laughs                Fussing

        Sleeps                    Reaches                Makes noises

        Cry                                               Reaches

        Yell                                              Look




     List all of the physical output Jack is able to reliably use, which might be included as a part of his
     communication system:
         Pulls hands away
         Makes noises
         Touch
         Smile
         Laugh
         Looks
         Cry
         Sometimes holds objects
         Sometimes drops objects
         Screams
Activities: List all of the preferred activities and activities Jack does not like.



                     Preferred activities                            Non-preferred activities



          Certain voices                                    Work
          Talking to me!                                    Sitting alone
          Playing with hands

          Attention from Peers

           Some foods

          Time to go home!
 Read part of the story by using a pre-
  taped script activated by his script (he
  loves to listen to voices, be read to, etc.)
 Hold and manipulate items that apply to
  the story (he needs to use his hands other
  than to just “play” with them and to
  respond to very simple directions)
 Select a peer to help him answer
  questions (loves to be with peers, loves
  peer’s attention, needs to make choices)

What will Jack do???
Daily Schedule for Jack - Beginning of the daily goal matrix

   Time                                     Target Behavior   Target Behavior   Target Behavior

   8 AM             Get off the bus/go to
                    home room
   8:30             Computer work

   9:00             Morning meeting

   9:20             PE

   10:00            Math

   10: 30           Science

   11:00            Lunch

   12:00            Brush teeth

   12:20            Language Arts

   1:20             Music

   2:00             Get ready to leave
Communication Programming
Must Be a Collaborative Process
 Collaboration is essential
for effective communication
in the classroom, and each
team member has a unique
             role.

 Hurd, Robin. (2009). AAC and the IEP. Perspectives on Augmentative and
 Alternative Communication, 18: 65-70.
•Parents bring a long-term perspective of
 the student

•General education teachers bring their
 knowledge of what curriculum will be
 covered in the inclusion classroom

•Special education teachers bring their
 training in working with and making
 adaptations for students with special
 needs
• Paraprofessionals support student’s
  learning in a variety of curriculum contexts

• Related service personnel (OT, PT, others)
  provide insight into student’s adaptive and
  physical functioning

• SLPs pinpoint student’s specific areas of
  language need and provide teachers with
  ways to address those areas of need
  within their curriculum
   The General Ed teacher is your new best
    friend… s/he has cool activities that
    ◦ Are chronologically age-appropriate
    ◦ Are aligned to the content standards and
      district curriculum guides
    ◦ Involve peers who can model appropriate
      communication




Quick Tips/Resources
 Integrated   related services
 Collaborative teaching
 Grouping arrangements
 Addressing multiple intelligences
 Positive behavioral supports
 Facilitating social relationships
 Interesting stuff to talk about

What contributes to a supportive
educational environment?
 We cannot address
ONE aspect of service
  for students with
significant disabilities
 without the input of
      the TEAM!!
                       Remember what we
                       saw initially




    Let’s see how he
    does following
    intervention


Consider Bruce
 What was blocking Bruce’s full
  participation in his age-appropriate
  academic curriculum?
 Communication – yes, BUT also
    ◦ Gross motor deficits
    ◦ Fine motor deficits
   Creative teaming to develop access to
    an appropriate communication system to
    allow him access to the general
    curriculum!
Service Delivery
   Effective Teaching Behaviors
    ◦ High levels of engagement
    ◦ Frequent opportunities to respond
    ◦ High levels of success
    ◦ Systematic presentation
    ◦ Immediate feedback
    ◦ Ongoing analysis of data


What promotes achievement for students
with significant cognitive disabilities?
 Academic   content which supports
 communicative competence is
 essential for
 ◦ Increasing communicative
   competence
 ◦ Social interactions beyond “hello
 ◦ Development of concepts and skills
 ◦ Social validity – what other kids are
   talking about…
We must get past hello…
Content Catalog of Academic Activities
AGE/GRADE ______2______ Teacher _____________

Reading           Math          Science       Social Studies
Writing
Reading the
Enormous          Math rules…   Electricity
Potato to         Number + 0    What makes    Map
                  Number + 1    the light
identify the
author’s          Number + 2    come on?      Skills
problem and the
solution.
Writing a
personal
narrative
about solving
a personal
problem
 This cannot be accomplished without the
  creative interaction of the entire team
 For example, even if a primary target is,
  say communication, students with
  significant disabilities often require the
  active participation of the full team to be
  able to successfully utilize a
  communication system
     All service providers follow the
    recommendations of each individual
    discipline so that programming for
    the student is consistent…

   For example… if the SLP recommends a
    particular communication strategy then
    everyone on the team practices that
    strategy when interacting with the student



Integrating Related Services
“Services that may be required to assist the
 child with a disability to benefit from
 special education” (IDEA, 20 U.S.C. 1401
 (a) (17))




Related Services
   Service Delivery for this population
    ◦ Think blocks of time IN the classroom
    ◦ Think short interventions delivered more often
      through out the day or week
      10 min 3 X per week or even 5 minutes 5X
    ◦ Teach Others
      Teachers, other related service providers,
       strategies.. Don’t forget peers.
    ◦ Utilize the context of on-going instruction to
      deliver services –
      reading activities, math, science, PE,
    ◦ Remove from setting only as NECESSARY……

Integrated Related Services
 Teleconference
 SKYPE
 Email
 Note strategies




So you can’t meet…..
Use Available Tools & Resources
     What          We Know                      What          We Know
        Most                                        Least
          Vocabulary                                Phonemic
           acquisition                                awareness
          Reading fluency                           Phonics
          Reading                                   Algebra
           comprehension                             Geometry
          Numeracy                                  Spatial awareness
          Measurement                               Most of Science
          Operations
          Personal safety
          Weather* not
           included in formal
           studies

Academic Domains in the
Research Literature
Browder, D.M., Wakeman, S., Spooner, F., Ahlgrim-Delzell, L., & Algozzine, B (manuscript
submitted for publication). Research on reading for students with significant cognitive
disabilities. Exceptional Children.
Strategies for Maximizing Successful
  Communication in the Classroom
 •Work with IEP/AT team to
  determine student’s present level
  of communication functioning
   •Communication Matrix

 •Communication targets should be
  slightly above the student’s
  present level of functioning
  (Gillette)
• Find out what is motivating to student.

• Observe child in a variety of activities
  and settings.

• Which objects does he/she prefer?

• Talk to parents about child’s favorite
  toys and activities

                 Wiley, D. http://www.tsbvi.edu/Outreach/seehear/fall04/joy.htm
                 http://commons.wikimedia.org/wiki/File:Black_Brant.jpg
• Teach language and literacy using
  highly motivating topics

• Incorporate student’s preferences into
  curriculum based activities as much as
  possible




                     Wiley, D. http://www.tsbvi.edu/Outreach/seehear/fall04/joy.htm
                     http://commons.wikimedia.org/wiki/File:Black_Brant.jpg
                     http://commons.wikimedia.org/wiki/File:SurefireU2JPG.jpg
•Provide opportunities for student to
 demonstrate successful
 communication with peers

  •Social scripts/rehearsal
  •Peer support
  •Pre-teaching
• Encourage independence! Plan
  communication opportunities in a variety
  of settings with a variety of partners.
• With IEP team, prioritize curriculum
  content.
• Collaborate to monitor progress
• Roles and responsibilities
• Sample chart
Involve peers who demonstrate age-
appropriate communication skills in social
and learning opportunities with students
with disabilities.
Google is a content resource
   When involved in the following activities
    and given a choice between 3 objects,
    activities, or people, M will choose 1 by
    activating a communication device paired
    with actual object 9/10 opportunities
    across 3 consecutive days.
    ◦ Sample Activities
        Choose   clothes for school
        Choose   friend to work on project
        Choose   classroom chore
        Choose   book


Integrated IEP objectives
                 Sentence
                 Dictation

                     Cut up
                     Sentence



               Journal Writing


Student Activities for Language Arts
   A word of caution when considering
    releasing students with significant and
    complex needs from services…
    ◦ Regardless of the use of ORAL speech, what
      language development needs does the student
      have? What is the probability of regression if
      services are discontinued?
    ◦ What physical/sensory needs does the student
      have and/or what is the risk if these skills
      regress? Or the appropriate supports are not
      provided?


“Failure to Progress”
     Honoring Natural Gestures- And Natural
                    Output-
        Recognizing Communication!!!!!!!
•   Already in the students repertoire– he knows what they
    mean!!!
•   If acceptable behavior, increase and respond to
    regularly
•   Then couple these with more sophisticated
    communication
•   Too often we jump to sign, pictures, etc. when the student
    is not ready. All we teach them to do then, is go through
    the “repertoire” of “stuff” we have taught them- IF the
    student does not/cannot use the system we develop, we
    often say HE IS NOT MAKING PROGRESS, SO WE WILL
    DROP FROM THERAPY
 The student just produces a sign
  indiscriminately or touches a picture,
  switch or button on an AAC device
  because he’s been taught to do X to get Y,
  but he has no idea why
 Let’s try to identify some strategies to
  address that problem
Do you have any questions?

				
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