Exam 3 Flashcards
1
Q
Components of AAC Intervention
A
- Selection and personalization of AAC for effective communication
- Instruction in strategies and skills to effectively use AAC for communication
- Instruction for family members and other important communication partners
- treatment plan can/should include goals on training the family
- need to determine if what we select will be utilized over time
2
Q
Principles of AAC Intervention
A
Long term success of an AAC intervention plan may involve:
- Interventions that utilize environmental adaptations - need to consider space and location of where they use the device and any barriers that may be present - need to ask ourselves: can they access the system easily?
- Interventions designed to increase natural capabilities
- Interventions that incorporate AAC strategies and techniques
3
Q
What factors should be considered when determining goals?
A
- Strategies and skills that are most important to the individual who relies on AAC
- Those that are valued by the family, friends, and community
- Those that can be used regularly in the real world
- Those that are most likely to be learned successfully
4
Q
What should goals for AAC include?
A
- The targeted skill or strategy
- the means of communication
- the partner(s) and environments(s)
- the targeted criterion
goals are written to support communicative competence
5
Q
What instructional methods have been shown to be effective and what are they?
A
- Responsive Social Pragmatic Intervention
- AAC Modeling
- Explicit Instruction
- Milieu or Incidental Teaching
6
Q
Responsive Social Pragmatic Intervention
A
- Parents and other communication partners are taught to fulfill communicative attempts and to model target skills
- Used in naturally occurring interactions
- Kent-Walsh, Binger & Hasham in 2010 trained parents:
- Read + provide an aided AAC model;
- Ask a wh-question + provide an aided AAC model;
- Answer the wh-question + provide an aided AAC model
7
Q
Responsive Social Pragmatic Intervention Example:
A
Child: {chooses a picture}
Adult: Tell me what happened that day.
Child: birthday
Adult: Whose birthday?
Child: I
Adult: Oh! This is your birthday.
Adult: So to make that a little bit more clear, we need a few little words, right? Because it happened in the past you can say: “THIS WAS MY birthday.” Can you tell me that?
Child: This was my birthday.
8
Q
AAC Modeling
A
Communication partner uses unaided and/or aided AAC in conjunction with spoken input
- Total communication uses manual signs with spoken input
- Key word signing provides selected models of manual signs with speech
- AAC symbols paired with spoken input
need to remember to model WITHOUT expectation
9
Q
Explicit Instruction
A
Based on principles of applied behavior analysis
- Stimulus- Hold up a cookie, What’s this
- Cue- Clinician points to the picture of a cookie from an array of two photograms
- Correct response by the learner- Points to cookie photo
- Reinforcement- Yes that’s a cookie
Occurs in less natural situations
Need to address avoidance of prompt dependency
Ex: teaching hand shapes for signs to a preschooler
10
Q
Milieu or Incidental Teaching
A
Explicit instruction is paired with milieu or incidental teaching to promote generalization of skills to the natural environment
- Manipulating the arrangement of the natural environment
- Targeting specific communication goals in natural context
- Utilize prompt techniques to elicit the target skill
- Respond to the individual’s communicative attempts
11
Q
What methods can be used for evaluating intervention?
A
- Goal attainment scaling
- Functional communication measures
- Participation inventory
- Consumer Satisfaction
Can also use ASHA’s functional communication measure - the resting scale to determine any improvement over time
12
Q
What does pre-intentional mean?
A
the natural and involuntary behaviors children display to show how they are generally feeling. Although they are not intentionally communicating, these behaviors are observed and interpreted by parents and caregivers to determine what the child may want or need
13
Q
What do pre-intentional communicators assess:
A
- Behaviors that are within the individual’s repertoire
- Antecedents to these behaviors
- Consequences of these behaviors
- Evidence of intentionality
14
Q
Steps to build intentionality:
A
- Establish routines focused on motivating activities
- Initiate the interaction
- Pause and wait expectantly
- Watch carefully for the signal
- Respond immediately to the signal as if it were intentional
- Repeat this sequence
15
Q
What are the key goals for pre-intentional communicators?
A
- Develop intentional communication
- Identify appropriate signals to indicate acceptance and rejection
Signals for yes and no
16
Q
What are potential indicators of intentional communication?
A
- Eye gaze - looking at partner or object, often accompanied by facial expression or vocalization
- Facial or head orienting - postioning one’s face or head toward a partner or object with or without vocalization
- Vocalization - producing a sound aimed at a partner or object
- Facial expression - using facial muscles to produce a countenance directed toward a partner or object
- Physical actions - producing movements of the upper or lower extremities directed toward a partner or object
- Body posturing - positioning one’s body toward or away from a partner or object
17
Q
What is intentionality?
A
To do something “intentionally” means to do it on purpose. And for children at the beginning stages of communication, a big developmental step happens when they learn to send intentional messages.
“Intentionality” refers to a child’s ability to send messages on purpose, directly to someone to achieve a specific goal.
18
Q
Evidence of intentionality:
A
- Persistence of the behavior until the goal is achieved
- Cessation of the behavior when the goal is achieved
- Substitution of another behavior or act if the first means is not successful
- Change in the quality of the act if the first attempts are not successful
19
Q
What are key goals for intentional but pre-symbolic communicators?
A
- Communicate choices
- joint attention
- Use consistent signals to express acceptance/rejection
- Take turns consistently in social interactions and develop social closeness
Developmentally appropriate is going to be more wants/needs
EX: What’s the most developmentally appropriate type of yes/no question?
- Answer: Do you want goldfish?
20
Q
Teaching clear signals for acceptance and rejection
A
Label meaning of signal
Fulfill intent
Model a more conventional symbol
21
Q
Teaching communication of choices
A
Identify opportunities to communicate choices
Determine how to represent choices
Determine how to present choices
Select instructional technique
22
Q
Teaching how to request objects and activities
A
Initiate after skills for communicating choices are addressed
Most appropriate for beginning communicators transitioning from pre-symbolic to symbolic communication
23
Q
Teaching how to take turns
A
Learning to take turns in social interactions is the foundation for building social closeness
Focus on the communication partner
24
Q
Develop joint attention
A
Reduce attentional demands when teaching joint attention by gluing symbols into a book or object you are using to help; or you can hold symbols near your face.
25
What are key goals for developing symbol communication (early symbol)?
* Develop diverse vocabulary
* Initiate requests for objects and activities
* Make comments/answer simple questions about ongoing activities
* Ask simple questions
26
What are factors to consider for developing vocabulary skills?
* Choose concepts
* Select appropriate representations
* Teach in meaningful contexts
* Provide Input via Speech and AAC
Aided language stimulation, augmented input, natural aided language, aided language modeling
27
How can you teach initiating requests for objects and activities?
* Teach generalized requesting
* Teach the Picture Exchange Communication System
* Teach conditional requesting
28
What should you consider when teaching how to comment and to ask questions with symbols?
* Reduce joint attention demands
* Provide instruction to teach commenting
* Teach how to ask questions
29
What are key goals for those combining symbols?
* Continue to develop diverse vocabulary
* Express a greater range of communicative functions
* Combine symbols to communicate
1. More complex comments about ongoing activities
2. More detailed responses to questions
3. More specific requests for objects or activities
4. More explicit protest or rejection
5. More complex questions
30
What are the domains of communicative competence?
* Linguistic (comprehension, expression, semantics, syntax, morphology)
* Operational
* Social
* Strategic
31
Linguistic skills:
**Comprehension**
- Understanding vocabulary
- Improving understanding of sentence structure
- Increasing understanding of morphosyntactic structures
**Expression**
- Natural speech
- Code of AAC system
- Language of family and community
**Semantics, Syntax, Morphology**
Develop skills in the native language(s) spoken and written in the home and broader social community
32
Linguistic skills: Developing skills in the native language(s) spoken and written in the home and broader social community
* Understand spoken single-word vocabulary that represents a wide range of concepts
* Understand a wide range of simple and complex sentence structures (e.g., wh- questions, directions)
* Understand morphology (e.g., plural, past tense)
* Develop as many expressive skills (content, form, and use) in the spoken language(s) of the home and broader social community as appropriate
* Code switch between different language(s) and cultural norms as required
* Develop literacy skills to understand and use the written language(s) of the home and broader social community; code switch between these written language(s) as required
* Develop knowledge of a rich and varied vocabulary; know the AAC symbols used to express these concepts, including both content and structural words
* Develop morphosyntactic skills to express more complex meanings via AAC
* Choose appropriate AAC modalities to meet the needs in different cultural/ linguistic environments
* Demonstrate appropriate linguistic conventions (content and form) for different communication media, including face-to-face, written, and digital communication media
* Core vocabulary plus vocabulary to support language learning
33
Operational skills:
* Develop the skills needed to produce the unaided AAC
* Learn the skills to operate low tech or high tech aided AAC
* Range of learning demands- motor, sensory, perceptual, cognitive, and linguistic
* Personalization of system should address minimization of demands
* Operational skills will still need to be learned
* Produce unaided symbols as appropriate
* Operate low-tech and high-tech aided AAC accurately and efficiently
* Operate digital communication apps and other mainstream communication tools
* Goal is to promote accuracy and efficiency and to reduce effort and fatigue as much as possible
* Interventions typically involve demonstration of the skill, repeated performance, and feedback
* Approaches can involve explicit instruction or a cognitive developmental approach
34
Social skills challenges:
* Disability associated with specific impairment in social interaction
* Difficulty developing orientation skills to focus on partner
* Limited social circle
* May have few meaningful opportunities to interact with a diverse range of partners
35
Strategic skills:
Compensatory strategies to overcome language, operational, and social challenges
Intervention to build strategic competence:
1. Teach introduction strategies
2. Teach use of humor
3. Teach use of regulatory phrases
4. Teach use of conversational repairs
36
Challenges for developing Semantic skills:
* Need to learn spoken words and corresponding AAC representations
* Words in system may not reflect internal lexicon
* Individuals who use AAC may not receive feedback about their vocabulary
* Development compromised if only access to a limited range of concepts
Core vocabulary plus vocabulary to support language learning
37
Language skills:
Knowledge and skills in vocabulary, syntax, morphology, narratives, and other genres (e.g., expository, persuasive)
38
Phonological awareness skills:
Ability to notice, think about, and manipulate the phonemes (sounds) of words, including sound blending (e.g., blending sounds to form words) and phoneme segmentation (e.g., breaking words into component sounds)
39
Letter-sound correspondences:
Knowledge of the sounds represented by each of the letters and of the letters used to represent different speech sounds
* teaching lowercase letters that occur more frequently first
* start with letters that occur most frequently
* consonants in isolation before blends
40
Single-word decoding skills:
Ability to apply knowledge of letter-sound correspondences and sound blending to sound out words with regular spellings (e.g., cat, pig, dad)
41
Sight word recognition skills:
Ability to read/ recognize words without sounding them out, especially irregular words (e.g., light, their, are)
* teaching high interest words
42
Intervention to build semantic skills:
Fast Mapping
Shared Book Reading
Focused Stimulation
Explicit instruction
43
Challenges for learning syntax and morphology skills:
* Rely on short messages
* Use simple clauses
* Complicated to learn with line drawings
* Intervention often focuses on semantics and pragmatics
44
Application of decoding and sight word recognition skills in shared book reading
Using knowledge of letter-sound correspondences, sound-blending skills, and sight word recognition skills as required to read target words during shared book reading with a literate partner
45
Reading and understanding of text (reading comprehension skills)
Ability to decode or recognize by sight each word in the text, access the meanings of the words, process the words together to derive the full meaning of the text, and relate this meaning to prior knowledge and experience
46
Single-word encoding skills
Ability to apply phoneme segmentation skills and knowledge of letter-sound correspondences to break down regular words and spell them (e.g., mom, run)
47
Sight word spelling skills
Ability to recall and select the correct letters in sequence to spell words with irregular spellings (e.g., said, know)
48
Handwriting skills and/ or keyboard knowledge
Knowledge of the correct shapes for letters and the fine motor skills to produce these shapes legibly and/ or knowledge of the location of the letters on the keyboard and operational skills to select them efficiently as required using appropriate access techniques
49
Application of encoding and language skills in simple writing activities
Using knowledge of letter-sound correspondences, phoneme segmentation skills, and sight word spelling skills to encode appropriate words in simple sentences to communicate meaning to others
50
Intervention goals for building syntax/grammar:
The basic goal of all grammar interventions should be to help people with complex communication needs improve in the use of grammar so they become better communicators in conversation, narration, exposition, and other textual genres in written and oral modalities.
The functionality of grammatical targets is paramount.
Consider questions such as “What kinds of meanings does the person produce with single graphic symbols?” and “What kinds of symbol combinations would make the person’s messages more complete and more readily interpretable?”
The specific goals of grammatical intervention should be based on the person’s functional readiness and need for the targeted forms
* Observe the person’s performance in communicative contexts and select target goals to teach syntactic constructs that are sometimes used correctly or for which the person demonstrates a need but consistently does not use or does not use correctly
The social, physical, and linguistic contexts of intervention should be manipulated to provide frequent opportunities for both facilitator modeling of specific grammatical targets and use (or misuse) of these grammatical targets by the person with complex communication needs.
* Arrange the environment (objects, activities) and the linguistic context (i.e., partners’ communicative behaviors) to create a real need for the target grammatical constructs. Provide numerous language models of the target construct (via speech + AAC) and wait for the person to respond.
Immature AAC utterances should be systematically contrasted with more grammatically complete forms, using sentence recasts.
* Recasts are responses to the productions by a person with complex communication needs that maintain the meaning of the person's attempts but add grammatical detail and/ or information to complete the meaning. Incorrect productions by the person with complex communication needs should be followed with recasts that model the target grammatical construct.
Telegraphic models should be avoided and replaced by grammatical models in well-formed phrases and sentences.
* Spoken models and recasts should be grammatically correct and complete (e.g., The doll is crying rather that Doll cry), even when simultaneous AAC models cannot correspond one-to-one with the target grammar (e.g., in this example, because symbols for the, is, and/or –ing are not available on the communication display).
51
What type of approach should you consider for teaching operational skills?
Intervention: promote accuracy and efficiency, give explicit instruction. Demonstrate, repeat, and give feedback (i.e., push button to turn on device)
52
Sociolinguistic skills:
* Discourse skills-taking turns, initiating conversation, maintaining conversation, etc.
* Communicative functions- requesting attention, requesting info, providing info, confirming info, etc.
53
Sociorelational skills:
* Interpersonal aspects of communication that form the foundation of positive relationships
* Active participation in interactions, demonstrating interest in communication partners, projecting a positive self-image
54
What should you consider to develop sociolinguistic skills?
* Express a wide range of communicative functions (e.g., request information, provide information, provide clarification, confirm/ deny, request attention)
* Communicate complex needs and wants
* Provide detailed instructions to manage personal care
* Communicate needs effectively and efficiently in interactions with healthcare professionals
* Develop a plan for emergencies
55
Sociolinguistic skills intervention:
Teach how to communicate more complex wants and needs
Teach how to initiate and sustain social interactions:
* Initiating and topic setting strategies
* Conversational coaching
* Displaced talk
* Story telling
Teach how to exchange more complex information
56
What should you consider to develop sociorelational skills?
* Participate actively in interactions (e.g., take non obligatory turns; make meaningful contributions)
* Be responsive to partners; provide appropriate feedback as a listener
* Demonstrate active listening skills; demonstrate respect; express empathy as appropriate
* Demonstrate interest in partners (e.g., use the partner’s name, ask partner-focused questions)
* Put partners at ease
* Project as positive self-image
* Maintain a positive rapport with partners; communicate respect
* Give feedback and handle conflict effectively as required
57
Sociorelational skills intervention:
Teach use of nonobligatory turns/listener feedback
Teach active listening skills:
* LAF, Don’t CRY
Teach use of partner focused questions
Teach how to give feedback and handle conflict
58
What should you consider to build strategic competence?
Teach introduction strategies
Teach use of humor
Teach use of regulatory phrases
Teach use of conversational repairs
59
Psychosocial factors that can impact AAC user success and how to address them?
Motivation
Attitude
Confidence
Resilience
Interventions:
* DO IT! Strategy
* Describe the problem
* Outline the ways to solve it
* Identify the best solution
* Take action
Celebrate success
Mentor programs
60
How can you provide access to AAC for emergent literacy activities?
* Incorporating signs and gestures into story book reading
* Using objects to communicate choices during story reading
* Providing simple switches programmed with repeated story lines
* Providing low tech communication boards with vocabulary to ask questions and comment about story
* Providing AAC technology programmed with appropriate vocabulary
* Books with repetitive lines
61
What are ways to develop emergent literacy skills in AAC users:
* Select appropriate books
* Introduce the topic of the book
* Introduce new vocabulary as required
* Read the text of the book
* Use time delay (wait expectantly)
* Ask appropriate questions
* Model use of AAC and speech
* Respond to communicative attempts
* Encourage the individual to tell the story
* Providing independent access to reading materials
* Building narrative skills
* Building emergent writing skills
* Introducing phonological awareness and letter-sound correspondences
62
Select appropriate books: factors to consider
* Allow the individual to choose books of interest
* Ensure books are at an appropriate language level to support the individual’s comprehension
63
Introduce the topic of the book: factors to consider
* Encourage the individual to think about the topic of the book
* Discuss related experiences
* Discuss the purpose of reading (e.g., enjoying the story)
64
Introduce new vocabulary as required: factors to consider
* Explain new concepts to the individual (e.g., illustrate with examples, relate to prior experience)
* Teach appropriate AAC symbols to represent new concepts
65
Read the text of the book: factors to consider
* Read each page of the book out loud, tracking word by word with a finger under the text as it is read aloud
* Regularly pause and provide the opportunity for the individual to ask a question or make a comment
66
Use time delay (wait expectantly): factors to consider
* Focus attention on the individual with an expectant look
* Wait at least 5-10 seconds
67
Ask appropriate questions: factors to consider
* Ask questions to encourage the individual to think about the story
* Encourage the individual to make predictions
* Relate the text to the individual’s prior experiences
68
Modeling use of AAC and speech: factors to consider
While reading or talking about the story, sign or select the appropriate aided AAC symbols from the individual’s AAC device or low-tech communication board
69
Respond to communicative attempts: factors to consider
If the individual asks a question or makes a comment, respond by answering the question or expanding on the individual’s comment by adding more information
70
Encourage the individual to tell the story: factors to consider
With repeated readings of the book, pause and encourage the individual to retell parts of the story
71
What are adaptations to conventional literacy instruction?
Adaptations to accommodate speech impairments
* Alternative response modes
* Adapt materials to aid in decision making for instruction
* External scaffolding
* subvocal rehearsal skills (hearing, thinking)
Adaptations for motor or sensory-perceptual impairments
* VSDs (reduces attentional demands)
* low tech options if the user is not familiar with their devices yet (reduce cognitive demands)
72
What skills should you address to build advanced reading skills?
* Encourage silent reading using subvocal speech to build fluency
* Increased reading by the individual and focused instruction to develop advanced language skills
* Build world knowledge by supporting increased reading of a wide range of texts
* Build reading comprehension
* learning strategies
73
What are adaptations to teaching reading comprehension strategies for individuals with complex communication needs?
*see chart on study guide*
74
What skills should you address to build advanced writing skills?
* Building knowledge and skills in writing conventions (capitalization, how to write a paragraph, etc.)
* Complex communication needs require more explicit instruction
* Learning to use writing strategies
* Building writing skills for social purposes
*see chart on study guide (PLAN, WRITE, EDIT)*
75
What are the five stages of intervention for those with cerebral palsy?
* No functional speaking ability
* Limited speaking ability
* Reduced speech intelligibility
* Obvious disorder with intelligible speech
* No detectable speech disorders
76
What are key considerations for AAC intervention of those with cerebral palsy?
Team approach
Ensuring access
* “Access to the world”
* Adaptive play activities with single switch technology
* VSDs or video VSDs to support social interaction
* Need multiple modes of communication
* Adaptable toy list
Planning intervention across the life span
77
What are key considerations for AAC intervention of those with Down syndrome?
* Provide early intervention
* Setting appropriate expectations
* Provide AAC supports to meet changing needs
**video VSD for job training**
**low tech options when aging due to risk of Alzheimer's**
78
What are key considerations for AAC intervention of those with an intellectual disability?
* Personalizing intervention to meet needs and skills
* Eliminating opportunity barriers
* Addressing challenging behavior
79
What are key considerations for AAC intervention of those with an intellectual disability?
* Promoting social communication
* Providing intervention across the lifespan
* Utilizing effective intervention techniques
80
What are key considerations for AAC for those with childhood apraxia of speech?
* AAC is used as a secondary intervention in conjunction to improving natural speech production
* AAC intervention can help stimulate language development
* Children with CAS increase the complexity of their messages when using AAC compared to speech alone
* AAC to support communication and language learning for those with severe impairments
* AAC for speech supplementation, alphabet, or topic
* AAC when their speech is not understood
* AAC to support literacy learning
* AAC to practice speech production
81
What is communication compentence?
Mastery in all language domains (operational, social, strategic, linguistic)
82
Sociolinguistic vs sociorelational:
Sociolinguistic: FUNCTIONAL acts of pragmatics (accepting, rejecting, maintaining, commenting, etc.)
Sociorelational: teaching the AAC user to relate to their conversational partner on a deeper level than just pragmatics (facial expressions, head nods, reciprocating questions, showing the partner that what they're saying is important)
83
Conversational coaching
Coaching a client to maintain a conversation effectively
Ex: goal is for client to ask partner focused questions
84
Strategy Instruction
Teaching strategy itself (what it is, when and how to use it, how it helps, implementation)
Ex: goal is for client to learn strategy to ask for information to be repeated or written down when not understood
85
Fast mapping
A rapid process by which children hear a word and connect it with a general understanding of the concept
86
Effective approaches: semantics
* fast mapping
* shared book reading
* focused stimulation and AAC modeling
* explicit instruction
87
Effective approaches: morphosyntactic
* conversation based intervention
* shared book reading
* focused stimulation and AAC modeling
* explicit instruction
88
Effective approaches: operational
* cognitive development approach
* explicit instruction
89
Effective approaches: social
* strategy instruction
* conversational coaching
* explicit instruction
90
Effective approaches: strategic
Strategy instruction
91
Expected skills for emergent literacy users
* phonological awareness and letter-sound correspondences
* narrative skills
* knowledge of parts of a story
* vocabulary/access to reading material
* knowledge of how to read a book (turn page, etc.)
* emergent writing skills (tracing, drawing pictures, holding writing utensils if possible (OT for adaptive tools, device if not))
* ability to participate in shared reading
92
Segmenting
"Instructor says the first sound, and then client identifies SYMBOL that starts with that sound" (keyword - symbol)
* most important skill for encoding (segment = spell: SS)
93
Most important skill for decoding, or reading?
Blending
94
Which is more challenging to learn, reading or writing, and why?
Writing!
* more information to hold in working memory (syntax, semantics, etc).
