Assistive Technology to Support Positive Behavior

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ANA NEVARES: at the Mailman  Center for Child Development   at the University of Miami. I used to be a special education teacher in the public school classrooms  here in Miami-Dade for several years before joining FAAST. So now I assist anyone that wants  to learn more about AT products in our community. Obviously having a passion and an understanding  for school-aged children, since that's my background. Joining us also is a new addition to  our South Florida FAAST program and that is Miss Christina Givner. So I'll give her a couple  seconds to introduce herself to you as well. CHRISTINA GIVNER: Hi I'm Christina  Givner; I also go by Tina. I am a bilingual speech language pathologist  at the Mailman Center, and I also assist within the FAAST lab. I've been doing speech  therapy now for a little over four years,

and I'm very happy to be on the University of  Miami team now. Even though I didn't go there. ANA: Ha, that's true. So if you have any  questions at any time, you feel free to ask them in the chat. Also at the end, if you  have any questions, feel free to answer them or interrupt if I know it's kind of weird to have an  interactive format when I can't really see you, but I'll be sharing at the end  also our contact information. So if you have any more questions you can  definitely reach out to Tina or myself, or the FAAST program later on with additional  concerns that we'd be more than happy to help. I'm

not sure the audience that we have, but in terms  of what your background is, but I hope we can you know tackle that and feel free to share anything  you want to share with us in the chat as well. Everyone can see the screen? I hope so. Good?  Thumbs up? Yeah, I'll take this as a yeah. So our objectives for the  presentation today is we're   going to go over, again not being as familiar to what your respective knowledge on AT may  be, but I'm just going to walk over what assistive technology tools are and how can we use  these tools and the strategies to help a child, you know, focus, pay attention, follow  routines, help them be more independent in their own environment, and be able to communicate  their needs because communication is highly tied to behavior outcomes. I also want to touch  upon how FAAST, again not knowing maybe

how much you may or may not know about  FAAST services, but I want to talk about how FAAST can be a resource. A assistive  technology resource to you or those that you know. Talking about what is assistive  technology, keep in mind that it is any tool that you either make it yourself, or  whether you buy it off an expensive website, or Amazon that is going to help someone  either increase, maintain, or improve a specific function. It can range, so  it can be low-tech, mid-tech, high-tech. We don't have to necessarily think of AT  as expensive devices, we can think of them as even strategies that help someone accomplish a  task. And the ultimate goal of AT is to increase

independence and participation. So think of it  in the sense of a child, since our focus for this presentation mostly centers on children. It's  how can we use AT to help a child do something he or she would not be able  to do without, and how   can they be more independent in that given task. That's the whole purpose  of introducing someone to   AT. And as you know, AT is not a basic, you know, here take a quick quiz or test to determine  what's the AT that's going to work for you, it is something that requires some thought  process, understanding the person's or the child's strengths and weaknesses, the environment where  the tool is going to be used, understanding the task at hand, and trialing the tool to make sure  that it's the right fit for the person. So like

a lot of feature matching goes into determining  what AT is going to be the best for the child. The benefits of introducing assistive technology  for families, especially tools that are going to help a child with their behavior, is that it's  going to decrease, for example, the amount of energy that parents have to put and time  into a specific task. Or helping the child achieve a task because the tool is meant to help  the child be more independent and successful in that task. Therefore, with in decreased, you  know, negative behaviors, we can encourage them

mutually satisfying interactions and developing  a well-being between the parent and the child in the sense of their emotional  well-being. So it has   a lot of ramifications that when we can implement an AT tool successfully in the environment and  interaction between the child and the parent. For the child, having an at that is successfully  introduced and utilized can make their experiences be more stimulating, there are opportunities  to experiment with positive environments, so the child understands  what is expected of them,   is able to express their ideas and thoughts more clearly, and they can also by this independence,  encourage active learning. So a lot of the times when children have maybe limited speech or  certain, you know, difficulties, they learn to be more passive learners where things are done  for them, or where they are told what to do, or given what to do versus having the freedom to  be more actively engaged in their environment, novel in their ideas that they want to share,  and have more control over what they want to do. When we talk about AT for positive behavior,  we talk a lot about using visual supports. Whether, and we'll go over the presentation  about the different types of visual supports, but in general, visual supports can  help with transitions. So a child

can understand what's coming next and not be  feeling flustered about being moved around, whether we're talking in a classroom setting  from activity to activity or whether we're talking at home when we're moving from, you know,  home and leaving the house to go do an errand that the child may not know it's gonna  happen. It can help teach routines, routines offer predictability which is  something that can also impact behavior. It attracts and holds a child's attention and  focus on a message that it's clear to them. It increases the understanding of spoken words  because when you think about speech, we may say things that after we say them, they sort of like,  I equate them, they disappear in thin air. Versus a visual support is a concrete representation of  your message that remains permanent for reference.

For you to emphasize what you expect from the  child or for the child to express what they want to you. And it just becomes a part of everyone's  way of communicating. By showing a visual support for example, you can alert someone that, you  know, we're moving ahead to, we're leaving now to go shopping or, you know, the Publix,  or whatever may be. Your expectation is being said to the child and it becomes part of just  a communication system for everyone to follow. So the type of visual supports, as you see  on the screen, have to be, I think, match to what the capabilities may be of the of the  child at the moment. So for example, you have visual supports for non-readers, for beginning  readers, and then for fluent readers. This is a simple way to categorize how we use them. For  non-readers, as you see in the first picture,

where you see the words eat, drink, more, you  see actual tangible objects represent a word. So it's easier for the child to make a  connection than maybe seeing a symbol that might not be concrete enough or a word that  they may not be able to read, they can attach a meaning to that word by seeing that  tangible object that they can touch. For a beginning reader, you can then go into pairing  a word, like you see in the next picture, where you put a symbol of write, a word right,  with a picture of, you know, a hand and a pencil. So they can start making that association,  that that word means that symbol. And then for fluent readers, you may be able to just  use text to remind them of what is expected or to use that as a visual support. It's time  to read now, so you can just show the text. So it's important to make sure that whatever  visual support you're using, it's something that the child is going to be concrete enough,  for the child to understand what it represents because you have to attach meaning to what these  words mean. You have to teach them basically.

To help a child stay on task and  follow routines with visual supports, there's the creation of daily schedules or  visual or activity routines. In this picture, you can see an example of a first or then board,  where you can add a visual representation of first I expect you to complete your homework or to  do this task. You can put a visual of whatever you expect the child to do first, you know, put  away your shoes, whatever the task may be. And the then board, can have then the rewards, then you  can play with your toys, then you can, you know, listen to your music. So there is a visual  representation of the expectation of what to do,

and the reward or, you know, the reinforcer  that you get once you do your task. But it can easily be used for many different  things, like transition cues, communication strategies, behavior cues, you can use timers  also as the presentation of time constraints, and these again are all things that are visual  support. Something that makes things that are not tangible, be tangible for  someone that needs that support. We have here an example of how visual supports  could be used to break down a task. Now that in some cases, a lot of children are transitioned to  being at home with online school, I've through our FAAST SFRDC lab, we've received a lot of requests  for help with how to manage parents or therapists, you know, having children at home, and break  down tasks so that they can participate in online school. But this is something that can be  carried over regardless. So to make a task more manageable for a child, let's say you can create  a visual representation of the steps that they have to do to complete a  test, and this is just an   example. For example, you can, you know, first you

need to write your name, then you need to color,  cut, or glue. Whatever the task, however long or short you need to make it, so that  a child can follow through the routine, you're making it easier for them to know what  to expect that they have to do. know the steps, be able to understand what  is expected of them. As   again, it can help the child ease that nervousness or that uncertainty of not knowing what to do by  just having these visual representations in front of them. And in this case, they're simple based,  but as we showed earlier, they can be tangible objects like an actual pen, an actual crayon  box, an actual scissor, or they could be just words attached to them. Again, feature matching  to depending what the child needs at that time.

I wanted to show here a highlight on AT that can  facilitate visual schedules, visual supports. As we mentioned, these can be earlier, I showed  you visual supports that can be printed, you know, whether you're using real objects or  symbols, but this is for example an app called Choiceworks that kind of does the same thing. I  am not selling you the app, I'm just showing you one example of many that is available out  there that can facilitate visual supports. The Choiceworks app has a schedule board  where you can build a schedule for each child where he or she can then check off tasks. As the task images slide to the all done column,  the child gets both visual and audio confirmation. The schedules are easy to  edit and fully customizable.

For children that need extra  support, you can add a timer. With an all done column, children  can work toward a motivating reward. Supporting positive behavior and giving  them a more enriching classroom experience. Okay, so this is just as I mentioned, one example  available, in this case in the Apple Store of an app, that is very robust and can facilitate  the creation of visual support. It even has feelings boards. You can actually record the  child following the steps themselves, so they

can actually see themselves instead of symbols  representing whatever task you want to include, and we find that it's being very successful  when used whether it's in the classroom, or home, or therapy. And just as this is  available, there are many other types. And at the end of the presentation, I'll talk  more about FAAST and I can talk about how, you know, anyone can actually  borrow some of these   things and trial them in their real environment. We can't talk about positive behavior without  mentioning communication. So a child's ability to be able to communicate with  familiar or unfamiliar   communication partners, can impact their behavior as we kind of, you know, may know already. Not  only their ability to speak, but their ability to

comprehend what is expected or spoken to them can  also affect their behavior. And the following, I just want to make sure I didn't miss  something, if you don't mind, let me just check. I felt like I missed something here, but I  didn't. Okay. So the following, is a video that's going to talk about some AAC tools, some  words that we come in AAC meaning augmentative alternative communication, so communication  tools that are available. Again, a range, because AT is range of things, from very simple  things that we can do ourselves, to more highly sophisticated or robust  devices. Words that we can   include in these devices and the ways that we can use these communication tools, not only for the  child to, you know, for the child to be able to communicate or to understand the expectations  which, in turn, can help with behavior.

Just because a child can't speak,  doesn't mean they have nothing to say. Communication is a basic human need that allows  children to connect with others, express their feelings, and feel part of the community they  live in. Children that have problems developing language or speaking, still have the same  opportunities as their verbal peers. We need more structured tools, strategies, and explicit  instruction to grow their communication skills. When verbal speech is not  progressing, alternative   means of communication could be of a great benefit. We call this augmentative alternative  communication or AAC. A system that utilizes

tools and strategies to teach children vocabulary  that have different communication functions, with the assistance of special tools and strategies.  One of the most important questions for teachers or caregivers to ask is:  What words should I teach   my child? Oftentimes when introducing new words, we focus on words that are too  specific or that the child prefers such as bubbles or car. This can limit your  child's ability to communicate novel ideas in different environments. A better option of  words would also include core words. Words we

use the most in everyday  life and across different   settings and environments like school and home. Core words are those 250 to 400 words that make  up most of what we say in everyday conversation. Since these words can be more abstract to  teach than nouns, verbs, and descriptive words, we have to be more thoughtful and  intentional in the way we teach them.

However, they equip the child with important  communication functions including requesting, negating, directing actions, and commenting. There are different AAC tools a child  can use to communicate. There is no order to follow when choosing  a communication tool. A child does not need to master a more basic  AAC tool before introducing a higher tech one. What's important is to consider  the child, environment, task, and tool to match  the child to the right AAC, and to use the appropriate strategies to teach  the child how to use them. Constant modeling by the adult using the AAC tool, teaches the  child that this is a new way of communication.

Introducing the AAC tool during highly  engaging and motivating activities, ultimately the child needs to feel like a successful  communicator wanting to continue to use AAC. For example, here Alexis is making a connection by using the AAC tool. It is helping  her get more of her favorite snack. Keep in mind, the same words could be used  during other motivating activities to give Alexis the opportunity to continue practicing  the same words but in different contexts.

Focus on using specific words in different  environments. One way of structuring the process of teaching and modeling core words, is  to select a set of words to focus on each week or each month. This makes the modeling more  manageable. Offer lots of practice and support. No one learned to speak in a day, month,  or year. Same with AAC. It requires lots and lots of opportunities to practice. Avoid  expecting mastery to be your ultimate goal

or feeling that your child has to use a  set of words before teaching new ones. We do more harm by limiting access to new  words, than we do by giving them too many words. So, it's important to focus on communication  because as I mentioned earlier, it's highly tied to behavior. And as you saw in that example of  the little girl in the video requesting a snack,

the ability for her to understand the words,  or the symbols, or the AAC device to be able to request that, can maybe prevent someone or  child to, you know, have a frustrating experience requesting what they want. It's just one example  of that. And that's why it's so important to focus on communication when dealing with behavior  as well. If I may check something, I just feel like I knew I had missed something. I had missed  this slide. I apologize because I was talking

now on communication, but I'll go back to that. I  just wanted to highlight some examples of visual support that I know I had missed. I had spoken  about visual schedules with the Choiceworks app, but this is an example of a copy that you  can make. Laminate to make it more durable, you can add velcro, so a child can, you  know, add or remove parts of the schedule. You can use positive behavior  cards or, you know, picture cues, like where you see this one, this sit down  and walking is a reminder, a verbal reminder, of what an expectation is. So the child can  comprehend by looking at the visual, obviously being taught first, what  the expectation is before   we can expect the child to do it on their own.

We can use timers to make sure that a child  understands time constraints so they don't get, for example, exasperated when they're moved from  one activity to another or preferred activity ends. This is just one example of a color-coded  timer that has auditory, as well as, visual cues, where it will light up when your time starts  in green, remind you auditorily in yellow, also visually, by saying you have, for  example, five minutes left and then turn red when the time's up. And this is just the  bottom one, with the child reading a story and has a visual timer as an app on an iPad or a  tablet. So as an example of an app that can serve as a visual timer, so he had a dare as a timer  for his reading time. Okay, now I can move on. Okay, so as we saw in the video, having a way of  communication, a tool for a child to express and understand what is expected,  can be used to record   or to show daily routines. These are some of the

examples that can be used for. It can be recorded  with motivating messages. Let's go! It can model the use of a device, you have to give cues and  wait time when you are offering the child with these visual supports or these AAC tools. So you  have to first use it in front of them. You have to give them examples of how to use it. You have to  give them space to process how to use them, that's the wait time. You have to provide immediate  feedback, so when they do select the right,

you know, visual, you have to celebrate it, or  when they use the right communication attempt or card to let you know something, so that they  know that, you know, they're on the right track. You have to create the opportunities for  communication to happen. So, you know, you may actually create a play activity where you  want to practice certain visuals or certain words, and you engineer the environment for the words  to have to be used, so that they can practice. So just like, you know, you would teach a little  bit more thoughtfully how to write your name, or how to distinguish shapes, or how to read, you  kind of have to do that too, when introducing a visual support or an AAC tool. You have to almost  teach it so that they understand the way that the children understand the way to be used. And  obviously it goes without saying, that you have

to ensure accessibility so  that whether the visual   support or the AAC tool is always accessible to the child and at their  disposal to use. It doesn't   work if they don't have it available to be used. These are examples of AAC tools that you can  use, as you saw in the videos. Laminated picture symbols of different emotions for a child to  communicate during an activity. You can record a device, for example, with food choices during  snack time. You can use picture symbols of words like turn, or more, or like. So if you're reading  a book with the child, the child can press the

device to let you know turn the page or compress  the device to say or show you a word that says, you know, a picture symbol that says like to  let you know that he's liking the activity that you're doing. Whether it's reading, or bubbles,  or snack time, you could record repetitive story lines. So for example, a popular children's book:  Brown Bear, Brown Bear, What Do You See? That's a story line that is repeated throughout. You  could record I see and then the child can press it to participate in the story. This can help  obviously children who may have limited verbal speech or who may not be able to participate in  an activity, to be more actively engaged in it. This is another example of, as I  was mentioning, the Brown Bear book, of how you could use in this picture; you have  a GoTalk 9. You can include. in this example,

we have again Brown Bear Brown Bear  visuals to the Brown Bear activity, where the child can tell you I see, and then  the animal that they see. So imagine just an activity where the teacher, for example, or  the parent at home is reading the book, and if a child is not able to fully communicate or  express what they want, they would be again that passive participant. But once you allow them  to have a device, or a tool, or a symbol where they can say "Oh I see the yellow duck" or, you  know, that becomes more of an active participant. They can now express what they want, they are  engaged, and they be part of the activity as well.

So, the conclusion on assistive technology  is that when you are using AT whether it's to support communication or to support behavior,  you're increasing the opportunity for children to experience their environment. You are  promoting positive experiences, on top of that, because they have a way to understand and let  you understand what they want. Understand you, and let themselves be understood. They can be  again active in their learning, not just passive.

And it can encourage physical, cognitive, and  socio-emotional development which is so important especially in children, to have these positive  experiences. I mentioned that as part of the FAAST program, everyone in our state has  the opportunity, for example, to borrow, or receive a training, or a demonstration on  any of the tools that we showed in all those videos today or that we talked about today.  So it's not only having access, for example, through a device lending library like FAAST has  for 30 days to like, you know, borrow let's say a GoTalk 9 or borrow that time timer, but also  receive a demonstration or training afterwards on how do I actually, now that I was able to borrow  it, how do I use it? How do I take it home, or school, or therapy, and  use it so that it actually   serves a purpose. And the nice thing about FAAST is that, you know, you can get that, you know  obviously being free. So, you can contact our faast.org website, which is our general FAAST  office or each RDC, regional demonstration center,

respectively where you live. We happen to be  the South Florida RDC, so anyone living in the southeast or southwest of Florida can contact  us directly to set up a device demonstration, or training, or loan, or any further assistance  regarding AT. And this is extremely, I think, beneficial because half of the battle is  acquiring or getting the opportunity to trial AT, but the other battle, which is I think equally  important, is understanding how to use AT.

There's a lot of AT abandonment because  we only sometimes think of the tool, without really understanding  the environment where   we have to use it, or the task that we have to use it, or even the individual, the person, the child  that is using it to make sure that we're pairing the right tool with the best features that we can  for that person, or that child, or individual. I open it now to any questions that anyone has,  feel free to add anything if you want to, to what we presented today, or I presented  today, and anything you want to say. I know this format is a little, you know, weird  in that sense that it doesn't allow that freedom.

We can talk about it individually  later as part of FAAST. We can help with individual cases or people  that may have concerns as well. And this would be our contact information  for the South Florida FAAST program.

Any questions? Okay. Again as I mentioned, if you have  any specific concerns regarding any specific consumers, you can feel free to  email me or call our office, Currently, the way we're working obviously with COVID, is that you can leave us  a message. We will return   all phone calls within 24, typically 24 hours. We can do all types of  demonstrations and training   virtually, and any device loans we can either ship directly to you or we can set up a sort of  like curbside pickup at our FAAST location in Miami if need be. Obviously all our  services are free, so we're here to help. I think with that I will,   I'm a little early. It's  a little earlier than normal, but if nobody has

any questions or anything else to add, I think  that's it from my end. Hannah anything else?

2022-06-18

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