AAC & Autism:Teaching Communication Through Motor Planning

Thank you…

Michigan Integrated Technology Supports

The Mission of LAMP

To improve public awareness of the unique qualities of the power of AAC to change the lives of non-verbal individuals with autism and other developmental disabilities by:

– Providing specialized clinical training to health care professionals, teachers, and parents

– Supporting Clinical Research

– Supporting clients and families with education, resources and information

By the end of this session you will be able to:

1. Briefly describe the five key elements of LAMP

2. Identify the relationship between motor planning and communication using AAC

3. Identify the benefits of using core words to teach communication using AAC

What is LAMP?

Language Acquisition Through Motor Planning

A therapeutic approach

What is LAMP?

Language Acquisition Through Motor Planning

A therapeutic approach

Built on principles of motor-learning

A Case for Motor Consistency

"In the practiced automatic movements of daily life attention is directed to the sense impression and not to the movement. So, in piano playing, the beginner may attend to his fingers but the practiced player attends only to the notes or to the melody. In speaking, writing and reading aloud, and in games and manual work, attention is always directed to the goal, never to the movement. In fact, as soon as attention is directed to the movement, this becomes less automatic and less dependable."

Cattell, J.M.

1893

Ming, Brimacombe, Wagner2007

154 Children with ASD found that 41% of 2–6 year olds and 27% 7-18 year olds showed clear evidence of oral motor and/or hand muscle apraxia

Mirenda, P. (2008) A back door approach to autism and AAC; Augmentative and Alternative Communication, 24, 220-234

Motor Planning Indicatorsand ASD

High prevalence of motor planning difficulties in ASD

Speech requires high degree of motor planning

Automaticity facilitates motor action

We can take advantage of motor planning when:

• Each word has its own motor pattern due to consistent icon locations

• Motor patterns don’t change

• Patterns build upon themselves as language grows

We cannot take advantage of Motor Planning when:

– Significant navigation of the system is required– Requires continuous visual refocus and visual

reorientation– Large bank of icons to learn– Same motor plan has different language outcome– Too many or inconsistent rules for generating

language

What is LAMP?

Language Acquisition Through Motor Planning

A therapeutic approach

Built on principles of motor-learning

Emphasizes independent access across environments

Communication Goal

Same as for all AAC users…S: SpontaneousN: NovelU: UtteranceG: Generation

i.e. expressive, generative communication

What is LAMP?Language Acquisition Through Motor

Planning

A therapeutic approachBuilt on principles of motor-learningEmphasizes independent access across

environmentsMulti-sensory

LAMP approach

Good

Poor

Low Moderate High

Perf

orm

ance

Arousal Level

Zone of Optimal ArousalThe Inverted U-Principle

(Duffy, 1962)

Considerations for Treatment– Enhance or minimize sensory input– Manipulate sensory input to maintain a “zone of

optimal arousal:• Client must be able to orient, discriminate,

attend, explore, interact, and learn• Match activity to level of arousal• Incorporate sensory strategies throughout the

day to help maintain appropriate arousal level

LAMP approach

Child-Focused

As suggested by Stanley Greenspan, enter the child's activities and follow the child's lead. If the child wants to line up cars in a row or twirl a top, the parents will join the child in his or her preferred activity (with the intent of developing this action into an affective interaction) rather than demanding that the child join them in their preferred activity (a process which, at best, will produce no more than rote action and reaction).

From Autism National Committee http://www.autcom.org/behaviorism.html

Follow the child’s lead: Watch for what interests the child and use that interest to create a meaningful language learning experience.

Join in with the child: Shared focus develops through interaction.

Purposeful and Intentional

Use Movement

Surprising and Novel

LAMP approach

LAMP LAW…

LAMP LAW…

Initiating a unique motor plan

Hearing the word produced by that movement

Experiencing another’s reaction to the word

Things to remember:

Device Position

And…

Random Selection and Perseveration

Why??

Stable key location enables the development of automaticity

When using AAC, teach location, NOT metaphor

Each consistent pattern of one, two or three hits on the AAC device must always result in production of a unique word.

Automaticity

Automaticity

• EMG brain : new vs. automatic tasks• Repeated movements become subcortical• Cortical areas can then be put to “better use”

Avoid temptation to “check comprehension” by shifting locations of pictures

because …?

LAMP approach

The auditory output stimulates the child’s auditory system, providing auditory feedback with the motor response, …

… which may later stimulate the child’s natural attempts to imitate the auditory output he/she gets from the AAC device and the auditory feedback from his/her communication partner.

Auditory Signals“Input from the vestibular, proprioceptive, and

auditory systems is critical for the development of speech and language (1989, Windeck & Laurel)

Children need to experience words, not just repeat them In LAMP each unique motor pattern = specific

auditory signal……a specific wordSGD provides critical auditory

information

LAMP approach

Any attempts to communicate should have natural

auditory/verbal, visual, and social consequences.

Social Exchange

No Mistakes:

No matter what the child selects on the AAC device, the rule for the communication partner is

RESPOND RESPOND RESPOND

LAMP Language Consideration: Single Words

“Communication is based on the use of the individual words of our language. True communication is spontaneous and novel. Therefore, communication systems cannot be based significantly on pre-stored sentences. Communication requires access to a vocabulary of individual words suitable to our needs that are multiple and subject to change. These words must be selected to form the sentences that we wish to say.”

ASHA’s AAC Glossary

Focus on “core”

vocabulary

Words Percentage1. I 9.52. No 8.53. Yes/yea 7.64. my 5.85. the 5.26. want 5.07. is 4.9 8. it 4.99. that 4.9 10. a 4.611. go 4.412. mine 3.813. you 3.2 14. what 3.115. on 2.816. in 2.717. here 2.718. more 2.619. out 2.420. off 2.321. some 2.322. help 2.123. all done/finished 1.0

96.3%

Toddler Vocabulary

Arranged by FrequencyThese 26 core words comprise 96.3 percent of the total words used by toddlers in this study

Banajee,M., DiCarlo, C, & Buras-Stricklin, S. (2003). Core Vocabulary Determination for Toddlers, Augmentative and Alternative Communication, 2, 67-73.

1. again2. all done3. all gone4. away5. big6. go7. help8. here9. I10. it

11. like12. mine13. more14. not/don’t15. stop16. that17. want18. what19. you20. my

21. do22. down23. get24. in25. little26. off27. on28. put29. some30. out

First 30

Words

©Van Tatenhove, 2005, Revised October 2007

Michael Brian Reed (2009) Is “campaigning for people with communication

impairments to be given a way to say the same 100-400 words that speaking people say most each day…”

Questions for, teachers, SLPs, decision makers and makers of communication aids: 1. What is your plan to introduce core vocabulary to

students with communication disabilities? 2. Can teachers and SLPs be sure that during preschool

years specific core vocabulary and all language functions be introduced.

3. Can teachers and SLPs be sure that students have access to core vocabulary in education?

The “Core” of Language Representation

Picture producing words RARELY provide communication power

Early vocabulary samples have very few, if any, picture producing words

Any representation method requires learning

DO NOT create the AAC displays based upon what can be easily represented

Word List

I Stop

Go Not

Eat Drink

More

Vocabulary Expansion– Pronouns: I, you, it: “I go; You stop. More

it”– Colors: “Get red; Need blue.”– Foods: “Eat soup.”– Toys: “More bubbles; Need truck”– Drinks: “Drink juice; Want water.”– Adjectives: “Good work;” “Not bad.”

Unexpected in the expected

Fulfilling Needs

Opportunities for Communication

Rapid Generalization

Core words have many meaningsBack

Up

Meanings of these words are continually revised by children as they are used in different contexts.

To match or harmonize

The shirt goes with the pants.

To fit:

The belt won’t go aroundmy waist.

To circulate:

The rumor goes around the school.

To make a sound:

The dog goes “bow wow”.

To function:

The engine is going.

To come into a condition:

Time to go to sleep.

go

Move around an axis or a center:

To reverse the sides or surfaces :

Other ideas?

To affect or alter function:

Bend or change the course:

turn

Don’t over-train in one activityLook for social exchangeMove quickly to next level; may be next

word, may be combined words, may be next level (sequenced)

May not need to “train” each word

References

• American Speech-Language Hearing Association (2009). Augmentative Communication: A Glossary. Retrieved from http://www.asha.org/public/speech/disorders/accPrimer.htm.

• Angermeier, K., Scholosser, R., Luiselli, J., Harrington, C. & Carter, B. (2008). Effects of iconicity on requesting with the Picture Exchange Communication System in children with autism spectrum disorder. Research in Autism Spectrum Disorders, (3), 430-446.

• Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62(5), 564-573.

• Banajee, M., Dicarlo, C., & Stricklin, S. (2003). Core vocabulary determination for toddlers. AAC: Augmentative & Alternative Communication, 19(2), 67.

• Bruinsma, Y., Koegel, R., & Koegel, L. (2004). Joint attention and children with autism: A review of the literature. Mental Retardation & Developmental Disabilities Research Reviews, 10(3), 169-175.

• Bruneau, N., Bonnet-Brilhault, F., Gomot, M., Adrien, J., & Barthélémy, C. (2003). Cortical auditory processing and communication in children with autism: electrophysiological/behavioral relations. International Journal of Psychophysiology, 51(1), 17.

• Buffington, D., Krantz, P., McClannahan, L., & Poulson, C. (1998). Procedures for Teaching Appropriate Gestural Communication Skills to Children with Autism. Journal of Autism & Developmental Disorders, 28(6), 535.

References, cont.

• Cafiero, J. (2007). Challenging our belief systems regarding people with autism and AAC: Making the least harmful assumptions. Closing the Gap, 26 (1) 7-9.

• Cattell, J.M. (1893). Aufmerksamkeit und reaction. Philosophische Studien, 8, 403-406. English translation: in R.S. Woodworth (1947). Psychological research (vol.1, pp 252-255). Lancaster, PA: Science Press.

• D’Ausilio, A., Pulvermuller, F., Salmas, P., Bufalari, I., Begliomini, C., Fadiga, L. (2009). The motor somatotopy of speech perception. Current Biology 19 1-5.

• DeThorne, L., Johnson, C., Walder, L., & Mahurin-Smith, J. (2009). When "Simon Says" doesn't work: alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18(2), 133-145.

• Duffy, E. (1962). Activation and Behavior. Oxford, England: Wiley.• Durand, V. (1999). Functional communication training using assistive devices: Recruiting

natural communities of reinforcement. Journal of Applied Behavior Analysis, 32(3), 247.• Elder, P.(1992). Phone conversation as cited in Unity: Language for Life Training Manual.

Wooster, OH: Prentke-Romich Company.• Fey, M. (2008). The (mis-)use of telegraphic input in child language intervention. Revista

de Logopedia, Foniatria y Audiologia, 28(4), 218-230.• Fitts, P. & Posner, M. (1967). Human Performance. Belmont, CA: Brooks/Cole.• Gernsbacher, M., Sauer, E., Geye, H., Schweigert, E., & Goldsmith, H. (2008). Infant and

toddler oral- and manual-motor skills predict later speech fluency in autism. Journal of Child Psychology & Psychiatry, 49(1), 43-50.

References, cont.• Koneya, M. & Barbour, A. (1976). Louder Than Words… Nonverbal Communication.

Columbus, OH: Merrill.• Light, J., Roberts, B., DiMarco, R. & Greiner, N. (1998). Augmentative and alternative

communication to support receptive and expressive communication for people with autism. Journal of Communication Disorders. 31, 153-180.

• Ming, X., Brimacombe, M., & Wagner, G. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain & Development, 29(9), 565-570.

• Mirenda, P., Wilk, D. & Carson, P. (2000). A retrospective analysis of technology use patterns in students with autism over a five-year period. Journal of Special Education Technology, 15 (3) 5-16.

• Olive, M., de la Cruz, B., Davis, T., Chan, J., Lang, R., O'Reilly, M., et al. (2007). The Effects of Enhanced Milieu Teaching and a Voice Output Communication Aid on the Requesting of Three Children with Autism. Journal of Autism & Developmental Disorders, 37(8), 1505-1513.

• Provost, B., Lopez, B., & Heimerl, S. (2007). A Comparison of Motor Delays in Young Children: Autism Spectrum Disorder, Developmental Delay, and Developmental Concerns. Journal of Autism & Developmental Disorders, 37(2), 321-328.

• Reed, M. B. (2009, July 28). AAC campaign questions [video file]. Retrieved from http://www.youtube.com/watch?v=B-qFcPpeNu8

References, cont.

• Rogers, S., Hepburn, S., & Wehner, E. (2003). Parent Reports of Sensory Symptoms in Toddlers with Autism and Those with Other Developmental Disorders. Journal of Autism & Developmental Disorders, 33(6), 631-642.

• Schepis, M., & Reid, D. (1998). Increasing communicative interactions of young children with autism using a voice output.. Journal of Applied Behavior Analysis, 31(4), 561.

• Schlosser, R., & Blischak, D. (2004). Effects of Speech and Print Feedback on Spelling by Children With Autism. Journal of Speech, Language & Hearing Research, 47(4), 848-862.

• Siegal, M., & Blades, M. (2003). Language and auditory processing in autism. Trends in Cognitive Sciences, 7(9), 378. doi:10.1016/S1364-6613(03)00194-3.

• Thunberg, G., Ahlsén, E., & Sandberg, A. (2007). Children with autistic spectrum disorders and speech-generating devices: Communication in different activities at home. Clinical Linguistics & Phonetics, 21(6), 457-479.

• Windeck, S. & Laurel, M. (1989). A theoretical framework combining speech-language therapy with sensory integration treatment. Sensory Integration Special Interest Section Quarterly / American Occupational Therapy Association, 12 (1) 44-48.

• Wynn, J. & Smith, T. (2003) Generalization between receptive and expressive language in children with autism. Behavioral Interventions, 18(4), 245-266.

• Xu,J., Gannon, P.J., Emmorey, K., Smith, J., Braun, A. (2009). Symbolic gestures and spoken language are processed by a common neural system. Proceedings of the National Academy of Sciences, 106 (49); 20664-69.

www.aacandautism.com

Mailing Address: P.O. Box 1317

Wooster, OH 44691Telephone: 330-202-5800 (local or international toll line)

866-998-1726 (toll free US)Email: lamp@aacandautism.com

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