TODD - the people, the process, the PERSON AAC in the Home, School and the Synagogue for a Young Man with Autism

froma Cummings, OTR/L
Laurie Person

Web Posted on: November 22, 1997

This session will focus on the past, present and future of a 12 year old young man with autism who has recently added a Pegasus Lite to his total communication system. Discussion will include reason for referral for a new augmentative communication device, a brief history of Todd's previous communication strategies, Todd's current communication, and rationale for recommendation of the Pegasus Lite based on a feature match assessment. Description of Todd's page sets on the Pegasus Lite as well as his interactions using the device will be highlighted.

Reason for Referral: Todd's total communication system appeared inadequate for his current and upcoming communication needs. His total communication repertoire needed expansion to accommodate his expressive needs across environments, and more specifically, for his Bar Mitzvah which is scheduled for May, 1997. This very significant religious and family experience requires hours of study and preparation for all young people reaching this milestone. A student typically studies for an average of 30 minutes daily for a full year prior to the event. Todd's challenges and learning style is such, that a more vigorous study and preparation schedule is anticipated. In addition to the weekend of the observance, family discussion prior to, obviously during and certainly afterwards, center around this meaningful event.

History of Communication Strategies: Todd's total communication has included use of the ZYGO Macaw, Canon Communicator, Connect Four letter board and facilitated communication. He has chosen to use selected methods with his variety of communication partners. These devices, in addition to other communication strategies, all continue to be useful to Todd.

Communication Partners: Todd's communication partners at school range from classmates in his Life Skills Program to typical students with whom he is in contact in his 'home room', special activities, during recess and in the cafeteria. The receptive skills of these peers include those who show age appropriate skills, others who are hard of hearing and many who do not read. He participates in his after school program with another group of peers and care providers. Several of his adult listeners expect him to communicate using facilitated communication. Others read his total communication or share his frustration during the unsuccessful interactions.

Communication Needs: Todd's mother describes the extensive expressive communication that will be required of him at his Bar Mitzvah. Todd will 'speak' in both English and Hebrew in front of the congregation to recite prayers independently, lead the congregation in prayer and lead the congregation in responsive readings. He will need to 'speak' in a timely manner during this well rehearsed one hour service. The voice output must be highly intelligible in both languages and the device must have capability for memory to exceed sixty minutes of digitized speech for this occasion, in addition to his ongoing communication. Todd must be able to readily and immediately move from one prayer (page) to another, without manually changing or possibly confusing the overlays.

Current Communication: Todd's ongoing communication strategies, prior to receiving his Pegasus Lite, included the following: leading the communication partner to that which he wants, pointing, taking his partner's hand to point, total body language, gestures, pointing to 'yes/no' written on paper in response to a question, pushing partner or item away, vocalizations, limited signs, very limited verbal approximations, independently selecting the letters of his name on the computer keyboard, independently selecting by pointing to numbers on a calculator, facilitated communication (with selected partners) and using the Macaw (voice output communication device). He used these language strategies to initiate interaction, express wants and needs, answer questions, and announce what he is doing. Motivation and interest play a significant role in the richness of his communication. Todd demonstrated an increased awareness of people in his environment, as demonstrated by seeking eye contact, teasing and reaching out to people. His overall newly evidenced persona could be described as engaging, reaching out and interactive.

The following represents a sampling of his current communications:

* During a community based class trip to McDonald's, Todd had messages recorded on his Macaw for breakfast. His color overlay, using PCS symbols, pictured McDonald's, three breakfast food choices and three drinks. Todd was guided to the counter, but showed no interest in ordering. At his table, he noticed and looked at the McDonald's picture menu. Todd very quickly found the picture of the french fries and used his total communication strategies to indicate to his adult communication partner that he wanted french fries. He very eagerly accompanied the adult to the counter, and, when the McDonald's person gave Todd the picture menu, he immediately and intentionally pointed to the picture of the french fries. During the four minutes it took for the french fries to cook, he led his original partner back to the counter as if to say "Where is my food?" and led another familiar adult to the counter for the same reason.

His mother reported that he told her about this that evening. Todd reportedly also told her about the rest of the trip to the Republic-Gazette, the robots that he saw there and that he would like to be a newspaper reporter, because "they write but they don't have to talk to people". Mrs. Person was aware of the field trip, but had not sent Todd with money for a snack.

* Todd was having a 'grumpy' day, and a familiar communication partner at school asked 'yes/no' questions in attempts to understand his unhappiness. He independently pointed to the words "yes" and "no" printed on paper to respond. His answers supported each other and were never contradictory. The accuracy of Todd's responses was later validated by his mother.

It is noteworthy that this strategy is not always successful. There have been occasions when Todd chose not to respond to this method of interaction.

* Todd's adaptive P.E. class goes to the bowling alley once every three weeks. His picture overlay on the Macaw had a variety of "bowling pictures' including an announcement of the activity, related comments, specific comments about who goes next and numbers for the score. Colored PCS symbols were used with one inch target areas arranged in time sequence. Each square had a full message on it. Todd always enjoyed touching the upper left message, "Let's go bowling".

During a community trip, Todd touched "let's go bowling" reliably, then followed by putting the Macaw down, retrieving his bowling ball and taking his turn. While seated, he explored the overlay and touched the target areas with the numbers. Todd was possessive about the Macaw, allowing other students to touch it while he held it, but not relinquishing it readily to another student.

* A very popular game in Todd's classroom is called number search. Each student copies the number sequence from the board onto a white board. They then take turns, within the game structure, to find the papers with the correct numbers which are scattered around the room. Todd participates in this activity by independently and very rapidly pointing to numbers written on a matrix. The numbers can be as small as those on a regular calculator.

* Todd saw a paper container filled with soda with the Jack in the Box logo on it. He led this clinician to the cup, and pointed intently to the logo. Assuming that he wanted the soda, his water container was emptied and the soda poured into it. This was not Todd's intention and he did not drink the soda. Instead, he led another adult over to the cup with the Jack in the Box logo and pointed intently. She was not able to understand his intended message using his full repertoire of communication strategies. It was glaringly obvious that Todd wanted to communicate something of importance to him, but, after approaching three familiar adults, he was unsuccessful with his communication. His repair strategy involved seeking out another communication partner, rather than attempting to use other methods to convey the message to his current partner. Todd walked away from this unsuccessful communication without evidencing any unacceptable behaviors.

Summary and Impressions: Todd used a full repertoire of communication strategies across environments and with his various communication partners. His range of communication strategies included body language, leading, pointing, using a voice output communication device, taking his partner's hand to point, total body language, gestures, pointing to 'yes/no' written on paper in response to a question, pushing partner or item away, vocalizations, limited signs and very limited verbal approximations.

The cited examples evidence that his total communication system was not adequate for his current and upcoming communication needs. This was true, even though he is not using all 32 messages on each overlay. It was speculated, as suggested by the communication sampling, that Todd needs messages that have not been anticipated by the person designing the overlay. Todd, in the Jack in the Box situation, had a message to say that was not available to him. He attempted to communicate this message to three adult partners unsuccessfully, and then had to relinquish his idea. This would suggest that Todd needs a method by which he can generate his own messages without relying on spelling or an abstract multi-meaning icon approach.

When provided with a dynamic display communication device (even with very limited communication opportunities during evaluation sessions), Todd showed understanding of the concept of dynamic display on two separate occasions using four different dynamic display communication devices. He made up to 5 hits to find the desired page with his intended message. Todd demonstrated the ability to direct select to a dynamic display screen, maneuver his way through 6 pages of information to select his message and recognize and self correct his errors. He appropriately sought help when the board was not responding to his touches. He combined two messages on one screen and searched the pages for his intended response when directed "find the---"' Todd vocalized and smiled during the interactions. Todd watched the screen and moved his chair closer to the device. Todd engaged in the activity for 15-40 minutes and demonstrated appropriate social, interactive behaviors during the evaluation periods.

Professional Recommendations: A communication system was recommended for Todd to accommodate his ongoing communication needs in addition to those more specific to his Bar Mitzvah. The necessary features required in a device are as follows:

• highly intelligible speech in English and Hebrew
• digitized memory to exceed two hours
• DecTalk synthesized speech
• user generated language which does not require spelling or an abstract multi-meaning icon approach
• portable and lightweight
• colored symbols are preferred but not mandatory

The Pegasus Lite, because of its features and especially because of its weight, is recommended as the best fit device, in accordance with a feature matched assessment, to meet Todd's communication needs specific to his upcoming Bar Mitzvah and his ongoing communication needs.

The following strategies were recommended and employed to enable Todd to generate his own language using the Pegasus Lite:

• Meaningful language pages were developed to accommodate Todd's communication needs. Pages included up to 48 messages, including colored PCS symbols and newly learned photographs. Page structure included constants in the bottom 2 rows to enable Todd to manipulate pages within the system without having to return to his master page.
• Todd experienced role play, exploratory and interactive opportunities to expand his language. He demonstrated a learning style described as follows: presenting him with the messages, allowing him to explore the messages with supportive assistance available but not intrusive, allowing him to practice the communications within his own privacy (possibly as a role play), and then reinforcing the interactions by providing him an appropriate, real life opportunity to interact.
• Todd was assisted to further develop pragmatic skills necessary for interactive communication. These included but were not exclusive of: initiating interaction, topic maintenance, changing the topic, timing- responding in a timely fashion, commenting, questioning, answering questions, using a narrative to describe events or provide information. Todd's current abilities, including the ability to produce simple phrases (on a dynamic display device) using very basic sentence structure and linking words and symbols in correct grammatical order (ie. Noun + verb) must be expanded to enable Todd to further develop high level language and cognitive skills such as reasoning and problem solving.

Todd received his Pegasus Lite, funded by Title XIX (Arizona) in September, 1996 and currently has approximately 70 pages programmed into his device. The page sets used most often by Todd are "restaurants", "Phoenix Suns", "music", "yesterday", and "computer". He enjoys choosing where to eat dinner with his family, saying hello and ordering at McDonald's or Applebees. This may entail a sequence of 4-5 hits. At school, the Pegasus is used for academic subjects, including social studies, math, Spanish and APE (bowling). Todd interacts with adults in academic situations and spontaneously with peers. Often at school, he will try to change the activity to one he prefers to talk about, as would any typical teen!!! In music therapy, he can help direct the session by choosing the instrument, tempo, pitch and volume. Thus, he uses his Pegasus to answer questions, comment, interact socially, direct the activity, changing the topic, providing information and responding in a timely manner. The feeling of empowerment has changed Todd's life significantly. He is more positive about his role in school, the community and home because he is in control of his communication.