What factors do we think about when considering high-tech AAC?

This blog post comes thanks to a Parent who asked me a question on Twitter.  Thankyou for all your questions, it helps me to understand what you need from me.

In this case, the child was using a low-tech AAC system, but being considered for transition to a high-tech system.  The Parent wanted to know what sort of things a Therapist is going to be thinking about if they think a child is ready for high-tech AAC.

First, an overview:  If you live in England, your child may be able to access funding for a high-tech device through one of the specialised AAC assessment centres across the country.  If your Speech Therapist is considering requesting funding for a device through this system, then there will be specific criteria that need to be met, which will form part of the assessment that your local Speech Therapist is carrying out.  One of the jobs of an assessment is to make a decision about which funding ‘pot’ would be appropriate if we do decide to pursue getting a device. In our area, key criteria are that children can combine more than one symbol in a message, and that they show some navigation skills using low-tech systems (e.g. they can navigate to the right page to build the message they want).   This does not mean that there are not options for children who do not meet these criteria, but that we will be thinking about different funding options.

Each child is a little bit different, but some general principles we will be thinking about if we are considering moving to a higher-tech device:

  • Does the child understand the purpose of communication yet?  Are they making intentional attempts to communicate with other people?

A child who is not yet an intentional communicator is very likely to need more practise at this cognitive skill before we consider a device.  A device is a means to communicate, but cannot compensate for other areas which a child needs to be an active communicator, such as motivation to communicate.

  • Does the child consistently access a low-tech means of communication (whatever that might look like)?  Is there some reason that this does not meet the child’s needs, or do we have reason to suspect that their needs will be better met with a high-tech device?

It can take time to get an AAC system right.  We need to explore and assess various factors in low-tech form so that we can make better decisions about which high-tech device and software will best suit a child’s needs.  In addition, we will always need a low-tech alternative to a device, for times when tech goes wrong or is not available for various reasons.

But there is definitely a point where a high-tech device will be a better ‘fit’ for your child.  Some potential reasons that this might be the case are:

    • Your child needs much more vocabulary available to them than we can reasonably keep on top of in a book
    • Your child would benefit from the wider communication options that can be available to them in a high-tech device, for example, they could use their device to communicate, but it would also open up the potential for accessing email or social media for example, which some software enables.
    • The physical access to a book is a challenge for various reasons.  A device would therefore make communication quicker and/or more independent.
    • Where a high-tech device would considerably reduce the barriers to communication for the child, for example, it would allow them to communicate with a wider range of people in their community and be understood (but we can’t forget that an electronic device can also be a barrier to inclusion if it creates fear of the technology and reduces interactions with other people)

 

  • Is there commitment from the team around a child to use a device?

This is a really big one for me – devices are typically highly reliant on everyone in an environment to be successful.  We look for signs of commitment to and understanding of a child’s communication using low-tech before we pursue high-tech.  There is often a perception that a high-tech device is ‘better’ than low-tech (not necessarily the case at all).  If a class team or family are not commited to using, updating and modelling a child’s low-tech system, then they are not likely to be able to maintain motivation to support a high-tech system.  There is often a lot of excitement when a high-tech device is being discussed, and a lot of motivation is created in the short-term.  But the truth is that using a high-tech system requires a lot of learning, thought and maintenance from everyone around a child.  It is not inherently easier to implement or use.

  • Are expectations of a high-tech device realistic?

We need to make sure that our expectations of a high-tech system are realistic. A child who has very few motivators to communicate may find a high-tech device more motivating than a low-tech one, and this may be a reason to consider a move to high-tech.  But they will not become a child who suddenly wants to chat and communicate as any other person of their age.  If we do not make sure that this is understood, then we may be setting a child up to ‘fail’ at a system because we have not had shared understanding of what our own expectations are.

  • What is the child’s response to technology generally, and a high-tech device in particular?

I would usually be interested in a child’s interest in technology, and want to trial a high-tech device with them (even of it is not necessarily what will be their system in the end), as this will give us lots of information about their readiness for high-tech.

This is a general picture of the kinds of information we will be gathering as Therapists, I hope that is helpful!

Angharad

key trans

If you would like to ask any other questions about AAC or any other communication issue, please come and find me on Facebook (www.facebook.com/findthekeyslt), in my Facebook group (www.facebook.com/groups/findthekeyfamilies), on Twitter (@FindthekeySLT) or drop me a message via email findthekeyslt@hotmail.com

 

 

 

 

 

 

What if the best Speech Therapy was your Physiotherapy?

You may notice that all the blogs I am writing this month are loosely arranged around a theme of  “do your best, don’t beat yourself up”.  This is because this pretty much summarises how I encourage families to think about their child’s Speech Therapy.  I truly believe that beating yourself up is a waste of your precious emotional bandwidth, and it’s not the best way to get things done.

I also think this is a good theme for January, the time of year when you are supposed to be most motivated and coincidentally – a cosmic joke – the time of year you most fancy staying in your pyjamas in the house.

Obviously, I think Speech Therapy is important.  In fact it can be a transformative force in a child’s life.  But the fact is, especially when you have a child with complex medical, developmental or learning needs, it can be just another thing on your list.

So I hope this blog brings you good news when I tell you that there are many children that I work with where I advise families to focus on their Physiotherapy if they want to support a child’s feeding and communication.

Oral skills for feeding and for talking are fine motor skills, growing out of the underpinning gross motor skills such as head control and trunk control.  In addition, movement is an important foundation for:

  • Motivation (if you can move, you can explore, which gives you lots to talk about)
  • Body awareness – the use of your body sensations to understand where your body is in space.  An important underpinning skill for our sensory learners, for children with feeding aversions and for many children with Autism diagnoses.

We need the best skills in the body that we can if we want to support children’s communication.  So next time you are carrying out your child’s Physiotherapy, you might just have their communication work covered too.  And next time you see your Physiotherapist, ask them if you can see them with your Speech Therapist, so they can enhance each other’s work.

Angharad   key trans

 

If you would like support and information about your child’s communication and feeding, I would love to see you in my Facebook group for Families

In March we will be having a Physiotherapist come into the group to talk about the impact of low muscle tone (hypotonia) on children’s learning

 

Stories we tell ourselves

I have been ill all over Christmas.  One of those bugs that deceives you into thinking it is going and then just moves to a slightly different part of your head and throat.

I am usually pretty good at being ill- I am a big believer in resting and hydrating and letting your body do what it needs to.  But I confess that when I woke up still ill this morning, two weeks in, feeling worse than yesterday, I very much reached the feeling sorry for myself stage.

I was very tired going in to the holiday, and feeling a bit demotivated.  I was hoping a really good rest would re-enliven me for the New Year and that I would start with a boost of energy and motivation.

You wouldn’t have known it to look at me, but internally I was in full toddler tantrum mode about being ill.   It occurred to me that part of what I was feeling sorry about was that I hadn’t really been able to fulfil this storyline- yes, I had rested, but not in that restorative way, more in a ‘being immobolised against my will’ sort of way.  I hadn’t managed to catch up with the household jobs I had planned for between Christmas and the New Year.  And so I was telling myself that now I wouldn’t have the energy I needed to start the New Year, and this was a bad start to it etc etc.

This got me thinking about storylines.  In my experience, it is often not the thing that has actually happened that causes you the pain, more the narrative that you attach to it.

What storylines are you carrying about your child’s communication needs, their learning or their eating?  What storylines are you maintaining about your role as a Parent? Are your stories helping, or are they wearing you out?

Stories are a natural by-product of being human, they are our attempt to create sense out of events, and they can help us when they motivate us.  But when we are weighed down by our emotional responses to our stories and so often, completely unaware that those stories are playing out in our minds, then we can be making things much harder for ourselves.

As a Speech Therapist, it is not unusual for me to be trying to support children to develop their ability to sequence and explain events in stories.  But also as a person working with families, it is my wish for you that perhaps you can become aware of and let go of some of the stories that might be getting in your way.

Angharad

 

If this post resonates with you, I’d love it if you would join the Facebook group that I run for families of children with complex communication needs.

Lots of practical stuff about supporting your child, and a chance to talk with a Speech Therapist and with other families about communication.  I like to talk about the emotional aspects of being a Parent or family member  to a child with communication needs too, so we are here for whatever you need at the time.

 

 

Things We Love #5 Life with Greyson + Parker

One of the fantastic things about the internet is being able to find people in your ‘tribe’.  As a Speech and Language Therapist, I enjoy being able to hear from Parents who are going through similar things to the families I work with.

It is reassuring too, when you can see families implementing ideas like the ones we suggest in therapy all the time, and seeing them working, and celebrating their successes with them.

Chrissy is Mum to Greyson and Parker, two boys on the autism spectrum.  She talks about, and posts videos of, a lot of their Speech Therapy sessions.  She also is a powerful advocate for their use of their AAC (alternative and augmentative communication) devices, and shares videos of the family modelling.

Chrissy also posts about family life and lots of other things.  Following this page is a life-affirming experience.

If you’ve got a page, website, book, blog or resource you’d like to share, please do so in the comments.  They might make it into a future blog post, too!

The Tactile System and your child’s behaviour- Undersensitivity

Continuing our series of posts on the tactile system….

In our last post we talked about how an over-sensitivity to touch might show up in your child’s behaviour.  This time, we are looking at signs that may indicate that your child is under-sensitive (hyposensitive) to touch.

A difficulty in sensory processing may be apparent in a child’s motor skills, and/or in their emotional and behavioural responses.  There are many areas in which tactile difficulties might show up.  Because my posts are more feeding-oriented in origin, I’ll focus a little more on signs you might see in that area.  Sensory processing is very complicated, so no one post or list will ever quite capture your child.  That is why a good quality assessment of sensory processing is important.  As we’ve discussed previously, a child with a general pattern of under-sensitivity may react passively (not acting to address their needs), or actively (seeking out sensation to meet their needs).

Under-sensitivity:

  • Poor awareness of food in the mouth- poor oral skills, poor chewing skills, gagging (there are lots of physical reasons why children might show these too)
  • Cramming food into their mouth
  • May enjoy very highly flavoured foods, or tend to like highly textured food (like crunchy things)
  • Unaware of food on their face or left in their mouth
  • May drool with little awareness
  • Poor awareness of being dirty
  • Low pain awareness
  • Seems unaware of temperature
  • May seek out tactile experiences- e.g. rubbing their face against the carpet, mouthing excessively
  • May have a poor sense of personal space
  • May eat non-food items

If your child is showing these signs, they might benefit from working with a Speech and Language Therapist with the appropriate sensory training, and/or an appropriately trained Occupational Therapist.

Coming up- Look out for posts on practical ideas to support your child who is under- or over- sensitive to touch.

Posts from Find the Key Speech Therapy are intended for information.  They are not inetnded to, and cannot, take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

Things your Speech Therapist wants you to know #2 It’s OK to cry in sessions (AKA We are aware you have emotions)

Working in the areas of Complex Needs and Feeding has been an emotional education for me.  Until you work with people who are needing to recalibrate their lives in the face of overwhelming circumstance, whilst learning how to apply the advice of several different degree-level specialists, some of whom disagree with each other, you don’t have a clue, really.

I consider it part of a Therapist’s skill set to sit with you through these times in your life.  Not a skill set we are altogether prepared for in our training, it seems to me, but then perhaps no-one can prepare you.

Please know that I do not expect you to use any shred of your precious emotional and physical energy to suppress your feelings during our sessions.  Crying is OK.  Feeling overwhelmed is OK.  Feeling angry is OK.  It’s all OK.

Sometimes I find in feeding therapy that we don’t seem to be able to make progress towards our goals.  I sometimes find later that my advice has pushed on an emotional button that a Parent wasn’t ready for me to press, and so they haven’t been able to implement what I’ve suggested.   That’s Ok!

The feeding therapy relationship can be an intense one.  It’s important to give yourself the emotional space to adjust to the new challenges that you and your family face.

My therapy appointments have that space in them, if you want it.

Posts from ‘Find the Key Speech Therapy’ are intended for information.  They are not intended to, and cannot, take the place of advice from an appropriately qualified Speech and Language Therapist who knows  your child.  ‘Find the Key Speech Therapy’ does not take responsibility for the use of any advice without appropriate professional guidance,

 

Things Your Speech Therapist Wants You To Know #1 This is What Progress Looks Like

So many of the lessons I have learned working in the area of complex needs, communication and feeding therapy, are life lessons really.

What a privilege and an education, that a family lets you learn these lessons with them and from them, and then in time, that you get to model these lessons to someone else’s family.

Making progress with your child’s communication and feeding can be hard.  Your child starts to lick a new food, and then they get a cold, and they stop. You were just getting going with that communication board, and then your child was admitted to hospital for a month, and now you don’t even remember where you put that communication board.

The human brain is really good at experiencing events, and then making a story out of them that links them all together.  We all love a good story.  So the human brain has a habit of viewing progress as a neat linear process.

It can be tempting to conclude that you are doing something wrong when your child’s progress doesn’t look like this.  But in reality, all progress is made of tiny steps forward, the odd step backward and the occasional topple from the path altogether.  Nobody’s progress has ever looked like a nice straight line, ever.

Don’t get caught up too much in the story your brain is telling you about the progress being made, or you will be trapped in an exhausting cycle of elation and crisis as you interpret whatever your child did today as the whole story.  This is especially true when you are tired and stressed.

Keep your eye on the big picture- what is your goal?   Understand the steps you need to take to get there, and just do them, as consistently as you can manage.  Don’t beat yourself up about the day you didn’t get the therapy work done, just quietly refocus on the goal and start your baby steps again.

On a day-to-day basis, it can feel like you’re not getting anywhere, but when you look back, you will see how much progress you can make this way.

Like all things that are true, this probably sounds irritatingly trite and positive-thinky. But I hope it comforts you that you are not in charge of the big picture, just the little bit of time right in front of you.  As a Therapist, I know that time and consistency will take care of the rest.

Image by Iain Welch Art and Design

Posts from Find the Key Speech Therapy are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance.