Assistive technology devices have been a HUGE part of curriculum and behavior management techniques for the Day School. Communication devices are evaluated using the The Assessment of Basic Language and Learning Skills-Revised, (ABLLS-R), and teacher observations to determine the student’s level of communication. From that point, a loaner device is provided at the child’s level, from there, more formal evaluations can be requested from the Department of Education. There is a strong demand for communication devices, but we need to understand that sometimes more advanced or more expensive devices are not always simplest answer.
There is a ton of research in the area of communication and technology more than I can mention in this blog, it’s a “hot topic” among professionals and parents, but as we all know some of the best ideas come from following some of the simplest of rules of Applied Behavior Analysis.
Edward is an eight year old boy just transitioned into a new school, and his first few days at school were difficult. Adjusting to the new environment, new faces of therapists and classmates made Edward’s experience quite overwhelming. Being non-vocal he would resort to multiple forms of problem behavior to get his point across. This included tantrums, grabbing towards or at favorite objects, and dropping to the floor when denied access. He was unable to express his needs in an appropriately way and his therapist’s ability to strategically manage, and figure out his environment made his behavior a big challenge. Edward did not display the ability to use universal gestures, rather resorting to sustained tantrums as a quicker, more effective means of getting what he wanted. All the signs pointed to tangibly maintained problem behavior. When beginning instruction, Edward would not tolerate the removal of favorite items from his possession.
Initially, his therapist practiced removing his preferred items (stuffed animal, musical toy), then returning it back to him while gradually increasing the time to return the item. If Edward did not engage in problem behavior within the interval, the items were returned. This occurred over several sessions until he was able to tolerate removal of objects for over 30 seconds. This may not seem like much time, but took over 1350 trials and between those trials, redirection was required. As days went by, Edward began to maintain tolerating longer periods of item removal with less frequent tantrums, but it was still only the first steps.
Since he was new to the school, it was observed that he became interested in other items around the classroom, mostly musical toys, or the classroom radio. The clever therapists’ noticed that when these items were turned off, or taken away, they would trigger tantrum behavior. Conversely, when his preferred items were in his presence he would sit appropriately and wait. They also noticed that these items were strong motivation tools that could be used to help teach him during instruction.
The classroom therapists decided that they would teach him to ask appropriately for these items as an alternative to the tantrums. There were a few days of interesting debates between the classroom staff and speech therapists as to which mode of communication Edward should start to learn, picture exchange, sign language, gestures, or a assistive technology. Trial by trial testing was used with all modes and it was determined that he gravitated towards the audio feedback and button pressing. It was also very helpful to see that he already knew how to press buttons on his musical toys as well.
Edward was given a single button communication device. This small, simple device had one windowpane and recordable audio feedback, saying “I want radio.” There was also a picture symbol in the device windowpane. This button was located on a small triangular board, placed on the table with enough space to prevent him from knocking it over, or grabbing the device off of the board. It also gave therapist enough room to prompt and re-direct him, if he lunged towards the radio, or mis-pressed the button.
Edward was prompted to press the communication button; he was given 10 seconds of preferred music to listen to. This was conducted in trial-by trial format where items were removed and therapists would reinforce him with the radio when he pressed the button. He made this connection after practicing across many sessions. After 2 months, Edward was able to identify and make a connection between the button press and the back-up reinforcer (access to the radio and his favorite musical toys). This caused him to appropriately wait as well as being able to request his most favorite items without resorting to tantrum or maladaptive behavior. He developed a very powerful contingency system.
Although there are still going to be difficult moments and goals to reach in other areas outside of the teaching session, Edward was able to establish an alternative means to express himself and control some of his surroundings in the simplest of ways. This one communicative contingency was successful in significantly reducing his problem behaviors and is a simple example. For many other students this type of contingency can be used to shape behaviors in many other areas. Edward was taught to press the button under different scenarios, in different locations, and staff realized that they could place this contingency into effect during other types of programs leading to greater independence.
Our loved ones with communication deficits have many options with the advent of a broad range of technologies. From learning simple gestures to sophisticated sign, using a visual picture exchange, to the most expensive com device you can find on the market, achieving communication still requires 4 things: prompting, reinforcement, time, and consistent implementation.
But as my brother so callously told me one day on the golf course, it’s not about the golf clubs; it’s how you use them, and I could not use them. When I first started out playing, missing swings was my strong point, curving left away from the fairway my best suit. Only after hundreds of practice shots at the range, I was able to develop a (somewhat) straight, controlled shot; my clubs are a set of handed down 1972 Walter Hagen’s. You could not have put a brand new $900 set of Ping golf clubs in front of me, and expect a hole in one all the time. Prompting, (correcting my swing), reinforcement, (scoring lower), time (thousands of practice shots), and consistent implementation (practicing often) lead to greater success.
Just like in the Edward’s story, we can’t just put an advanced device in front a child with communication and behavior deficits and expect an immediate “hole in one”. So many times, I have observed therapist and family members wanting to use these strategies, only to succumb to incorrect or insufficient knowledge about how to use the tool. This leads to frustration on the part of the child, and on the part of the person wanting to use the technology.
It comes with time and practice, it comes with identifying motivators, and teaching communication comes from learning the contingencies that elicit behavior. Starting to sound familiar? Conditioning takes effort and every attempt should be made to prevent communication from degrading as time goes by. Best practice dictates that we need to consistently implement the use of communication training throughout the entire day for it to become a useful skill. Just keep prompting…
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