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Visual Schedules and Core Vocabulary

Visual Schedules and Core Vocabulary

A visual schedule is a visual depiction of expectations for a child for the sequence of upcoming events or activities. It can be composed of real objects, photographs, line drawings, colored icons, written words, or a combinations of these modalities differentiated to the student’s needs.  A visual schedule should tell a child what he is doing during a designated time period.  One child may need a visual schedule for within a 30 minute activity, while needing a separate scheduling depicting the child’s entire day.  

Why are visual schedules important?

Visual schedules are evidence based and have been shown to be helpful as part of Functional Communication Training (Bopp et al, 2004). A visual schedule can visually show what is expected for a child within a certain time frame (5 minutes, half hour, half day, full day, etc.).   They can also help a child predict what will come next and which may result in avoiding negative behaviors due to frustration of not understanding a transition.  Students with special needs may become frustrated, overwhelmed, or anxious if daily activities are not clearly indicated, or if they don’t understand the sequence of events that are expected of them during an activity or across a time period.  It is very common to assume that students are comprehending and organizing more auditory information than they actually do.  Then performance deficits are assumed to be “behavior” or lack of effort.   The use of visuals in a schedule acknowledges the strengths of many students and assists them in using their stronger skills (visual processing) to overcome their areas of difficulty (i.e. auditory processing of speech).

Explain Core Vocabulary and Visual Schedules…

Our generative language systems consists of a 80%-20% Core to Fringe (or Core to Fringe + Personal Core) ratio.  This ratio is consistent for children as we talk about how they communicate during their school day; however, oftentimes, we often provide visual schedules which don’t match what we are actually saying.  Instead, we provide noun filled schedules which don’t depict these important and frequently used core words.  As a result, our schedules become very unlike like our generative language system.    Instead of a “noun only” visual schedule, I recommend adapting visual schedules with core words.  This creates a more natural way to speak to a child and also model language.  If we can increase what a child understands receptively, there is greater chance that the child may begin to use those words expressively.

Benefits of adapting schedules with core words:

Increase understanding of core and fringe words

Pair language with pictures to increase speech to icon association

Increase understanding of spoken language when paired with a visual

Increase use of aided language stimulation

Increase understanding of transitions and sequences

Increase understanding of expectations within or across activities

Increase opportunities for learning word meaning

Increase opportunities for generalization of word meaning across contexts, activities, and communication partners

Increase understanding of spontaneous novel language

Use of visual schedule to target past tense and recall past information

CVES Solution Visual Schedule

Potential target language:

Sit at table

Put on coat

Go on bus

Go home

Child or communication partner moves first sequence to the red area when an activity is finished.

Child or communication partner continues this sequence after each activity by moving the core and fringe words into the red area when each activity is completed.

When all activities have been completed as shown above, the icons can be reset for the next time period/activity or moved into the inside of the visual schedule for storage.

Past tense recall:

Past tense recall can be targeted to talk about what happened within the activity or school day.  Two word combinations or adding subjective pronouns might be appropriate depending upon what the educator is targeting. The core vocabulary words can be rotated to include pronouns, action words, locations, etc. in order to target various grammar structures and to increase mean length of utterance.

sit table/Sat table/I sat at table

Put coat/I Put on coat/coat on

Go bus/went bus/I go/I Went on bus

go home/went home/I go/I went/I went home

 

Consider adapting your visual schedule with core vocabulary words, or check out the visual schedule in the CVES Solution Store.

 

 

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Working on Recurrence: Again versus More

>Did you know that the word “again” is one of the top 60 words that children acquire between the ages of 18 and 36 months of age? (Marvin, C. A., Beukelman, D. R. & Bilyeu, D. 1994). Children use the communicative function of recurrence frequently throughout their days to ask their their parents for more of something, or to repeat an activity or action.

What is recurrence?

Recurrence occurs when a child either comments on or requests the recurrence/another instance of a thing, activity, or person (i.e. “monkey again,” “more juice, another cookie,” “jump again”).  This can occur with or without the original item/instance still present (Lahey, M. (1988)  Language Disorders and Language Development. )

When should I use the word “more”?


Looking at typical acquisition of language, we may target the word “more” at the single word level, and then move to using this word in two-word combinations. The word “more” can be used as a single word.   On the CVES core vocabulary foldout with an emergent communicator, the word “more” may be removed directly from the foldout and given to a communication partner.  The communication partner takes the icon “more,” may hold the icon next to their face (to encourage orienting to communication partner), and verbally names the icon “more” aloud.  This allows the communication partner to assign meaning to the word within the context of the activity at hand.  The communication partner can then respond back to the child using their voice or by using the same icon “more.”   Depending upon the child’s language level and target utterance, the communication partner may verbally name the single word  by itself (“more”) or may say the word and add a fringe vocabulary word (i.e. “more cookies”).  The communication partner may begin to use the core communication card to target 2-word utterances (no more, more what?, more cookie, more bubbles, want more? etc).
“More” is a good target word for recurrence when the child is working on more of an item, thing, or food.  A good rule of thumb is if you can add to or take away from something, then the word “more” can be targeted.    Similarly, if there are multiples of items that can be acquired or added by a child, then “more” would be an appropriate target.  Examples of items that can be used to target “more”: Juice, milk, water, pretzels, chips, (any food or drinks during snacks and mealtimes), Bubbles, Paint, Shaving cream, sand and sand toys,  magnet letters, magnet blocks, figurines, music.

Alternatively, we may also be working with kiddos who aren’t interested in some of the items listed above.  One of my clients had very little interest in traditional play items which might be offered throughout his school day.  In fact, most of the items that were presented to him as incentives to ask for “more” resulted in disinterest, and him leaving the area.  A reinforcer assessment revealed one of his favorite items to be colored rubberbands.  These items were then used to target recurrence during  targeted language instruction to teach the concept of “more” and recurrence.  Following spontaneous use of this communicative function, structured opportunities for requesting recurrence were scheduled throughout his schools day in addition to honoring his spontaneous requests.

When should I use the word “again”?

The word “again” can be used by itself or combined with other words when a child is requesting recurrence of an activity or action.  “Again” is a very powerful word and clinically we can look to use this word with the same frequency that we target the word “more.”  “Again” can be targeted with the same frequency as “more,” however we are teaching the use of this word paired with an action or activity.  Tickling, jumping, walking, peek-a-boo, hugging, being carried, being pushed on a swing, being bounced on a ball, are examples of actions that may be requested with the word “again.”  Activities such as watching a tv show or movie, listening to a song, doing a puzzle, being picked up or swung back and forth by an adult, repeating a song, sliding down a slide, going for a car ride, climbing through a tunnel, playing a game, can all be requested using the word “again.”

What about using “more” and “again” with other communicative functions?

While working on the concept of recurrence, it is important to keep in mind the other ways that “more” and “again” can be used across communicative functions.  Both “more” and “again” can be used to request an answer from a communication partner in the form of a question.  For example, a child working on two word combinations may use more + fringe word to ask if they can have more of a preferred item.  A child may say “more + cereal?” at snack  time as if to say “Is there more cereal?” or “can I have more cereal?”  A child may say “go again?”  or “do again?” to their parent to ask if they can  go down the slide again at the park.

Alternatively, the words “again” and “more” can be incorporated into requesting actions from other people.  More specifically, a child may work on directing an adult or communication partner to do an action.   “Do again!” may be used this time as a way to tell a parent to push them on the swing again.  “Up again” may be used to direct a caregiver to pick the child up again.  After a child has learned generalization, or understanding and use across a variety of activities, the next target for therapy would be three word combinations (Do it again, I want again, want up again, etc.).

Next month check out as we talk about visual schedules and core vocabulary!

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CVES as a Multimodal Communication Tool

CVES as a Multimodal Communication Tool

While CVES can certainly be used as a stand alone low-tech AAC system, it can also be utilized as a language teaching tool.  In the latter example, CVES can be used as a multimodal communication tool to support receptive and expressive communication.  Multimodal communication includes all forms of communication that one may use to communicate, including speech or word approximations, pictures such as those in the CVES Core Vocabulary Foldout or Binder Inserts, manual signs, gestures, body language, or speech generating devices.  It’s important to consider all forms of communication to support both receptive and expressive language needs of clients who have complex communication needs.

Dynamic Display Speech Generating Device
Sign Language
Gestures
CVES 3 Word Combination
CVES Intermediate Single Fold
Body Language

For my client Thomas, CVES has been very effective as a language teaching tool.  Thomas is 15 years old, has a medical diagnosis of Autism, and uses an Accent with Words For Life software.  He attends a local high school in an Educational Life Skills Classroom.  Thomas is kind, smart, and incredibly capable of learning language; however, he has difficulty with communication partners getting too close and/or touching his communication device to model language.  For Thomas, looking at a second screen on my device was overwhelming, and resulted in frequent communication breakdowns, perseveration on auditory feedback, and decreased orientation to the communication partner.  It should be noted that this is not a blanket statement for all users of speech generating devices; rather an observation that my current tool to teach Thomas language was ineffective for him.  For several of my clients who have speech generating devices, I may model my language on my own personal communication device, but I have learned over the years how important it is to differentiate to each learner’s needs.  I have found that low tech communication supports can be quite powerful to model and teach language, and with Thomas, low-tech has been the most powerful support for his language system to grow.  Upon input from Thomas’s mother, we moved away from using a second device to the CVES Advanced Trifold 189 .

CVES Advanced Trifold 189

General goals for Thomas include: increasing functional communication (wants, needs, preferences, ideas), increase mean length of utterance and variety of syntax structures, increase spontaneous novel utterance generation, increase understanding of spoken words, and decrease use of verbal prompting.

Collaborating with Thomas’s mom, we set specific goals for Thomas’s language development with a focus on using core words and addressing functional communication skills.  Specific goals for Thomas are of follows:

  1. Thomas will use core words to greet (i.e. what’s up, how are you) using his voice/communication device.
  2. Thomas will make a functional request using core words with his voice or communication device.
  3. Thomas will use core vocabulary words to take turns during a game or structured social activity by using his voice/communication device.
  4. Thomas will use core words (i.e. more, again) to ask for more of a preferred activity or item (i.e. music, music video, light toys, food) in 80% of opportunities across a variety of activities given physical prompting as needed.
  5. Thomas will protest using novel language (don’t do, don’t touch, stop that) across functional activities in 80% of opportunities given fading prompts.
  6. Thomas will use core words (i.e. “help” “help me” “need help”) to ask for help in 80% of opportunities given fading prompts.
  7. Thomas will express likes versus dislikes using core words (i like that, I don’t like)  in 80% of opportunities given fading prompts.
  8. Thomas will name category labels (i.e. clothes, winter clothes, summer clothes, food, pets, toys, etc.) for a variety of categories.
  9. Thomas will use core words to describe functions for a variety of common items in 8/10 opportunities across 3 trials given fading prompts.
  10. Thomas will describe a picture or story using pronouns (he, she, it, they) in 80% of opportunities given given fading prompts.
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CVES and Core Vocabulary in Early Intervention

Renee received her Bachelor’s degree in communicative disorders from the University of Redlands. She earned her Master’s degree from the University of Rhode Island. After obtaining her Master’s degree, Renee completed the Assistive Technology Program at the University of Illinois Chicago. She is also a credentialed Early Intervention Provider. Renee has over 10 years experience as a speech language pathologist and has worked with patients from birth to 21.

This month, guest author Renee Bourke shares her perspective of how CVES can be used as a language teaching tool with the Early Intervention Population.  

I think one of the most underutilized  interventions in early intervention  is Augmentative and Alternative Communication (AAC). And, I get it. The pressure is to make these littles talk; that is the family goal- Abby will use words to tell us her wants and needs. Parents want you there to make their child actually say words. I find this pressure leads clinicians to ‘forget’ the two most important things that are fundamental to what we do 1. You can’t talk about what you don’t understand or understanding comes before expression and 2. Communication is our ultimate goal; not speech. Don’t get me wrong, I see each one of my kids with the hopes that they leave me talking or at least saying a few words; but, and more importantly, my goal is that they leave me empowered with the ability to understand language and communicate.

This leads me back to my original statement: AAC is too often underutilized in early intervention. With the exception of using a few signs; it is rare that low tech picture communication systems are used in early intervention. However, the research tells us that using AAC will support our goal … and it is not just for kids who are not talking. I have used the Core Vocabulary Exchange System (CVES) to support comprehension and to increase the utterance length of early intervention aged kids.

So here is why I think you should use AAC with your early intervention clients and how I have used CVES with my youngest clients:

Provides a visual to support understanding:

Research in learning tells us that visuals help us to learn and remember information. For a child who is struggling to process auditory information, pictures provide a support to aide in understanding by requiring the person giving the direction to use fewer words, increasing the child’s chances of processing the information and being successful. A pictures also provides information about a word a child may not understand or missed. CVES makes it easy to use visuals with my clients because it has the core words need to provide meaning to utterances.

Keeps language simple:

Using pictures can help remind us to keep our language simple and clean. It is easy to forget that a child who is using little or no language may also be understanding little or no language. By keeping our language simple; for example instead of ‘ Hey Sally do you want a chocolate chip cookie?’ we use pictures to just say ‘want cookie’ we provide a situation where the child is more likely to understand and process what was said. Simultaneously, we are modeling language closer to the child’s developmental level; giving them the model of how to use that language appropriately (in this example the model would be requesting a cookie in the future using want cookie); and providing a model for how to create that sentence by the child watching you pull the icons of the board and sequence them on the communication card.

Slows rate of speech:

I’m a fast talker. It’s my nature. Even though I know I need to slow down when I’m working with a client, it’s tough. Using pictures as I talk slows my rate down. When using CVES I go to the board and remove each icon I am targeting and place it on the communication strip as I say it. This slower rate of speech supports increased language understanding because it reduces the number of units that need to be processed per time unit. A slower rate of speech has also been shown to support language production.

Provides a visual for making utterances longer:

I have used CVES to help the littles on my caseload who just can’t seem to get past single word utterances. Putting the icons of the targeted utterances on the communication strip and pointing to each one as you say it, provides a concrete model to the child that each word is a different and independent piece of information. When it is the child’s turn, the icons are a visual prompt for the target utterance.

AAC has many benefits in early intervention and these are just some examples of the benefits that using CVES has brought to my sessions with this population. The takeaway here is that as a discipline we need to remember to incorporate what we know works and we know AAC supports language both receptively and expressively even in our youngest clients.

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CVES and Core Communication Checklist

ASHA defines functional communication skills as forms of behavior that express needs, wants, feelings, and preferences that others can understand. When individuals learn functional communication skills, they are able to express themselves without resorting to challenging behavior or experiencing communication breakdown (American Speech-Language Hearing Association).  Functional communication skills are a high area of needs for our students with complex communication needs. 

Requesting 3 Word Combination: I want this

 

Rejecting 2 Word Combination: Don’t want

 

Check out the Core Communication Checklist, a data collection tool geared to help collect baseline data of a student’s functional communication skills and guide functional communication goal writing.

Click Here to Download: Core Communication Checklist Final

CVES Core Vocabulary Foldouts are designed to target a variety of functional communication skills. Check out the CVES Core Vocabulary Foldouts page to review 9 differentiated low-tech user areas.

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CVES and Data Collection

As a special educator or treating therapist, you are probably overloaded with daily, quarterly, and yearly paperwork.  You might be thinking, I have so many kids on my caseload, and it’s really hard to keep track of their language acquisition while also keeping track of IEP goals, behavior intervention plans, sensory diets, visual schedules, and academic goals!  To help guide my intervention with students in a life skills classroom, I developed 3 data collection checklists.  These 3 checklists correspond to the CVES Core Vocabulary Foldouts in each CVES language series: Emergent, Intermediate, and Advanced.

Click each link below or check out our library to download a copy of these reproducible data collection tools:

 

Click here to download: Core Word Acquisition Emergent Color Coded – Google Docs

Click here to download: Core Word Acquisition Intermediate Color Coded – Google Docs

Click here to download: Core Word Acquisition Advanced Color Coded

Up next, we will share a Core Communication Checklist which addresses Functional Communication Skills!

 

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CVES and Early Childhood Education

Cynthia A. Quiroga, Bilingual Spanish-English Speech Language Pathologist

Meet Cynthia Quiroga, a certified bilingual speech-language pathologist from Arlington Heights, Illinois. Cynthia obtained a bachelors in Early Childhood Education with a special endorsement in Special Education before becoming a speech-language pathologist.  Cynthia works both in an early child classroom as well as in private practice.   Today she shares her experiences as a therapist and how she is using CVES with the early childhood population.

Communication makes my world go round.  In my personal and career life, language has been an important component of my life.  I grew up in a Spanish speaking home in Indiana with two older brothers.  We were raised by Mexican immigrant parents, who taught me very early that eye contact itself could have a variety of meanings, especially, when an adult stares with eyes wide open into a child’s eyes.  Although, I did not understand at the beginning of every summer why my friends flew to Disney World and others went to summer camp, yet we drove at least 24 hours to Mexico.   Today, I appreciate and miss the ability to travel to Mexico for extended visits in the summer and see all of my family and cousins which go beyond counting on my fingers and toes. In Mexico, unknowingly at the time I learned Spanish, culture, manners, respect, lifestyle, body language and most importantly communication that allowed me to access the environment around me.  

As a Bilingual Spanish-English Speech Language Pathologist, I frequently discuss with colleagues, student interns and other disciplines in the field that being culturally competent is crucial in our field, as it is being a person in our society.    Throughout my career, I have worked with monolingual Spanish speaking students and families, simultaneous bilingual students, and my current speech and language disordered clients and students include early childhood students with origins including but not limited to Eastern Europe, India, China, Korea, Peru, Mexico and Myanmar.   Therefore, my cultural competence continues to grow by reading, asking questions and having discussions about perceptions, expectations and traditions.  However, it is always very important not to generalize, because even though it may be one culture, every family can be different.

As a Bilingual Speech Pathologist, I also have studied and witnessed communication development regarding second and simultaneous language acquisition. Families are also different in regards to generation and/or if they have felt the need to assimilate or unintentionally have because of societal pressures.  Having learned and used different forms of aided language stimulation to help children obtain and express language, some methods have worked others have been hard to stay consistent.  I’ve explained to parents that using pictures is not intended to stop verbalizations but to increase with visuals and modeling is a big part.  Parents of many cultures expect expressive language to emerge and increase, however family education about the importance of receptive language acquisition and skills are as important as the expression.  Conversations and discussions should be open where we allow parents to state concerns.  For example,  communicating that quitting one language will make another one stronger, is a myth, even if in some cases other professionals have recommended this as a personal opinion.

This past year I worked with a client who was of Eastern European origin.  She presented with a limited set of skills both expressively and receptively.  I understood we had a lot of work and explained to the parents her strengths of enjoying movement, dolls and toys as well as her needs of responding to her name, following a single step directive and the ability to express her wants, needs and ideas.  Our treatment plan to gain approximations for single words was developed based on the idea that she presented with an array of vocalizations.  We began treatment and indeed her vocalizations increased with communicative intent to a listener.  However, the approximations to real words did not increase as expected and this was confirmed by the parents in their native language.  I have always been a fan of Core Vocabulary and had used 50 word Core Vocabulary boards in the past by pointing to words during structured activities.    

CVES, Core Vocabulary Exchange System brought it all together for myself and this student. The Intermediate felt like a leap from vocalizations but I felt that we could always take it at a slower pace.  Since this student enjoyed movement we started with taking turns with a doll and a stroller, which was an activity we had done previously with trials for verbal approximations.  The first days we worked on “go” and “stop,” however, I also modeled “I,” “wait” and “go again.”

The great part about working with early childhood is that their brains are so plastic that if we are consistent and intrigue via interest the child’s brain will absorb after repetition.  After going around the school pushing a stroller, using the tri-fold out and a baby elephant in the stroller growth was seen every session from bringing “go,” “stop” and “wait” (for other students crossing in the hallway).    By the third session she gained “do” and “pop/stop” verbally while using the words on the strip but receptively was understanding “my turn,” “take out,” “put in” and so much more.  At the end of her sessions with this clinician she began putting two words together.  My favorite was a spontaneous response “you wait” when I asked for a turn.  As teachers, clinicians and staff know families move, make a different choice of placement or go to a private facility in the early childhood years.  My recommendation for her was to continue using not only core vocabulary but the intermediate level of CVES.  Since, CVES is a system that allows the facilitator to determine if a comment, response or request is appropriate for the clients skill set, depending on the particular goal.  Granted the next Speech Pathologist can design a different plan but this system is low-tech communication system with high communicative potential for her.

When using CVES, I felt all I was left to do is what I consider the fun part, fringe and personal core, which allows us connect with our client and families. To be honest colleagues allow me to to do what I call “the fun part of an IEP” which is asking the parents their child’s strengths and their current concerns about their child. I truly enjoy interviewing the parents about interests,  and funny moments with their child, family activities as well as investigating what draws the child to demonstrate communicative intent or intrigues them away from their norm.   In the early childhood years, I tend to use any interaction modality to develop a relationship with a child, especially children with Autism or social pragmatic disorders.  I remember being a young maybe 15 year old aunt playing with my nephew who did not speak much and was often “in his world.”  He is actually a 25 year year old man today.  Anyway, he and I would play a game where I would give him a soft hug and say 1, 2, 3, squeeze and give him a tight squeeze.   Sometimes, the counting would go very slow, other times fast, the best was when  the counting and hugging was initiated by him.  This simple activity has taught me that I was trying to reach my nephew in an expressive and tactile way, which led him to receptively accept the interaction and then facilitate the interaction.  It’s our job to see how we can connect with our students in order to build a relationship, because who wants to listen or talk to someone they do not like or enjoy.  The foundation of building the relationship with the child begins by understanding the family, culture, expectations and gaining the respect in order to be able to treat and educate all involved.  The fact is still participate with some of my clients the 1, 2, 3, squeeze game, with a much less tighter squeeze than I did with my nephew.

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Aided Language Input Part 4: Using Chaining

What About Prompting?

As a review, when we are using Aided Language Input, we are not prompting or making the child say something, and we are not testing a child to see what they know.  We can, however; use prompting to elicit language and expressive language.  Most importantly, we can use aided language input throughout the day across multiple communicative opportunities, but also use a prompting procedure when expecting the child to communicate and to elicit or naturally encourage communication.

Can I Use Prompting and Aided Language Input?

Over the years, many prompt hierarchies have been created to teach functional, academic, and language skills.   The most frequent prompt hierarchies that come to mind are the Most to Least and Least to Most Prompt Hierarchies.  Depending on the child’s individual needs, we may use one prompt hierarchy over another, or we may choose to use a combination of prompt hierarchies depending upon our expectations for the child.  For example, if we are teaching the visual motor integration and selection of an icon, we may need to use a most to least hierarchy.  If we know a child can physically remove an icon, we may move to a least to most hierarchy.  

When working with AAC, most of us think of using a least to most prompt hierarchy when prompting to elicit language from our clients.  When working with children who use high or low tech alternative and augmentative communication, the least to most prompt hierarchy is what I often use when I expect my students to use new vocabulary words. This is, of course, if they can physically access an icon.   With CVES, I need to ensure that a child can motorically access an icon and give that icon to the communication partner.  Instead of a least to most hierarchy, I can use a most to least hierarchy called “chaining.”

Chaining

We can use a most to least hierarchy in the form of chaining to teach physical motor access. More specifically, we can use “chaining” to teach the visual-motor sequence of selecting icons.  Chaining refers to a method of teaching a behavior using behavior chains. Behavior chains are sequences of individual behaviors that when linked together form a terminal behavior (http://abaappliedbehavioranalysis.weebly.com/chaining.html).  

Chaining has been using for many years to teach a variety of skills, including vocational and life skills tasks (washing hands, brushing teeth, stocking shelves, data entry), as well as language learning and foundations of language learning such as object-picture matching, color matching, picture discrimination, imitation skills, following directions etc.   In backward chaining, it is the last step or “subtask” that a child has not mastered that is focused on first.  This provides the child with immediate reinforcement through successful completion of the task.  Them, once the skill is mastered, the focus moves to the next-to-last subtask.  For example, a child learning to remove his shoes might initially focus on learning to put their shoes on the shoe mat after being assisted with other steps.  Next, the child would learn to take off his shoes and put them on the shoe mat. Chaining is a teaching method which can be used on CVES to teach the motor access of removing an icon from it’s position on the core vocabulary foldout, and giving the icon to the communication partner, then letting go of the icon into the communication partner’s hand.

How do I use Chaining?

We do “chaining” by teaching the last step first.  Provide full physical prompting on the Core Vocabulary Foldout to isolate the icon, grab it, pull it off, and hand it to the communication partner.  Alternatively, have the child place the icon onto the communication card if constructing phrases before handing the communication card to the communication partner.

If we want a child to learn “want stop”  the already learned “want” would be on the communication card.  The focus would then be to backward chain the word “stop” using full physical prompting of physically placing the icon onto the card, and then physically giving the communication card to the communication partner.  We can focus in on chaining to teach the visual motor integration, or physical sequence of the transfer of icon.

Can I Use Backward Chaining and Aided Language Input? YES YES YES!

We should focus on providing aided language input all day to the children we work with, but we can have separate expectations for the  use of icons.  We can use the word “go” and talk about “go” all day across various communicative opportunities (go bathroom, go fast, we go, i want go, go home, don’t go, want to go? Go up, etc.), but use chaining to teach communicative exchanges and have the child complete a communicative exchange with the target core word.  

Up next, guest author Cynthia Quiroga shares how she is using CVES!

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CVES Podcast

Several years ago I had the pleasure of meeting my friend Jeff Stepen at the Pittsburgh AAC Language Seminar Series (PALSS).  Jeff is the creator of the site Conversations in Speech Pathology, which provides podcasts meant to provide ongoing dialogue about topics important to the practice of speech-language pathology/therapy.    Today we will take a short break from aided language input to review a previously recorded podcast featuring core vocabulary and exchange.  Check out the link below as Jeff and I explore the importance of core vocabulary in low-tech AAC Systems and CVES:

http://www.conversationsinspeech.com/csp-017-the-pecscore-mashup/

Check back summer 2017 for a second podcast featuring CVES and Core Vocabulary!  Next month we will resume with Part 4 of our Aided Language Input Series. 

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Aided Language Input, Part 3: Using Traditional Language Techniques

Aided Language Input and Traditional Language Facilitation Techniques

While aided language put is generally considering modeling of language in “real time,”  we can also consider using traditional language techniques as aided language modeling to augment receptive communication and communicative reciprocity.  The child’s job is to look and listen to the communicative partner.  The communicative partner’s job is to react to the child’s behaviors or communication attempt, assign a communicative meaning, and respond to the child using language from the CVES Core Vocabulary Foldout and/or Binder Inserts.   We should always keep in mind typical language development when we are modeling and can ask ourselves “What is the child’s current word level?” “What is a natural response to their current mean length of utterance?” “How can I add a a second/third/fourth word to extend their language?”

1.Parallel Talk: This is when you describe what the child is doing/experiencing during play (providing “self talk” for the child)

Example 3 word level: You have ball. Put ball in.

2. Self Talk: This is when you describe what you are doing during play.  This helps assign meaning between actions and words.

Example 3-4 word level: I am eating goldfish. Goldfish are good.

3. Expansion: Take what the child says and expand upon the words by adding appropriate grammatical markers

Example: If child says “Daddy home” communication partner expands this to 3 word level “Daddy is home!”

4. Build Up and Break Down:  When the child says a word or words, expand and reduce the child’s utterance

Example: Ball, Big ball, Big ball go, big ball go up, big ball go, big ball, ball.

When we are pairing our speech with symbols, we are providing receptive input using symbols to teach their meaning across various contexts and communicative functions.  This will maximize the chance that a child will use the model to facilitate their own utterance.   Ultimately we want these utterances to be spontaneous and novel (SNUG) with reciprocal exchanges on a topic area. 

Let’s look at some examples of how a communication partner can respond to a child’s communication exchanges by using icons on the CVES Core Vocabulary Foldout:

Should I Slow My Rate of Speech When Modeling?

With typically developing children, adults naturally produce fewer words per minute and take longer pauses between words and utterances than when speaking with adults (Sheng, McGregor, & Yu, 2005).  Reducing the rate of speech can modify input for children with auditory processing difficulties:

  • Reduce number of units that need to be processed per unit time
  • Provide stable auditory model for words
  • Encouraging increased clarity by the clinician

With CVES, rate of speech can be slowed down to a more natural rate when we take the time to remove icons from the Core Vocabulary Foldout and then present the icon or icons to the child.    The benefits of a slightly slower rate of speech (and less verbal prompting) can help both comprehension and production of new words for children with language impairments (Montgomery (2005), Weismer and Heskith (1993)). 

What About Prompting?

In part 4 of our series, we will look at different prompt hierarchies and how to use both with CVES!

 

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Aided Language Input, Part 2: Using the Core Vocabulary Foldout

Aided Language and Core Vocabulary Exchange System (CVES)

Today, we are exploring how to do aided language input using CVES on the Core Vocabulary Foldout  and/or personal core words in the binder inserts.  Depending on the focus of the activity and the goal that’s been set for the child, there are 2 different ways of using aided language input with CVES.

Option 1: Individually remove icons directly from the Core Vocabulary Foldout

Using this method, the communication partner removes a single icon off of the core vocabulary foldout, shows it to the user, while pairing their verbal speech with the word on the icon.  In the video below, see Grace and Renee, as Renee focuses on the word “not” in their literacy activity.  Renee removes the icon for “not,” shows it to Grace, and verbalizes the word “not” throughout the story.

In the next video example, Renee demonstrates aided language input of the single words “big” and “little.”  Renee is using aided language input to model single words relating to size concepts.   You will notice that she also uses sign language for fringe vocabulary as she speaks to Grace.  Depending upon the needs of the child, the use of CVES can certainly be used as part of a multimodal communication approach,  including integrating.

Option 2: Remove single or multiple icons from the Core Vocabulary Foldout  or binder inserts and adhere them to the communication card. The communication partner can then bring the communication card to the child and point to and verbalize each icon. 

Using this method, the communication partner facilitates language by constructing single words, phrases, or sentences directly on the core communication card.  The communication partner can do this in 2 ways: to initiate a communication loop with a child, or to respond to a child’s communication attempt.  Our goal with CVES is to create communication loops where a child can initiate and also respond to communication exchanges made by others.  Using this method, the child can take the role of sender and receiver.  Ultimately, this should be our goal with every child that we work with!  

In the video below, Renee moves from using single words modeled individually to modeling two word phrases on the core communication card.  Renee models “get up” by sequencing two icons onto the communication card, then bringing the communication card to Grace, and verbalizes the words “get up.”

 

What Should I Model On CVES?

Aided language modeling can be used to demonstrate appropriate play and social interaction skills, and provide opportunities for learning new language concepts (Binger & Light, 2007; Drager et al., 2006).  Traditionally, aided language input occurs in “real time” during naturally occurring opportunities throughout the day.  So, we may take advantage of naturally occurring routines throughout the day and model specific language targets in order to teach various communicative intents and functions.

We can also use traditional language techniques as aided language modeling.  In part 3 of this series, we will spend time reviewing specific language facilitation techniques and how they can be used as aided language modeling.  We will also cover specific examples of how a communication partner can respond to a child’s communication exchanges by using icons on the CVES Core Vocabulary Foldout. 

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Aided Language Input, Part 1: The Basics

What is aided language input?

Aided language input, also known as aided language stimulation (ALS), is a strategy used by a communication partner to facilitate the understanding and use of symbols on an individual’s AAC system.    The communication partner teaches symbol meaning, and models language by combining their verbal speech with vocabulary words on the AAC System.    This can be done on low tech, mid tech, and high tech communication systems.  On a low tech system such as a core vocabulary board, a communication partner talks to the person while also pointing to the corresponding symbols.  On a high tech device, a communication partner may activate an icon while pairing that icon with their speech.  

Why use aided language input?

Typically, developing children often produce “first words” around their first birthday. By that time, they have had approximately 12 months of exposure to language in context. Drager (2016) states that it is difficult to calculate the number of verbal models that children will have heard by then, but a conservative estimate is in the hundreds of thousands of models. In contrast, children who require AAC often receive far fewer models of the language form that they are expected to use, if any. There are far more limited opportunities to observe another person using an AAC to communicate (Drager, 2016).

Aided language input is an input/output method that teaches the understanding of language (symbols/icons on communication system), and teaches the use of these symbols.  The more a communication partner models a symbol, the more a child will auditorily and visually pair speech with that symbol.   With greater understanding, comes increased use of these symbols.

 

When we are using aided language input with any AAC system, we are not testing, prompting or telling a child what to say.  Rather, we are modeling our language in a verbal + visual modality to increase icon association with verbal speech.  For many of our children with complex communication needs and language delays, deficits in auditory processing make it difficult to process speech alone.    A multisensory modality such as aided language input, can help strengthen the auditory-visual system and facilitate use of icons within an AAC system.

 

 

Is aided language input evidence based?

Yes. In 2016 Sennott Light and McNaughton did a review of 10 research studies and found that aided AAC modeling determined:

  • Improved pragmatic, semantic, syntactic, and morphological development for young children who are beginning communicators
  • With appropriate models within naturalistic contexts, paired with interactional techniques (time delay and recasting), individuals made gains in expressive and receptive language
  • Positive findings of impact of AAC modeling align with major acquisition theories regarding the importance of language input  (Gerken 2008, Hirsh-Pasek & Golinkoff 1996)

The use of aided language input also correlates to the research supporting the use of picture symbols for individuals with Autism spectrum disorder.  We can use the visual spatial strengths of individuals with autism to teach how to use symbols for expressive communication, including the use of a consistent visual communication system to clarify grammar that underlies spoken or signed language through spatial cues (Schuler and Baldwin 1981).  

How do I use Aided Language Input with CVES?

In part 2 of this series we will specifically look at how to use aided language input with the Core Vocabulary Exchange System. We will explore what language to model as well as how to use the Core Vocabulary Foldout to 1. Individually remove icons directly from the Core Vocabulary Foldout or 2. Remove single or multiple icons from the Foldout and adhere them to the communication card.  In part 3, we will discuss how to use most to least prompting to teach access and exchange of core words, while continuing to use aided language input throughout a child’s day.  In part 3, we will discuss using traditional language facilitation techniques as aided language modeling.  Finally, in part 4, we will discuss how to use most to least prompting to teach access and exchange of core words, while continuing to use aided language input throughout a child’s day.