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Autism and the Effectiveness of Augmentative and Alternative Communication

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Our understanding of Autism Spectrum Disorders has advanced rapidly in recent years. Autism spectrum disorders (ASDs) are a family of neurodevelopmental conditions characterized by unusual patterns in social interaction, communication, and range of interests and activities. While this profile is generally applicable for the entire ASD population, much variation actually exists. No two individuals exhibit the exact same symptoms and as such, ASD is a heterogeneous disorder.

Autism spectrum disorders can often be reliably detected by the age of 3 years, and in some cases as early as 18 months. Studies suggest that many children eventually may be accurately identified by the age of 1 year or even younger. The appearance of any of the warning signs of ASD is reason to have a child evaluated by a professional specializing in these disorders.

By age 3, most children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is “no.”

Some children diagnosed with ASD remain non-verbal throughout their lives. Some infants who later show signs of ASD coo and babble during the first few months of life, but they soon stop. Others may be delayed, developing language as late as age 5 to 9. Some children may learn to use communication systems such as pictures or sign language.

Children who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over. Some ASD children mimic what they hear, a condition called echolalia. Even though there are children with no ASD who go through a stage where they repeat what they hear, it usually is gone by the time they are 3.

Some mildly affected children may have minor delays in language. Some seem to be very verbal with unusually large vocabularies, but have great difficulty in sustaining a conversation. The usual “give and take” of conversation is difficult for them. They often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. They have other difficulties including the inability to understand body language, tone of voice, or “phrases of speech.” Sarcastic expression might often be misinterpreted. For example, if someone tells them, “Oh, that’s just great,” they would take the words literally, believing the speaker meant to tell them that it really IS great.

The body language of ASD children is also difficult to understand. Facial expressions, movements, and gestures rarely match what they are saying. Also, their tone of voice fails to reflect their feelings. A high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, and do not pick up on the “kid-talk” approach so common with their peers.

People with ASD are at a loss to let others know what they need because they cannot make understandable gestures or lack the language to ask for things. Because of this, some may simply yell or just take what they want without asking. ASD children have great difficulty learning how to get through to others and express their needs. As ASD children grow up, they become more cognizant of their difficulties in understanding others and in making themselves understood, which can result in more anxiety, depression or maladaptive behaviors.

Studies show that augmentative devices are a great help in fostering language in children with autism and other disabilities, and have achieved remarkable results.

Augmentative communication is all of the ways we communicate other than speech. It includes:  Gestures  Sign Language  Vocalizations  Facial Expression  Communication Displays (boards)  Communication Devices A group of aids, starting from simple, notebook-size plastic boxes to more high-tech devices that resemble an IPod or BlackBerry, has been developed to help those with autism to express their needs. These devices range in price from about $100 to several thousand dollars. Most are portable and the simpler ones are also very durable and well-constructed, a real advantage for children with autism.

Augmentative and alternative communication (AAC) devices are tools to allow people with severe or significant speech impairments to express themselves. These devices are used as a method to allow children to exactly say what they want and as fast as they can. It’s a valuable communicator that allows them to express their feelings, thoughts, ideas and get their needs met. These devices can range from low tech picture cards to high end speech generating devices.

However, regardless of low or high tech, the most important questions about the suitability of an AAC Device is: • can the person say precisely what they want • can they say it quickly

Children and adults that use AAC devices are more successful communicators when properly trained and when their teachers have basic training to help facilitate meaningful communication.

Many specialists believe that the Apple iPad is very adaptable for children with ASD to use as an AAC device. It lessens the symptoms of the disorder by helping kids deal with life’s sensory overload.

Autism experts like Dr. Martha Herbert, an assistant professor of neurology at Harvard Medical, and Stephen Shore, who wrote the book “Understanding Autism for Dummies,” agree about the iPad’s usefulness.

The disorder, which affects as many as one out of 110 children in the U.S. according to a CDC study, means kids have “no control over the pace of information coming at them,” says Herbert. With the iPad, she said, the child has more control.

Gili Rechany, the Education Director at Shema Kolainu-Hear Our Voices School in Brooklyn — which uses the iPad as part of their special education programs — says the iPad allows children with autism to have more direct control than a standard laptop which requires the use of a keyboard and mouse. She also indicated that, “the iPad is an AAC device that allows the child to access their speaker domain abilities easily through using technology with limited modality requirement and minimal cost.”

Aside from the fact that an IPad costs much less than some of the high end AAC’s available, it is also:  Easy to transport  Easy to use applications  Online tutorials are available for free  Educational, communicative and leisure time applications are available for free or for purchase

There are at least three dozen apps designed for autistic kids, including ones for music and reading. And the device itself supports spoken text and other aids for those with special needs.

Here are some links for all kinds of uses:  iPhone application – http://www.youtube.com/watch?v=lyBnt9wygyY  Possible Homework activities – http://www.youtube.com/watch?v=kdpjIR8KjLU&feature=related  Summary of multiple applications – http://www.youtube.com/watch?v=W-eWvnWMx6c&feature=related

In a leading book on AAC by Joanne Cafiero, PhD, Meaningful Exchanges for People with Autism, Dr. Cafiero discusses the ways AAC fits people with autism well (page 26) • Most people with autism are visual learner – AAC uses visual cues • Many people with autism are interested in inanimate objects – AAC tools and devices are inanimate • Many people with autism have difficulty with complex cues – Level of complexity can be controlled so AAC grows with the child • Many people with autism have difficulty with change – AAC is static and predictable • Most people with autism have difficulty with the complexities of social interaction – AAC provides a buffer and bridge between communication partners • Some people with autism have difficulty with motor planning – AAC is motorically easier than speech • Many people with autism experience anxiety – AAC interventions don’t apply pressure or stress (when introduced properly) • Many people with autism present behavioral challenges – AAC provides an instant means to communicate, preempting difficult behaviors • Many people with autism have difficulty with memory – AAC provides means for language comprehension that relies on recognition rather than memory.

Most people have not heard much about Augmentative and Alternative Communication with the exception of sign language. AAC is a different way of communicating with others without using your natural voice. But communication is a lot more than that, especially for children on the Autism spectrum, who can have difficulty with eye contact and the two–sided aspect of maintaining a conversation. It is estimated by the National Research Council that one third to one half of children and adults with autism do not use speech functionally. This makes them prime candidates for augmentative and alternative communication (AAC) systems, either to augment their existing speech or to act as their alternative method of communication.

What’s great about AAC is that there are all types of augmentative communication that can help fill different needs. You only need to find the right ‘fit’ for your child and their needs. For more information in augmentative communication, check out YAACK (Augmentative and Communication Connecting Young Kids) which offers a comprehensive breakdown of the evaluation process for whether to get a low or high tech device, funding issues, and issues with education. However, it is best to seek expert advice on how to proceed and for instructional measures which may “make or break” the success of any AAC program.

Joshua Weinstein has been an educator and administrator for over four decades. He holds a Ph.D., two Masters Degrees in Educational Administration and Supervision and an MBA in Executive Administration. He has been the CEO in healthcare, social services, and business corporations. He’s the president and founder of Shema Kolainu-Hear Our Voices, Tishma for children with autism in Jerusalem and ICare4Autism- International Center for Autism Research & Education- a global leader in autism research & education. He can be reached via email at jweinstein@skhov.org.

Dr. Joshua Weinstein

About the Author: Joshua Weinstein has been an educator and administrator for over four decades. He holds a Ph.D., two Masters Degrees in Educational Administration and Supervision and an MBA in Executive Administration. He has been the CEO in healthcare, social services, and business corporations. He’s the president and founder of Shema Kolainu-Hear Our Voices, Tishma for children with autism in Jerusalem and ICare4Autism- International Center for Autism Research & Education- a global leader in autism research & education. He can be reached via email at jweinstein@skhov.org.

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