Meet Michael
Michael is a 21-year-old student in a non-diploma, school-to-work program at a school for special needs students. He has been followed since he was a toddler for moderate to severe developmental delays in all areas, but especially profound in the area of communication. Test scores reveal that he comprehends spoken language at a 3 year level with scatter from 2 ½ years to 4 years. He is non verbal except for a few intelligible words (e.g., hi, bye, nah). He uses basic sign language and some fingerspelling with those who know signs. However, his signs are not intelligible to people unfamiliar with his patterns. He reads many sight words, but spelling is very difficult for him. Over the years he has tried several speech generating devices, most recently the Say It! SAM communicator. The SAM allows the user to type in novel information using an on-screen keyboard with word and phrase prediction and text to speech capability. It also contains customizable pre-programmed pages for quick, routine messages. Michael’s relatively good reading skills, along with the SAM’s ability to learn and predict words and phrases automatically and quickly make it a useful tool for Michael. When encouraged by teachers, he used the SAM willingly at school and in his after school care setting. However, he refused to use it at home, insisting on sign language with his parents. Michael’s teachers were concerned about his use of the SAM because he never initiated using it without a cue from a staff member. This cue dependency for the SAM was part of a behavior pattern that permeated all aspects of his day.
Relevent IEP Goals Objectives for Michael:
Goal: Michael will use compensatory strategies to increase/improve social interactions skills in school and the community.
Objective: In a structured learning environment, using an AT device, Michael will initiate interactions with adults and peers by asking a question or commenting, 80% of opportunities.
Tools and strategies for Michael:
Over the years, many strategies have been tried to help Michael reduce cue dependency and initiate actions on his own. In terms of augmentative and alternative communication devices, some of the ideas tried were: setting up necessary pages; positive verbal reinforcement for using the device; implementation of reward system; attempting to “wait him out”; increasing the number of situations in which he was expected to use his device and providing pre-programmed pages for these situations; encouraging sharing information between home and school.
Michael was in his last year of school and still not initiating use of his SAM, so the entire team met to work on the problem. In addition to the general problem of cue dependency, several sub-issues and possible solutions were identified.
Problem #1: The SAM is a device that should be charged every night. Michael often arrived at school with the device not charged and failed to notify anyone that it was not working.
Discussion: Observation of Michael connecting the charger to the device and consultation with his mother revealed that part of the problem was physical. Although he faithfully plugged it in every night, Michael’s fine motor problems made it difficult for him to insert the charger correctly.
Solutions:
- Provide additional training in operation of the charger and monitor him at home.
- Ask Michael’s family to purchase a second charger to keep at school.
- Add to Michael’s morning routine to make sure the SAM was working. If not, notify his teacher.
Problem #2: When the SAM did not function properly, staff did not know how to troubleshoot.
Discussion: Staff had turned over since the initial in-service on operation of the SAM. Once Michael graduated and entered a group home, this would be a continuing problem.
Solutions:
- Provide in-services and printed cheat sheets for staff on operation of the device and troubleshooting tips.
- Train Michael’s mother and instructing her to call company for help.
- Make a short video for mother to use as a refresher for herself and to train group home staff.
Problem #3: Michael needed a cue to use his SAM even for activities where he knew he was expected to use the device.
Discussion: This behavior was another example of his overall cue dependency.
Solutions:
- Continue to expect Michael use his SAM for those activities that had been identified in the past.
- Add new, highly motivating situations (e.g., ordering a sub sandwich for lunch, telling jokes with a peer, asking peers to pass food at group lunch.)
- Stay out of his line of sight, use physical, non-verbal, cues where possible (e.g. graduated guidance). Use waiting or indirect verbal cues (e.g.,”Did you want something?“ or “Is everyone ready to begin?”) if necessary.
- Frequent role play
- Positive Reinforcement for using the device independently.
Problem #4: Michael’s attempts at novel messages often failed because of his difficulties with spelling. His SAM often learned misspelled words and included them in the word and phrase prediction lists.
Solutions:
- Contact company help desk.
- Reset the device to prompt the user to decide if a new word should be added.
- Train staff
- Identify a list of words Michael needed for targeted activities and teach him to spell them on the SAM.
How did we check progress?
Both formal and informal means were used to check progress. His speech therapist took data on use of SAM during groups and shared the data with Michael and his teachers. The speech therapist also visited his classroom one or two mornings a week to work on spelling and checked with staff informally about his progress. Informal checks between staff revealed Michael’s increasing independence. Michael began initiating conversations with teachers and peers using his device spontaneously and without cues. Some examples of his increasing independence are as follows: At group lunch, he began to initiate telling jokes with a receptive peer. During groups with the speech therapist, he began to have his SAM ready with no cues. As the staff realized the capabilities of SAM, they requested pre-programmed pages for new situations, and expected Michael to use them. As graduation day neared, he began to initiate conversations with different staff about where he would live and work. His speech therapist programmed a custom graduation page, which Michael used frequently during group. He also initiated a long conversation with his mother at home.
Insights
The staff was motivated and devised many solutions to help Michael. These included considering and dealing with each problem directly. Reducing or eliminating verbal cues was an important key to success. Tracking progress had to become a group effort and informal communication became even more important than gathering data. Finally, and most important, Michael realized that he could communicate and began to take ownership of his device.
