the effort to engage in the activity. This often results in the stu- dent's team mistakenly thinking that they lack adequate skills, such as cause-and-effect, to develop switch skills as a method of access. In reality, it's often a lack of creativity that results in the disengagement of the student. From the very beginning, we must presume competence and assume that every switch activation is intentional. Each switch activation should be seen as a teachable moment where we de- scribe what happened when they touched the switch and en- courage them to try again. When discussing switch access and cause-and-effect skills for students with complex motor skills, Karen Kangas advises, "Don't get stuck in believing that the stu- dent does not know cause-and-effect; all humans are born with cause-and-effect. Model, demonstrate, and choose a switch that you know will be successful" (Kangas, 2012). When starting, it's important to determine the best place to position the switch. Clinicians should rely on their clinical observation to assess the student to identify where they move their body that may be potential switch sites. Often, the hand is not the most efficient access site for the student. Teams need to consider which move- ment allows for the most engagement with the activity, the low- est cognitive load, and the least motor planning and accuracy to execute the movement. Potential switch placements include the head, nose, elbows, chest, knee, and foot, among others. It may take time for the team to determine the best switch access site, as the initial choice may not always be the most efficient one. (Image 2)
Once a switch site is determined, it's crucial for teams to se- lect activities that are interesting and engaging for the student. These activities should be centered around age-appropriate, meaningful, and goal-directed play and leisure activities. Repeti- tion with variety is key to keeping the student motivated and en- gaged, as a wide body of research supports that slight changes during repeated play sessions help children master skills faster. If educators and therapists provide a child with only one switch site and one or two activities to practice a new motor skill, it may lead to a perception of a loss in motor skill, decreased motiva- tion, inconsistent performance, and a lack of cause and effect. In reality, it has very little to do with the student, but rather the need for play-based, fun activities with built-in repetition and variety (Bean, Ian, Switches Away From the Computer, 2022). We all are born with cause-and-effect. Our students do not learn cause-and-effect; they need to learn that they can have agency over their body to make amazing things happen. When you head out to see a student that you'd like to start working on switch access skills, you will need a switch, Step- by-Step voice output switch, an age respectful book, and a pre- sumption of competence. If the book has a repeated line, record that line in multiple voices on a Step-by-Step switch. If the book doesn't have a repeated line, record some comments about the story on the Step-by-Step switch and start reading with your stu- dent. You should model when to say the line while reading and then let the student know that you have placed the switch near their body part, allowing them to use the switch to read the line in the book. Model how to activate the switch, and give the stu- dent ample wait time, at least 10 seconds, to activate the switch. If the chosen location doesn't work after several tries, communi- cate with the student and suggest trying another placement. It should always be framed as a mistake in switch placement, not the student's inability to activate the switch. (Video 1)
Video 1: https://www.youtube.com/shorts/5sCava4b_-s Initial switch eval for a student. Activity was shared reading using the book Don’t Push The Button by Bill Cotter. The Step- by-Step is connected to a mechanical switch that is placed at the student’s head. Recorded on the switch is the phrase, “Don’t touch the button”in several voices.
Image 2: Student activating switch with her nose. Second switch site is the right side of her head
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