Part 4 of 5 Children with Complex Communication Needs

Part 4 of 5 Children with Complex Communication Needs and Cerebral Visual Impairment: What’s the complexity? By Kathy Howery , Maren Barros

augmentative and alternative communication (AAC)

Part 4 of 5

Children with Complex Communication Needs and Cerebral Visual Impairment: What’s the complexity?

To date the series on providing emergent literacy instruction for children with significant disabilities, including cortical visu- al impairment (CVI), has introduced readers to comprehensive emergent literacy instruction (Hanser, Musselwhite, & Wagner, 2019a), one component of this instruction – predictable chart writing (Hanser, Musselwhite, & Wagner, 2019b), and setting the stage for augmentative communication (Wagner, Hanser, & Musselwhite, 2020). In this, the fourth installment in this series,

the intention is to dive deeper into: the characteristics of chil- dren with both complex communication needs (CCN) and CVI are; the challenges they encounter in communication and lan- guage development; and the misconceptions that are emerg- ing about representation of language for these children. Final- ly, case studies will be used to reinforce the need for Teachers of the Visually Impaired (TVIs) to be integral members of AAC teams for these children.

KATHY HOWERY received her PhD in Special Education from the University of Alberta in 2017 where she explored the lived experience of young people who speak with (or through) speech generating devices. She began her career over thirty years ago focusing on finding ways for students with the most complex needs share their voices in the world. From 2004 to 2008 she lead the Alberta Assistive Technology for Learning Initiative. Since that time she has developed and taught graduate level courses in Assistive Technology, Learning and Devel- opment, Special Education, Universal Design for Learning, and Augmentative and Alternative Communication. Kathy is the Alberta representative to ISAAC Canada and a past board member of the Alberta Chapter of the Council for Exceptional Children. In addition, she has held positions on the Inclusive Learning Network of the International Society of Technology in Education (ILN/ISTE), and on the leadership team of the Universal Design for Learning -Implementation Research Network (UDL-IRN). Currently, Kathy provides ongoing consultation to Alberta school jurisdictions in the areas of UDL, special education, and supporting children and youth with CCN in developing communication, language and literacy skills. Most recently Kathy is working under contract with Alberta Education as part of the Provincial Wide Low Incidence Collaborative Supports team with primary responsibility in the area of complex communication needs. MAREN BARROS is a Teacher of the Visually Impaired and a CVI Endorsed Professional. She has been practicing in the field of visual impairments for 12 years, however having grown up with a brother who is blind, she regularly jokes that she has been in the field for much, much longer. These personal experiences have very much shaped the path of her career, starting off with a degree in Neuropsychology (trying to understand the development of visual perception but also the impact of trauma on the brain) and eventually led to the pursuit of both her B.Ed. and M.Ed. degrees. Her passion is working with students who have Neurological Visual Impairments and collab- orating with team members in order to best meet their educational needs. She resides in Stony Plain, Alberta but travels widely as a consultant to serve this population of students.

BACK TO CONTENTS

it may be a language issue, or, as is often the case for child with CVI and CCN, it could be both. Therein lies the complexity for professionals – vision and language are intimately interconnect- ed. Vision and language are perhaps most significantly intercon- nected for children and youth with CCN who are provided with AAC supports that privilege vision such as pictographic symbols or sign language. In order to provide the best access to com- munication and language development for these children, it is necessary to untangle the complexity of vision and language. This untangling will require professionals to step outside of our silos and work together in order to tease this relationship apart. WHO ARE WE TALKING ABOUT? The population of children who may benefit AAC to sup- port communication and language development is commonly referred to as having CCN (Buekelman & Light, 2020; Light & McNaughton, 2011; Loncke, 2014). These children are “unable to communicate effectively using speech alone. They and their communication partners may benefit from using AAC methods, either temporarily or permanently. Hearing limitation is not the primary cause of complex communication need.” (Perry et al., 2004, p. 261) The “etiologies associated with CVI and CCN in children are often the same” (Blackstone & Roman, 2019, p. 65). While not all children with CCN also have CVI or vice versa, AAC profes- sionals have long recognized that many children with CCN have problems with their vision. As many as 48 to 75% of children and adults with developmental delays and cerebral palsy and 75 to 90% of children with severe and profound cognitive dis- abilities demonstrate significant visual problems (Blackstone & Roman-Lantzy, 2018). According to Dutton & Bauer (2019) “40% of the brain serves vision, it is therefore highly likely that children with cerebral palsy and other major developmental dysfunctions, may have additional hidden visual difficulties” (p. 66). These vision difficulties may remain hidden “because affect- ed children cannot describe them, or because the evident mo- tor impairments have taken precedence. The default condition for all such children needs to be that they may have CVI, until proved otherwise, rather than the other way around” (Dutton & Bauer, 2019). WHO ARE CHILDREN WITH CVI/VISION NEEDS? Any child who is not using their vision typically isn’t seeing typically - this can have major implications for their literacy and language development! In the February/March article of this series, Wagner, Hanser and Musselwhite defined CVI as a “neurological disorder which impacts the processing of visual information in the brain” (2020). To date, the articles of this series have used the term CVI in a broad sense, and have depended primarily on outcomes of the CVI Range Assessment to help the reader choose visually appro- priate emergent literacy strategies.

Image 1: A man walking a goat on a leash.

WHAT’S THE CHALLENGE? The following short story provides as an example of the kinds of challenges people with CCN and CVI may encounter with the complexity of vision and language. It also highlights the fact that professionals may also struggle with these issues. As indicated in previous articles, Tietjen (2019) suggests that the primary and most persistent educational impact of CVI of- ten revolves around visual complexity. To illustrate this Tietjen, in his What’s the Complexity Framework Course (2018) presents an image, similar to the one below, of a man walking a goat on a leash (Image 1). The authors used this example when mentoring a speech lan- guage pathologist (SLP) who was working to support a young boy with CCN and CVI. What occurred was a unique opportunity to see and hear firsthand how tightly vision and language are in- terwoven, and how one’s professional lens may impact one’s in- terpretation of the child’s challenge of vision, language or both. The TVI was explaining the issue of visual complexity and the impact that CVI may have on a child’s ability to correctly interpret visual information by sharing the goat on a leash image. The TVIs version of why a child with CVI might incorrectly say that the ani- mal on the leash was a “dog” was due to their vision – they couldn’t visually discern that the animal on the leash was a goat and there- fore would go to their more general assumption that an animal on a leash would be a dog and therefore label it as such. The SLP to whom this issue of visual complexity was being ex- plained replied, “Well if I had a child label that animal as a ‘dog’ I would have assumed it was because they didn’t have the word “goat” in their lexicon ( vocabulary ) – that is: they didn’t know what a ‘goat’ was and therefore called it a dog.” Of course, both of those interpretations of the child’s labeling of the goat as a dog could be correct. It may be a vision issue or

BACK TO CONTENTS

In Europe and other areas of the world, the common term to refer to a neurologically-based visual impairment is CVI. In North America, the term Cortical Visual Impairment is used to de- scribe this same population of children; however, Roman-Lantzy (2019) argues that these two terms are not synonymous. She writes, “Cerebral visual impairment is a term used to describe a broad spectrum of visual processing disorders (Lueck and Dut- ton, 2015), whereas the term cortical visual impairment adheres to a stricter set of criteria that are associated with medical and educational visual impairment” (2019). The CVI Range Assess- ment is a tool that is designed very specifically for cortical visual impairment and is therefore not designed (nor appropriate) to be used with all children who have cerebral visual impairment. As a practitioner, this is where things can appear to be quite complicated. Perhaps, as Wagner, Hanser and Musselwhite state, CVI is “frequently undiagnosed and unrecognized” (p. 31) be- cause the field uses CVI to refer interchangeably to two different things. The question remains, how does one know which version of CVI we are seeing in the child? GATHERING OUR INFORMATION: VISION From a vision perspective, the TVI is charged with determin- ing what and how a child sees, typically by conducting a Func- tional Vision Assessment (FVA). For children who have low vision as a result of an ocular visual impairment and who also have spoken language, standardized approaches (e.g., vision charts) can be used to good effect to obtain fairly accurate measures of acuity, contrast sensitivity, color vision and depth perception. On the other hand, when a child has CCN and limited expressive communication, these standardized approaches are ineffective and often impossible to use. Instead, the TVI must rely on other assessment skills and strategies in order to determine functional vision. For a child with significant disabilities, CCN and suspect- ed CVI, the FVA might involve the following: • Comprehensive medical/file review, documenting any/all known or commonly associated neurological risk factors for cerebral visual impairment.

ed that they can use this tool with fidelity. This is important because, as mentioned above, this tool is best used for a specific subset of children and someone with the Endorse- ment would likely know when it should be used and when it should not be used. As the other articles in this series have so articulately pointed out, this tool is built around 10 commonly seen characteristics, and the CVI Range tool eloquently maps out where the child is functioning across all 10 characteristics. With planned, sequenced intervention strategies, these characteristics can and often do improve over time in a fairly predictable way. This information can then be taken and applied directly to informing the best presentation of the child’s literacy materials and the ideal format of their AAC system. CCN AND THE PROVISION OF AAC Successful implementation of AAC involves both the peo- ple with CCN and their communicative partner(s) (Perry et al., 2004). As the complexity of the disability increases, so does the complexity of communication needs and of finding appropriate AAC solutions, and “people with disabilities must also rely on the skills of others to help them to be a part of a conversation” (Iacono, 2014, p 83). Furthermore, provision of AAC supports and services for children and youth with CCN must not only provides a means by which they can communicate, but also provides a pathway to language development and language competence (von Tetzchner, 2017). We know that for all children, language learning is an active process that begins at birth (or before) and continues throughout life. Providing communication for every child is based on the foundational belief that every child com- municates and is capable of learning symbolic language (Howery, 2017). The field of AAC recognizes that children with CCN need ac- cess to representations of language (AAC) to support both their expressive and receptive language development. This means that they need to see their systems being modeled and used by others in order to develop their own communicative com- petence and growth in language (Dada & Alant, 2009; Harris & Reichle, 2004). And that modeling alone, while important may not be sufficient (Soto et al, 2020). In addition, there is a growing recognition that children and youth with CCN, no matter what the etiology, need access to a robust language system which somewhat simplistically may be thought of as meaning at least 100 words organized in an understandable, predictable manner (categorically, pragmatically or semantically) using a consistent and meaningful symbol system (Ahern, 2015). In order to com- municate beyond the here and now, and to grow and use lan- guage , children with CCN must have access to enough words, in a well thought out system, in order to engage in all of the various functions of language (requesting, refusing, declaring, questions, commenting, etc).

• Assessment of ocular vision.

• Extensive interviewing with the parents and school-based team, beginning with a CVI screening tool such as the one that can be found at https://www.teachcvi.net. This tool will be especially valuable to teams where CVI is perhaps sus- pected but remains undiagnosed. • In an ideal world, the TVI (or another team member) will have completed the CVI Range Endorsement offered by the Perkins School for the Blind (or at the very least had some additional professional development with this assessment tool). Someone with the CVI Endorsement has demonstrat-

BACK TO CONTENTS

their vision to see the chair, the photograph of a chair, and sub- sequent drawings or symbols representing chair. At the same time, they must learn to understand the concept of chair and its use in language. While a visual hierarchy may help a child learn to use her vi- sion to see what a chair is (e.g. first a real chair, then a different real chair, then perhaps a doll chair, a picture of a chair, a line drawing of a chair, and so on), the symbol hierarchy is not nec- essary and is likely counterproductive when we are talking about language development and expressive communica- tion using AAC. As stated by Burkhart and Costello (2008), chil- dren with CVI require consistent and predictable opportunities to experience and manipulate language. Their language expo- sure and success should be built upon, but not dependent on, engaging vision. HIGH CONTRAST SYMBOLS ARE BEST A commonly held belief in the field of AAC is that children with CCN and CVI should be provided with so called “high con- trast” symbols. Typically, these picture communication symbols are intentionally less complex in terms of detail in the image, highly saturated with bright color and placed against a black background. However, there is little evidence that these “high contrast” symbols are the best ones to use for children with CCN and CVI. It depends on the individual child. AAC professionals must depend on their TVI colleagues to help them provide chil- dren with CCN and CVI what all children need: symbols that rep- resent language in a way that they can not only understand but use (Tomasello, 2003). GATHERING OUR INFORMATION: COMMUNICATION AND LANGUAGE In the article Setting the Stage for Augmentative Communi- cation , Wanger, Hanser, and Musselwhite (2020) provide some guidance in terms of documenting how children with CCN and CVI are presently communicating. The form they present can be used to document what a child is doing as a communicative behavior, what that behavior/actions means (or what partners believe it to mean), what actions the partner(s) should take to re- spond to that behavior/act to support the child understanding its communicative power, and how the partner should respond both verbally (what to SAY) and in aided/augmented form (what to MODEL in their AAC modality). While this is indeed a useful form, it is sometimes difficult for partners to identify exactly how they know what a child is com- municating through their behavior(s) and to see how the child might be communicating for various functions. Three additional tools that may be helpful in identifying the child’s present com- municative behaviors:

COMMUNICATION, LANGUAGE, AAC AND CVI Blackstone and Roman- Lantzy (2019) state that children with CVI who need AAC have limited opportunities to explore robust AAC systems that contain vocabulary for commenting, protest- ing, questioning and communicating about their world. In addi- tion, they quite importantly point out that vision is a key com- ponent of visual joint attention , and therefore children with CVI may fail to see a partner’s pointing cues or any supplementary cues such as where a partner is looking. The consequence of this is that the child may clearly fail to see or even notice that their communication partner is modeling language on an AAC sys- tem where symbols are pictographic or visual (sign). However, there are other means of establishing joint attention, and not all AAC systems must be accessed visually. These and other issues may be impeding access to robust AAC for many children with CCN and CVI. MYTHS AND MISCONCEPTIONS ABOUT CCN & CVI Increasing access to AAC for children with CCN and CVI re- quires careful attention to a number of myths and misconcep- tions that professionals must grapple with across areas of exper- tise and interest. SYMBOL HIERACHIES The first misconception is an age old one for the field of AAC, but one that has thankfully been refuted. That is the idea that children must start with real objects, then progress to photo- graphs before we introduce graphic symbols. In AAC this is called the “symbol hierarchy.” It has been shown that it is unnecessary to follow the hierarchy (Romski & Sevcik, 2005), and it has also been asserted that it limits children’s learning of language (von Tetzchner, 2015). While parents, teachers and therapists may at- tribute meaning to a graphic symbol because it is iconic (looks to us like what it is supposed to represent), youth with devel- opmental disabilities and CCN can establish iconic and arbitrary symbol-referent relationships for symbols when given expe- rience with them, regardless of the iconicity of the symbol (Romski & Sevcik, 1996; Sevcik, Barton-Hulsey, Romski & Hyatt Fonseca, 2018). In other words, children don’t recognize symbols, they LEARN them through repeated opportunity for understanding and use! For children with CCN and CVI, this must mean that the sym- bols are perceptible and distinguishable from one another. They must also contribute to learning over time. For example, learn- ing that a photograph of a chair references an actual chair is only helpful if you want to reference the specific chair. Yet, we typical- ly want children to understand that the symbol represents any chair – it is a symbol for chair or, potentially, sit. The concrete reference for the original, specific chair is relatively easy to teach to a child who can see both the chair and the photograph of the chair. However, children with CVI may need to learn to use

• The Communication Matrix (Rowland, 2020) • Pragmatics Profile (Dewart & Summers, 1995) • Communication Signal Inventory (Cress, 2018)

BACK TO CONTENTS

implementing a system that allows for partner assisted auditory scanning , in this case, an alternative access Pragmatic Organiza- tional Dynamic Display (PODD). Two PODD books were created, one for Lance to use expressively and one with high contrast visual symbols, reduced display size and tear off high contrast symbols that will be used by communication partners to support Lance’s receptive language. This system supports auditory scanning while also leaving open the possibility of continued visual development through greatly reduced visual complexity of the array itself and careful use of colour and contrast. In addition to this, the team is using Linda Burkhart’s “stepping stones to switch access” (Burkhart, 2018) to help guide them in teaching Lance to access switches that he might use for more independent and autonomous access in the future. Jody is a student in Grade 8 who has a chromosomal deletion. She arrived at her new school with a high-tech eye gaze system in- tended to support access to AAC. Unfortunately, she has not been very successful in using the system. She has no diagnosis of CVI or even any documented visual impairment in her extensive school file; however, she does have a known moderate-severe hearing loss. She is non-ambulatory but has fairly good use of her hands. The TVI, who is CVI Range Endorsed, was slightly shocked to discover that Jody demonstrates CVI on the CVI Range. She is in Phase II on the Range (with a score of 6) and is beginning to more consistently integrate vision with function, and movement seems to activate and captivate her visual attention. The team decides to try and im- plement Makaton® ( simplified sign ) and continue to practice with the eye gaze system but with an emphasis on play-based activities that might support her vision development and use of eye-gaze over time. Miriam is a preschool student who has been diagnosed with Autism Spectrum Disorder (ASD). She is very active and visual- ly curious about the world around her. She often prefers to travel quite quickly in her environment, even though she is fairly clumsy and falls down often. She loves shiny objects, bubbles and things that move. The preschool team had been attempting to implement AAC support offering her four symbols at a time on an AAC app on an iPad, Miriam was not at all interested in this app, instead she insisted upon running up to the large, low-tech core board display that they had posted on the wall of the classroom. Despite the ap- parent increased complexity the core board presented, Miriam indi- cated this set up was more appealing and engaging than the four location set that changed for every activity. The consistent location of the symbols appeared to be helpful. When considering the ap- propriate AAC system for such students then, we would do well to explore privileging motor planning and the selection a system that incorporates consistency of array . In Miriam’s case, based on her apparent preference, LAMP was selected for trial. *Note: This does not mean that a highly complex visual display is

By working through these inventories with families and other familiar communication partners, a clearer picture can emerge as to how people “know” what it is the child is communicating, and a description of those behaviors can be developed for the “How I Communicate” Form. In addition, each of these tools can offer a present level of performance from which interventions can be designed, and through repeated measures communica- tive growth can be monitored and celebrated. BRINGING THE TEAM TOGETHER While thus far the emphasis has been on the need to include TVIs in decisions regarding AAC for children with CCN and CVI, this in no way diminishes the need for other team members such as Occupational Therapists (OTs), Physical Therapists (PTs) and educators (Erickson & Geist, 2016). Such a team is required to address ACCESS to communication modes with a focus on participation and language development. Physical and visual ACCESS to AAC must be explored from multiple perspectives in order to ensure the most efficient and effective means for children with CCN and CVI. This process involves documenting the child’s motor skills (e.g., their ability to point with a finger, use eye-gaze, switches), other sensory skills (e.g., hearing) and the impact of impairments when they occur in combination. As Iacono (2014) so correctly points out, “such is the unfair nature of disability that they often come in multiples” (p. 83). Given that, the need for interdisciplinary methods and practices cannot be understated!

SO WHERE TO START? PUTTING THEORY INTO PRACTICE.

It should now be evident that an interdisciplinary approach is absolutely vital to this process. Each specialist has a specific and valuable lens and skill set. The following case examples are provided to illustrate how working together can result in unique recommendations of AAC supports for children with CCN and CVI. Lance is in Grade 1 who has WEST Syndrome, a neurological condition that causes a significant amount of ongoing seizure ac- tivity. He is non-ambulatory, has significant cerebral palsy and has no access to expressive spoken language other than a few sounds. The TVI completed a CVI Range assessment and found that he is in early Phase I (i.e., he is continuing to work on building consis- tent visual behavior). Over the previous two years, the score on his Range assessment has fluctuated between 1 and 2.5, with regular “setbacks” occurring because of his seizures. This fluctuation and ongoing work to build visual skills suggests that he is not going to be able to directly access graphic symbols. Therefore, the team chose to privilege auditory information . Before finalizing this decision, they ensured that his hearing was adequate. When it is de- termined that this his hearing was adequate, they proceeded with

BACK TO CONTENTS

appropriate for all students with ASD! In the author’s experience, it is possible that highly complex displays are not accessible to every student with an ASD diagnosis and quite often the students are un- able to interact with them using a visually guided reach. FINAL THOUGHTS Information gathered from various disciplines should inform interventions for children and youth with CCN and CVI. Care should be taken to understand the combined impact of com- munication, vision, motor and other sensory impairments. Fur- thermore, teams should take care to move beyond myths and misconceptions that are negatively impacting access to AAC for many children with CCN and CVI. Working outside of profession- al silos will help reduce barriers and help address the fact that, at least not at the present time, there is NO COOKBOOK approach to AAC intervention for children with CCN and CVI. Ongoing, DYNAMIC assessment involving professionals from various dis- ciplines and a range of assessment tools is the only answer. “It is essential that vision and communication therapies be in- tegrated and that visual specialists, speech-language pathologists, and other professionals work collaboratively with family members to increase the child’s ability to use his or her functional vision so he or she can access language, communication and participate.” (Blackstone & Roman, 2019) Yes, AND, “It is essential that visual specialists, speech-language pathol- ogists, and other professionals work collaboratively with family members to help children develop language so that they can un- derstand (put words to) and express (talk about) what they are see- ing” (Howery, 2019). REFERENCES: Beukelman, D. R. & Light, J. (2020, 5th Edition). Augmenta- tive and Alternative Communication: Supporting Children and Adults with Complex Communication Needs. Baltimore, MD: Brookes. Brady, N C, S Bruce, A Goldman, K Erickson, B Mineo, B T Ogle- tree, D Paul, M A Romski, R Sevcik, E Siegel, J Schoonover, M Snell, L Sylvester and K Wilkinson. 2016. Communication Services and Supports for Individuals with Severe Disabilities: Guidance for Assessment and Intervention. American Journal of Intellectual and Developmental Disabilities 121, no: 121–38. Burkhart, L. (2018). Stepping Stones to Switch Access. Per- spectives of the ASHA Special Interest Groups, SIG 12, 3(1). Burkhart, L., & Costello, J. (2008, March). CVI and Complex Communication Needs: Characteristics and AAC Strategies. CSUN Conference. Los Angeles, CA. Cress, C. (2018, October). How to Use a Communication Sig- nal Inventory to Assess and Plan Intervention for Early Commu- nicators. Webinar for Alberta CCN PLC https://arpdcresources. ca/consortia/complex-communication-needs-ccn/?index=16 Dada, S., & Alant, E. (2009, Feb.). The effect of aided language

stimulation on vocabulary acquisition in children with little or no functional speech. American Journal of Speech-Language Pathology. 18, 50-64. Dickinson, D.K. & Tabors, P. O. (2001). Beginning Literacy with Language. Baltimore, MD: Brookes. Dutton, G. N. & Bauer, C. M. (2019). Cerebral (cortical) visual impairment in children: A perspective. In John Ravenscroft (Ed). The Routledge Handbook of Visual Impairment. New York, NY: Routledge. Erickson, K. A. & Geist, L. A. (2016). The profiles of students with significant cognitive disabilities and complex communi- cation needs. Augmentative and Alternative Communication, 32(3), 187-197. Fitch, A., Fein, D.A. and Eigsti, I-M. 2015. “Detail and gestalt fo- cus in individuals with optimal outcomes from autism spectrum disorders.” retrieved from https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4442733/ on February 16, 2020. Hanser, G., Musselwhite, C. & Wagner, D. (2019a) Comprehen- sive Emergent Literacy Instruction for Students with Significant Disabilities, Including Cortical Vision Impairment and Complex Communication Needs. Closing the Gap, October/November. Minneapolis, MN. Hanser, G., Musselwhite, C. & Wagner, D. (2019b). Providing Emergent Literacy Instruction for Students with Significant Dis- abilities, Including Cortical Vision Impairment: Predictable Chart Writing. Closing the Gap, December/January. Minneapolis, MN. Harris, M. D. & Reichle, J. (2004). The Impact of Aided Lan- guage Stimulation on Symbol Comprehension and Production in Children With Moderate Cognitive Disabilities. American Jour- nal of Speech Language Pathology, 13 (2), 155-167. Hoff, E. (2006). How social contexts support and shape lan- guage development. Developmental Review, 26(1), 55–88. Howery, K. (2017). Communication and Literacy for Every Child. The Inclusive Educator, 2(1). Iacono, T. (2014). “What It Means to Have Complex Commu- nication Needs.” Research and Practice in Intellectual and Devel- opmental Disabilities 1(1),82–85. Light, J. & McNaughton, D. (2011). Supporting the commu- nication, language, and literacy development of children with complex communication needs: state of the science and future research priorities. Assistive Technology, 4(1), 34-44. Loncke, F. (2014). Augmentative and Alternative Communica- tion: Models and Applications for Educators, Speech-Language Pathologists, Psychologists, Caregivers, and Users. San Diego, Calif: Ruffin. Lueck, A. H. & Dutton, G., Eds. (2015). Vision and the Brain: Un- derstanding Cerebral Visual Impairment in Children. New York: NY: AFB Press. Perry, A, S Reilly, S Cotton, K Bloomberg and H Johnson. 2004. “A Demographic Survey of People Who Have a Disability and Complex Communication Needs in Victoria, Australia.” Asia Pacif- ic Journal of Speech, Language and Hearing 9, 259–71.

BACK TO CONTENTS

Roman-Lantzy, C. (2019). Cortical Visual Impairment: Ad- vanced Principles. Including chapter by Sarah Blackstone and Christine Roman-Lantzy on Children with CVI and Complex Communication Needs. New York, NY: AFB Press. Roman-Lantzy, C. (2019). Cortical Visual Impairment: An Ap- proach to Assessment & Intervention (2nded). Arlington VA: AFB Press. Romski, M A, & Sevcik, R. . (1996). Breaking the Speech Barri- er: Language Development Through Augmented Means. Balti- more, Md: Brookes. Romski, M.A. & Sevcik, R. (2005). Augmentative Communi- cation and Early Intervention: Myths and Realities. Infants and Young Children 18(3), 174–85. Sevcik, R.A. , Barton-Hulsey, A., Romski, M.A. & Hyatt Fonse- ca, Amy (2018). Visual-graphic symbol acquisition in school age children with developmental and language delays. Augmenta- tive and Alternative Communication, 34(4), 265-275. Soto, G., Clarke, M. T., Nelson, K., Starowicz, R., & Savaldi-Ha- russi, G. (2020). Recast type, repair, and acquisition in AAC medi- ated interaction. Journal of Child Language, 47, 250-264 Tomasello, M.(2003). Constructing a Language: A usage based theory of language acquisition. Cambridge, MA: Harvard University Press. von Tetzchner, S. (2017, February). Making the Environment Communicatively Accessible (Pts 1 and 2). Webinar for Alberta CCN PLC. https://arpdcresources.ca/consortia/complex-com- munication-needs-ccn/?index=8 von Tetzchner, S. (2015). The semiotics of aided language de- velopment. Cognitive Development, 36, 180-190., 36. Wanger, D., Hanser, G., & Musselwhite, C. (2020). Providing Emergent Literacy Instruction for Students with Significant Dis- abilities, Including Cortical Vision Impairment: Setting the Stage for Augmentative Communication. Closing the Gap, February/ March. Minneapolis, MN.

BACK TO CONTENTS

Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7

www.closingthegap.com

Made with FlippingBook Ebook Creator