Part 4 of 5 Children with Complex Communication Needs

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

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