How the Anne McDonald Centre​ can help preschool children

The Anne McDonald Centre provides augmentative communication services to any Victorian who cannot speak (or cannot speak intelligibly) who can attend the Centre, regardless of age or diagnosis.  We are happy to see pre-schoolers, and work with their families and teams to find effective communication strategies that the child can learn to use before starting school.  We have seen children as young as 18 months.

 Communication problems in preschool children

Every child who has limited intelligible speech after the age of two should have a professional assessment by a speech pathologist with experience in augmentative communication as well as traditional speech therapy. For children with diagnoses associated with a high probability of speech impairment, such as cerebral palsiy, Down syndrome and Rett syndrome, intervention should start earlier. The aim of therapy should be to help the child communicate as fluently as possible, using any strategies which work for that child.

Parents are often anxious that early use of non-speech communication will prevent a child talking. In fact, every indication is that the reverse is true. For example, in the Helsinki signing study, children with Down syndrome who started using manual sign at the age of 6 months talked significantly earlier and more fluently than children who did not use sign.

It's not easy to replace speech. Manual sign is as portable as speech (like your tongue, your hands go everywhere with you) but only people who know sign will understand you. A communication book containing lots of pictures and words will be understood by more people but is a nuisance to carry round and can't be used in the swimming pool, or to talk to a number of people at the same time. An electronic voice is great for talking to a number of people, but the batteries go flat. And so on.

Every non-speech communication strategy has pros and cons. In selecting augmentative communication strategies, account has to be taken of these, in addition to the physical and sensory skills of the users, and their communication needs. It is rare for any user's overall communication needs to be met by one device or one strategy, partly because most people with severe speech impairments also find hand-writing difficult. The need for specialist training of communication partners must also be considered.

Just to give some idea of the range of possibilities, I've listed below the options I would choose to explore if I had a child with a severe communication impairment.   Because children's needs vary with age and educational situation, there are multiple lists.

Pre-school (up to age 6)

  • Speech therapy by a therapist with Prompt and Augmentative Communication training.
  • Signing and gestures - hand signs can be taught to very young infants. They will also need to be taught to family members and later to kindergarten and day care staff. They will not be useable by children with severe cerebral palsy and will be difficult for children with major motor planning problems.
  • PECS - Picture-elicited communication - sets of cards with pictures of common items are mounted in accessible locations. The child removes the card showing a wanted item and takes it to an adult.  Alternative set-ups will be needed for children with severe motor problems.
  • Symbol boards or book - collections of pictures and symbols such as Picsyms arranged according to subject which may be used to make comments and express feelings, as well as asking for things.   Depending on the child these may be used by finger or fist pointing (with or without facilitation) or with eye pointing.   Larger boards are more easily carried by children who use wheelchairs.
  • Step-by-Step, Cheaptalk, Chatbox, GoTalk  -- a simple portable voice output device - essential for singing along, talking to other children and joining in group activities. Children who have more severe physical impairments and children who are unlikely to develop intelligible speech before starting school are likely to require more sophisticated VOCAs - voice-output communication aids.
  • Lots of literacy exposure. As well as regular story reading, computer-based activities using software/hardware such as Intellitalk and Intellikeys, and books on CD-ROM are valuable - especially for children who cannot hold pencils or turn pages. Google Tarheel Reader to find an excellent on-line literacy resource, consisting of short picture books which are read aloud. The site is accessible to children who cannot turn pages or use a mouse.
  • Lots of work on hand skills including index finger pointing and eye-hand co-ordination. Children whose hand skills are unlikely ever to allow them to write or use regular keyboards should be starting to use alternatives.
  • Signals for yes and no - ideally these should be used without assistance, and not require any technology e.g. nod/shake, eye blinks, hand movements. Yes/no boards should be available for all children who do not have clear no-tech yes/no responses.

This is merely a brief tour of some of the communication options and issues which might be considered in relation to a child growing up with significant communication impairments.

Description of options mentioned

  • Yes/No boards - cards with YES and NO written on them for fist or eye pointing.
  • Multiple choice boards - white boards on which options are written or mounted quickly for fist or eye pointing.
  • Simple voice output devices - devices on which a limited number of utterances is recorded by a speaking person and accessed by fist or finger pointing – e.g. Cheaptalk, Voice Pal or Message Mate, Go Talk.
  • ABC boards - cards with the alphabet written on them in letters and layouts which have been chosen to suit the visual and hand function of individual users. Young children may point to them as an adult says the alphabet, or find the initial letters of common words. Older children can use them for spelling.
  • Modified computers –
    • keyboards with guards to prevent two letters being hit at the same time
    • enlarged keyboards to cater for people who cannot see or point accurately to small targets e.g. Intellikeys
    • miniature keyboards for people with limited range of movement
    • software which speaks the text typed, e.g. Intellitalk, or which reads the screen
    • computers which cater for children who cannot use their hands to type, which are operated either by eye-gaze or one or two switches.
  • Indexed communication books - booklets containing words and phrases (with or without pictures) which are relevant to the user.   These are arranged by topic, e.g. greetings, basic needs, feelings, school etc. to enable the user to find wanted items easily.  The layout, size and number of items varies from user to user.

Rosemary Crossley 

Anne McDonald Centre. 538 Dandenong Road, Caulfield 3162 Victoria, Australia Ph: 03 9509 6324, Fax: 03 9509 6321
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