How DEAL can help schoolchildren


Severe Communication Impairment in Schoolchildren


Every child who has very 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.

Often parents are 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.

Unfortunately, it isn't 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.

To give some idea of the range of possibilities, I have listed below the options I would choose to explore if I had a school-age child with a severe communication impairment.

Primary or elementary school (age 6 - 11)

  • Continuing speech therapy if speech is still developing. If not, support for non-speech communication.
  • Signing - hand signs can be taught, though they will also need to be taught to family members, teachers, and care care staff. They will not be useable by children with severe cerebral palsy and will be difficult for children with major motor planning problems. It's the most practical non-speech strategy for playground use.
  • 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. At this age PECS is still useful for initiating quick interactions, especially at home.
  • Symbol/word displays in a book, and ideally also on a computer --either a regular computer with specialised software such as Speaking Dynamically Pro, or a dedicated computer such as a Springboard Lite, designed specifically for use by people with severe communication impairments. Whatever the system, the vocabulary will need to be modified and extended frequently to take account of the child's rapidly changing world. Letter and number boards should be included from the start.
  • A means of spelling and producing text - a typewriter, a computer with Intellitalk, a Fusion or a Neo or an alphabet board - used with facilitation if necessary.
  • A portable voice-output device on which whole messages can be recorded e.g. Chatbox, Message Mate, Hiptalker, Go-Talk if a more sophisticated voice-output communication aid (VOCA) is not being used.
  • Whiteboards and other quick multiple choice strategies for use in class, and possibly also at home.
  • Continuing work on hand skills, including handwriting, and focus on independence in making choices.
  • Independent low- or no-tech yes/no strategy. This must be known by everyone involved with the child.
  • Every possible strategy for providing literacy exposure - library membership, story reading, books on tape or CD, books on computer, Tarheel Reader (Google) etc. etc.

Early secondary or middle school (age 12 - 15)

  • Traditional speech therapy probably will not have much more to offer, but students who continue to need to augment their speech will still require AAC support. Signing tends to be dropped outside home as it is impossible to teach everyone in the student's environment.
  • Quick portable low-tech communication strategies are essential - word/phrase/multiple choice boards or books including the alphabet, a calendar and numbers. The student's diary can be a valuable communication aid if it is filled in with sufficient age-appropriate detail about past and future events to support conversation.
  • If handwriting is not fluent, a typewriter or laptop for classroom use. A Neo with Co-Writer may be the most economical option for students who can type on a regular keyboard, but a computer which can run math programs and word prediction software will be needed for the senior years. Because secondary students change classrooms frequently, any system used has to be easily portable.
  • A voice-output aid, which translates typing into speech and has stored messages, such as the Lightwriter SL40, the Alt Chat, or a laptop with software such as Penfriend, is highly desirable for students who do not have more complex VOCAs such as the Vantage Lite or DynavoxV.
  • Focus on independent keyboard use if not already achieved.
  • Development of strategies for accessing the community - travel, shopping, using the phone etc. - as independently as possible.

Upper secondary or senior school

Quick, portable, low-tech communication strategies and diary as before.
Computer and VOCA use as before, with more complex software, word prediction etc.
Internet and e-mail access if possible.
Implementation of strategies for accessing the community independently.

Tertiary study or the workplace (adult - age 18 plus)

  • Portability is a major issue in everyday life. A text-to-speech device such as the Lightwriter SL40, which allows text-messaging, augmented by a light computer for note-taking such as a Neo or personal organiser, may be the most functional system for a walking tertiary student.
  • Individuals who cannot type without specialist equipment or support should have alternative systems that they can access independently, at least for multiple choice, and any high-tech systems should also be backed up with low-tech alternatives.
  • A system for fostering social interaction should be in place which allows speedy recall of common utterances such as 'Hello! How are you?', has 'scripts' for predictable interactions such as buying tickets, and makes use of conversational scaffolds such as a well-kept diary. Social networking sites such as Facebook may be useful for maintaining connections.
  • Strategies for undertaking adult responsibilities such as banking and voting will need to be devised. The Internet and e-mail may offer ways of circumventing difficulties with the phone or with face-to-face interaction at work. The National Relay Service, used to make phone calls by people with hearing or speech impairments, may be useful.

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

For more details of studies, devices, strategies or services mentioned, please contact DEAL.

Rosemary Crossley

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