Has My Child Reached Full Communicative Potential?
Although the Individuals with Disabilities Education Act (IDEA) of 1997 requires assistive technology (including communication devices) be considered for every child with a disability during Individualized Education Program (IEP) planning, it seems as though there is a specific population that tends to be overlooked…the high school-aged child.
While there is much evidence to support early intervention and the use of high-tech communication devices, there seems to be little evidence or studies looking at the use of new communication devices for the older student. In fact, many older students receive greatly-reduced speech therapy services or have even been dismissed from speech therapy services by the time they reach high school. Which brings us to question: have students met their full communicative potential by high school?
Forrest Holt, a special education teacher at Elizabethton High School in East Tennessee, began piloting a program two years ago to determine if students with severe language disabilities could still improve communication skills despite their ages. None of the students had ever received or consistently used a high-tech communication device prior to this program.
Students who were considered nonverbal, or who had limited verbal skills, were evaluated by the speech-language pathologist assigned to the school in conjunction with a speech-language pathologist who specializes in assistive technology. High-tech, voice output systems were recommended for the students in this program. It was determined that the students, many of whom would graduate within a few years, would need a device that could be used at home, school, and in the community, even after graduation. Working with a private assistive technology company and the students’ insurance companies, voice output devices were purchased for these students. Each device was selected based on the needs of the students (i.e., size of screen, number of icons, communication software, etc.) and individualized based on the students’ current level of communication and communication needs.
The device use was directly targeted by the classroom teacher, classroom teaching assistants, and the speech-language pathologist at least three days per week for a minimum of one hour per day (device use was encouraged throughout the day and week in different settings, but direct instruction on how to communicate using the device was provided for at least one hour, three times per week). Communication, academic, and behavioral data were collected for each student.
For the purpose of this article, we are only going to look at two students who present with autism as their primary diagnosis.
Case Study #1
Student #1 is a 16-year-old female. Prior to introduction of the communication device, she presented with mostly echolalic speech. She was able to repeat two to three word responses and inconsistently respond to questions using one word utterances (responses were often delayed by more than five seconds and multiple prompts/cues had to be given). The student’s visible frustration was noted daily and included yelling, high-pitched screaming, an increase in self-stimulation (i.e., hands to her face, pressing on neck), and running away from staff (usually toward an item/location she wanted). She was unable to express her wants/needs unless the items were physically presented by staff. She was not able to verbally respond to biographical or academic questions without prompting (i.e., What is your name? How old are you? What do you want to eat?, Which part of the plant did we learn about?).
After receiving instruction with the device for four and a half months, the student is now able to use her device to respond to biographical questions (i.e., What is your name, How old are you?, What grade are you in?, What is your favorite food?) as well as academic questions (i.e., What planet did we study today?, Where do elephants live?, How many pencils are left?). She is able to spontaneously communicate wants and needs by getting her device and navigating more than three pages to select an icon of a desired item (i.e., “I want a snack,” “I want Jumpstart Phonics DVD”). She has also learned to use the keyboard to generate conversations by typing spontaneous utterances (i.e., “I like movies”). Her “episodes” of frustration decreased from twice per day to less than three times per week. Her mother also reported a significant decrease in her frustration levels and meltdowns at home as she is now able to communicate her basic wants and needs.
Case Study #2
Student #2 is an 18-year-old male. Prior to introduction of the device, he was able to use short phrases to communicate, but only if highly motivated to respond and with prompting from others. He would often go entire school days without spontaneously speaking. He was able to read and write common words, but would not consistently use this skill to respond to questions or participate in classroom discussions.
Day 1 of receiving instruction with the device, the student spontaneously typed, “I love mommy go home drink Pepsi.” Mother reported that the student had never initiated a conversation or desire before; he had only repeated responses or responded after multiple prompts from others. After receiving instruction with his device for three months, he is now able to consistently respond to questions (i.e., What do you want for lunch?, How did the girl in the story feel?, What did the student in the video do?); he will often verbally repeat the responses, as well. The young man combines icons to create longer sentences (i.e., “I want hamburger French fries chocolate milk”). He spontaneously answers yes/no questions (instead of repeating “yes…no”). He types responses using the keyboard as well as selects icons to communicate during academic discussions.
Regardless of why assistive technology and high-tech communication devices may have been ruled out for students in the past, these case studies support the use of high-tech communication devices, even with older high school-aged students. It is recommended that the consideration of high-tech communication devices be evaluated every year, even when the students are in high school. With advances in technology occurring at a rapid pace, the future of communication options may continuously change for our children. Working with your child’s school or outpatient therapy team to determine the best options for your child and advocating for the use of high-tech communication devices when appropriate, regardless of your child’s age, may result in overall communication, academic, and behavioral improvements.
Jessica Lenden-Holt is a school based speech-language pathologist in East Tennessee. She was previously the clinic director of pediatric outpatient centers, including two centers for individuals with autism in South Texas. She was the founder of an Autism Support Group in South Texas and continues to run an online autism support group through Facebook, Parents Supporting Parents of Individuals with Autism and Related Disorders (PSP).
Forrest Holt is a high school, special education teacher in East Tennessee. He has been piloting programs involving assistive technology and communication devices in his classroom for the past two years. He is also a cofounder and participant in PSP.
Forrest and Jessica have two biological children, Alayna and Brayden Holt. They also currently foster a child with autism.
This article was featured in Issue 66 – Finding Calm and Balance