iPad Grant for kids with autism

When it comes to technology, I have way more ambition than skill. Getting an iPhone a couple years ago helped me see how even a novice user could find and use great apps. Diving further into the utility of technology for my personal enjoyment as well as my speech therapy practice, I was drawn to the iPad2.

Last spring my wonderful husband bought me an iPad2 (I may have given him a few helpful hints) and I dove into technology and apps with the aforementioned ambition. In addition to educational apps and therapy tools, I am impressed with the potential of the iPad2 to be used as a communication device.

One big drawback with most communication devices is that they are bulky and heavy, therefore the children may not drag their devices with them wherever they go. I've also seen devices that are used primarily by adults who know the child well and can "read" them enough to select the page or icon needed. Basically when this happens, the child is communicating to an adult who then communicates with the augmentative communication device.

The iPad2, I think, will be (and already is for some of us) the Augmentative Communication device of the future. Thin and lightweight, it's already ideal for portability. There are more communication apps becoming available daily, and they can be customized for individual needs. iPads are significantly less expensive than traditional devices and some insurance companies are catching on and starting to cover some of the costs.

Then there's the cool factor (spoken like a true nerd still longing for coolness) that the iPad offers. LOTS of people have iPads or would like to, and children using them have devices that don't look like "tools" but are appealing and versatile, and, well, just plain cool. On the spot, pictures can be taken and added to a communication app. Aides will not need extensive training for iPad use, because it is so user-friendly even a novice with technology (ahem, like myself) can easily learn to implement apps.

I came across a site, iTaalk.org, and saw that the iTaalk Autism Foundation is giving away an iPad a day until December 31, 2011 for children diagnosed with autism. There is an application online at their website, along with more information about iTaalk.org. Check out the resources and training for parents and professionals after you read about the grant at the link below.

http://www.itaalk.org/ipadadaygrant.html

"My Ball Died"

When I heard the words "My ball died" coming out of the mouth of a preschool boy I was seeing for speech therapy, I tried not to show alarm. "Tommy" didn't seem to be too upset, but he was clearly trying to tell me about something that mattered to him. I had not heard of any recent loss in this boy's life, but then again I only saw him once a week for speech therapy and didn't know about every single person in his life. I wanted to be compassionate and allow him to talk about what was on his mind. Tommy already had a very hard time expressing himself due to speech articulation (pronunciation) errors. Even to those familiar with Tommy's speech patterns, his speech intelligibility was poor. When I repeated his words back to him for clarification, he responded vigorously with head shakes and repeated insistently, "No. My ball died." Some children, when hearing their incorrect speech production repeated back to them, will recognize that what they are saying does not match the message they are trying to convey. As a result, some children will alter how they are pronouncing words in order to increase their intelligibility. Tommy was not one of those children. He kept saying the same thing in exactly the same way, over and over again with no change. Tommy still did not appear distressed, but was making eye contact and eagerly awaiting my response. As a speech therapist, I have been asked how to respond when you just don't understand what a child is trying to say. I think the correct response is usually dependent on the situation. If the child is just chatting to make a connection with another person, then it may be more critical to be responsive and caring than to determine exactly what has been said. Sometimes asking the child "Can you show me?" helps them use nonverbal means to get their meaning across. This is limited to messages that can actually be pointed out or demonstrated, though, so much of the time it isn't a very effective strategy. The strategy of pretending to understand the child can backfire, because you may be consenting to something you don't intend to or the child may try to continue the conversation and sooner or later the fact that you are faking comprehension will become obvious. Could this affect your relationship with the child? Another option when a child is clearly trying to convey a message to you is to begin asking questions to see if you can narrow down the possible topics the child is talking about. Even with barely intelligible children, knowing the context of what they are talking about makes it easier to discern what they are attempting to say. In Tommy's case, I started by asking him if someone in his family had died. Tommy looked uncertain, so I started naming possibilities by using yes/no questions since Tommy was able to respond accurately to them. "Did your grandpa die?" "Did your dog die?" and so on. Tommy continued to shake his head "no". When this line of questioning lead nowhere, I tried asking about his toys. "Did you lose a ball?" "Did something happen to your ball?" Again I was met with repeated head shakes and the verbal assertion, always pronounced exactly the same way, "My ball died." Tommy wasn't giving up on me, but continued to make eye contact with a hopeful expression on his face. I was feeling more and more inadequate to help this sweet child who apparently had some kind of loss to grieve. Through the open window of the room we were using for speech therapy, we could hear the sounds of children playing. Following a particularly loud vocal outburst from one of the children outside, Tommy cocked his head, grinned, and happily pronounced, "My ball died!" He certainly didn't look upset about a death, but instead looked at me in triumph as if he had just proven a point. Given the context, the words, and Tommy's speech sound error pattern, things began to fall into place. Hesitantly, I asked another question, "Is your brother outside?" Tommy responded with enthusiastic head nods, repeating once again with a look of utter satisfaction, "My ball died." Okay. So no one died and nothing was lost or irreparably damaged. What a relief! For whatever reason, it was very important to Tommy that I acknowledged that his brother was outside. Although it had to be frustrating for him when he couldn't quickly or easily convey his message, he was eventually rewarded for his persistence and I was relieved to discover that in fact, no ball had actually died.

Say What?

I love talking with my son, Josh. He has such interesting perspectives and the way he verbally expresses himself gives me insight into how he thinks and processes information. When he was young, Josh had some difficulty remembering words so he would use descriptions to get his point across. He once described his ankle as "you know, that part that's like the wrist of your leg". He tended to use vague words such as "thing" and "that" rather than specific word labels. Despite the circumlocutions, I could always tell what Josh was talking about. Since Josh struggled to recognize many nonverbal signals and had to be taught how to use appropriate body language when he interacted, I could never take it for granted that Josh would just pick up on social cues and be able to express himself adequately. He could learn how to interact with other people, but he had to be taught specific discrete skills for social interactions. For my daughters, social skills came naturally and they just seemed to intuitively know how to relate to others. For Josh, it was like being in a foreign land where everyone else seemed to know the language but he struggled to learn basic communication and was vulnerable to being frequently misunderstood. I did speech therapy with Josh to work on conversational turn-taking, topic maintenance, and nonverbal ways to let a listener know he was interested. Unfortunately, Josh often was not interested in what others wanted to talk about, so then I had to teach him about being polite and a good friend by sometimes letting someone else take the conversational lead. Once Josh had some of the basic skills for social interaction and was able to express himself more effectively, he continued to practice and fine tune his communication exchanges. I noticed that Josh often did not respond when given a compliment. Outside of the family, Josh didn't get many positive comments so he didn't really know how to respond when it happened. I talked to Josh about possible responses and we role-played several situations together. After our practice session I reminded Josh that he had lots of strengths worthy of compliments so it was good that he was learning how to respond to them. Josh informed me that "Vanity was never my strongest weakness." Say what? After some probing (they don't call me the Momster for nothing) I was able to help Josh expand his message so that I could understand what he meant. His intention was to indicate that although he was aware that he had many significant challenges, being vain was not one of them. Therefore, he needed some help in learning how to respond to compliments. Even today, Josh comes up with some unique responses that catch me by surprise. Just this morning our dogs were playing and one of them ran over and stood next to me. I said, "Look, Josh, she's on base." After a brief pause, Josh jokingly said, "Then I'll be lead guitar." Say what? Translation: "base" sounds like "bass" as in a type of guitar. What's a band without both bass and lead guitars? Josh was making a play on words, and at least now he understands what I say and makes a deliberate choice to joke and say funny things.

Crossing Midline

If you've had a child in speech, occupational, or physical therapy you may have heard about the importance of "crossing midline". When my children were younger, I heard from therapists that it was very important for babies to spend time on their tummies. In addition to helping the brain make connections as the child views things from different perspectives, changes in positioning provides different proprioceptive and vestibular input. Being on the tummy encourages a child to push up with her arms, which strengthens the upper body muscles. This is important for a growing child so she can develop the muscle tone and strength needed to reach over her head or move the arms outward and across the body with a good range of motion. Without such development, the child will have difficulty sustaining a physical posture or repeating motions without rapidly fatiguing. Therapists also work on helping a child to "cross midline" in a number of ways. When a child can reach her right hand across to the left side of her body and vice versa, she is crossing her midline with her arms. In addition to these large movements, a child crosses midline when reading as her eyes move from one side of the page to another without moving her entire head as she reads. The tongue crosses midline as it moves food from side to side to position the food onto the molars for chewing. When any of these activities occur, information is transferred from one brain hemisphere across the corpus callosum to the other brain hemisphere. The corpus callosum is a fibrous band between the two hemispheres and allows for the exchange of information between the right and left hemispheres of the brain. This side-to-side sharing of information is important for fluency in processing and acting on information received. When information is not readily crossing from one side of the brain to the other, there is usually a learning glitch or struggle. In the picture above, you can see that this child tended to paint in the same area, primarily on the right side of the paper. This same child, when the paint utensil was placed in his left hand, painted primarily on the left side of the page. This was just one indication that he was not readily crossing midline and might need some help to develop in that area. One of my favorite resources for addressing this and other brain processing issues is the book Brain Gym. It provides descriptions and illustrations of simple exercises that promote crossing midline, increasing alertness, improving handwriting, readiness for reading, and more. The exercises can be done by both children and adults in just a few minutes prior to a specific task. I have used the "brain buttons" and other exercises from Brain Gym to increase my alertness when feeling the fatiguing effects of a long car trip. With my AD/HD children, I had them do some exercises between school assignments to ready their brains and bodies for focused attention to the task at hand. Such simple exercises are easily implemented and help the brain develop pathways across the midline of the brain, resulting in more efficient processing and learning.

Inexpensive Game You Can Make

Today I want to share an idea with you for an inexpensive game that you can make using simple household items. The inspiration for this game was a young boy I am working with to develop simple turn-taking skills. I wanted to begin by teaching him a short, simple game like Tic-Tac-Toe, but his fine motor skills aren't yet developed enough for him to make the marks on a page without great effort. I wanted the game to be fun and easy for him to play so he would stay engaged in the learning activity. My young friend does better with 3-D manipulatives at this stage of development, so I took an empty cardboard egg carton and cut it to the size I wanted. That left me with a perfect grid for Tic-Tac-Toe as you can see in the picture above. Next, I gathered up blocks in two different colors so we could use those instead of writing X's and O's. I removed the label from an empty frosting can and washed it clean so I could store the blocks in it. The child and I took turns placing a block in one of the egg cup spots, working to get three in a row. The game is more visually appealing to the young child, and it's easy to show when there are three blocks of the same color in a row. It also offers some tactile input for the hands-on learner, and removes the demand of writing for the child with fine motor difficulties. If you don't have blocks, you could substitute two different colors of another object such as milk caps or pom-poms. Just find something that will fit within the egg carton space and that is available in two colors, and you are set to go.

For some children, this game can be used to focus on taking turns without the added task of learning the rules for Tic-Tac-Toe. In that case, you don't even need to sort manipulatives by color since you just need objects that are small enough to fit in the egg carton compartments. The simple back and forth of placing items might be a starting point for some children who have difficulty sustaining attention and interacting with others. For children on the autism spectrum, this is one more way to work on extending interactions and giving a sense of task completion.

In addition to using this game to teach Tic-Tac-Toe and turn-taking, you could use it as a reinforcer. Each time the child completes a task, they could put a block in the egg carton. Another idea is to put a number of blocks in the egg carton to represent tasks the child is asked to do, and remove one block each time another task is completed. When the carton is empty, it's break time. Put some non-skid shelf liner under the carton to stabilize it so it doesn't slip around too much. For children with fine motor challenges, I've used Velcro on the bottom of each egg cup and stuck the egg carton onto strips of Velcro on a plastic cafeteria tray so the egg carton stays put while the child works with it.

There you go! An easy and inexpensive game that can be used multiple ways and made with items you probably already have on hand! Have fun!