• Learn more about nonverbal individuals on the autism spectrum: http://sfari.org/news-and-opinion/news/2013/study-of-nonverbal-autism-must-go-beyond-words-experts-say
• App Proloquo2go: www.assistiveware.com/product/proloquo2go
• The International Society for Augmentative and Alternative Communication: www.isaac-online.org/english/home/
Standing in his living room, Bryce Smith told his son, Dylan: “Use your words. Tell me what you want.”
The boy’s hands quickly swiped through three screens of an application on his iPad digital tablet to find what he was looking for.
• Learn more about nonverbal individuals on the autism spectrum: <a href="http://sfari.org/news-and-opinion/news/2013/study-of-nonverbal-autism-must-go-beyond-words-experts-say">http://sfari.org/news-and-opinion/news/2013/study-of-nonverbal-autism-must-go-beyond-words-experts-say</a>
• App Proloquo2go: <a href="http://www.assistiveware.com/product/proloquo2go">www.assistiveware.com/product/proloquo2go</a>
• The International Society for Augmentative and Alternative Communication: <a href="http://www.isaac-online.org/english/home/">www.isaac-online.org/english/home/</a>
The iPad spoke aloud for Dylan. “Toy train!”
Dylan touched the screen again. “Toy train!”
Although Dylan Smith, 10, cannot speak, he is learning how to communicate.
So is Austin Porter.
Austin and his mom, Alicia Miner, sat on Austin’s bedroom floor building a long chain with colored plastic links. The game helps Austin practice fine motor skills, colors and numbers. The iPad on his lap helps Austin speak. He used his iPad and an app to tell his mom what link color he wanted next:
Miner handed her son a red link. He added it to his chain.
Then he used his iPad to tell his mom: “I want rice snacks.”
“What else do you say?” she asked.
Austin looked up from his links, grinned, and turned to the tablet.
“I want rice snacks, please.”
Austin and Dylan are nonverbal children on the autism spectrum. That makes communication challenging. But new technology now being deployed locally is providing new successes for Austin, Dylan, and many other children like them. Though communication may always be difficult for them, it offers a new avenue for learning and living.
After Dylan used his tablet to ask for his favorite engine in his Thomas the Tank Engine train set, he took Percy, the green train, from his dad and set it on the track. The train took off.
So did Dylan. Head uplifted, he smiled, squealed and jumped.
“That’s his happy dance,” said his dad, smiling.
A new voice
The new digital technology isn’t the first attempt to bridge the gap between parent or teacher and nonverbal child. Earlier, both boys communicated using Velcro-backed pictures attached to a book. Although the Picture Exchange Communication System did help them communicate that they were thirsty, for instance, getting the message across was too often cumbersome and frustrating.
“Before the iPad, there was a whole lot of screeching, screaming, crying,” said his Dylan’s mom, Teayona Smith. “We were trying to use PECS, which are pictures of objects like food items, favorite toys Velcroed to a board. He would bring us the photo of what he wanted. And then he received whatever it was. It was very difficult to go out into public because you can’t carry that many pictures with you.”
Digital tablets don’t have those limitations.
“Before the iPad, he had checked out. He was going through the motions, but had no real emotions,” said Teayona Smith. “Since the iPad, he’s much happier. He has a voice in the world. He knows his opinion matters.”
Now Dylan carries his tablet everywhere — at home, school and when he’s out with his family.
“It clicks for him,” his mom said. “Out of all the things we’ve tried, the frustration level is so much lower with the iPad.”
She credits the iPad for Dylan’s progress in starting to recognize words and to count.
Both Dylan and Austin are fifth-graders in Marshall Elementary’s Structured Communications Classroom. They are among about 50 students from kindergarten to age 21 with severe communication delays who are enrolled in the SCC program in Vancouver Public Schools. Most of these students fall somewhere on the autism spectrum.
In Vancouver, the youngest children attend the SCC program at Hough Elementary, then move to Marshall Elementary through fifth grade, to Discovery Middle School and finally Hudson’s Bay High School. Students can stay in the program until they are 21.
Only some of the SCC students are nonverbal. About 25 percent of people with autism speak few or no words, according to the Simons Foundation Autism Research Initiative. Autism spectrum disorder is almost five times more common among boys (1 in 42) than among girls (1 in 189), according to the Centers for Disease Control and Prevention.
To ensure children receive plenty of one-on-one instruction, the SCC classes at the elementary level have fewer than 10 students and about five staff assistants. The older children in the classes at Marshall seemed to be leaps ahead of the younger kids in the SCC class at Hough. Because the older children have better control of their emotions, on a recent classroom visit there were fewer meltdowns and outbursts. The older students could focus more on learning.
No tool for all
Nonverbal individuals have communicated with Augmentative and Alternative Communication devices since the 1980s. One of the best known users of an AAC device is British physicist Stephen Hawking, who must speak by manipulating a specialized computer with his cheek due to amyotrophic lateral sclerosis.
There is no one-size-fits-all communication tool for nonverbal individuals, said Patricia Dowden, who teaches in the Speech and Hearing Sciences department at the University of Washington. The low-technology Picture Exchange Communication System book works best for some nonverbal individuals, she said. Others may benefit from dedicated devices. An iPad equipped with specialized apps is one of the newer AAC devices.
“The iPad is an amazing revolution,” Dowden said.
But she cautioned that the iPad is not the best communication device for all nonverbal children. She suggested the child’s team of parents, teachers and specialists work together to consider the expectations of the child to find the best system.
“I have seen AAC open up tremendous doors, when it’s the right tool for the right child,” Dowden said. “It’s thrilling for children to realize they can communicate and they have power. I’ve seen that through AAC, whether it’s the iPad or other tools. The whole goal is communication. The technology has to be the means to the end.”
In 2011, Melissa Cantwell, a SCC teacher at Hough Elementary, wrote a $25,000 grant to purchase iPads for all 55 kids in the district’s SCC program. But school budgets can’t keep up with technology advances. Since the program received the iPads, Apple has released six newer versions.
The main app used in the SCC classrooms is Proloquo2Go, which turns the iPad into a communication device, said Cantwell. The iPad or iPad mini uploaded with this app costs from $400 to $800.
Students are not allowed to take their school-issued iPads home. However, many families have purchased iPads for home use.
The Proloquo2Go app offers a 14,000-word vocabulary, and new words can be added in minutes. With the PECS system, a teacher or parent had to go through several laborious steps to download, print, laminate and add Velcro to a new vocabulary word.
Cantwell believes the iPad has transformed her students’ development.
“Academically, they’re making progress at a much faster rate,” she said.
In Emily Farley’s SCC class at Marshall Elementary, her class of second- through fifth-graders worked calmly, mostly, at various tasks.
Michael Terwilliger, a fifth-grader, carefully added another wooden block to the tall tower he was building while an educational assistant worked with him.
At the same table, Colby Mendenhall, also a fifth-grader, played a fishing game with another educational assistant. The game helps students practice fine motor skills and color recognition.
“Whose turn is it, Colby?” she asked the boy.
He used his iPad to say, “My turn.”
The plastic fish slowly opened and closed their mouths. Manipulating a tiny plastic fishing rod, Colby dangled the line and lowered it into the gaping mouth of a red fish. The fish’s mouth clamped shut over the line. Next he caught a blue fish and an orange fish. Using his iPad, he said the color of each fish.
Dylan Smith sat at a table working on numbers with his educational assistant, Brandy Clarno.
“He’s made a lot of progress over the year,” Clarno said. “When we started, he was only doing ones. Now we’re about ready for fours.”
Emily Farley, Dylan’s teacher, has used the iPads with augmentative communication apps in class for four years.
“There’s so much less frustration with the iPads,” Farley said.
Through working with the iPad and practicing language, some of the formerly nonverbal students are learning to speak. Next door in MaryJane Melmer’s class, only two of her students rely on the iPad to speak for them.
During the morning’s calendar time in Melmer’s SCC classroom, Austin Porter, 11, a nonverbal boy on the autism spectrum, used his iPad to tell his teacher the month, date, day of the week and even the color of the sky. Afterward, an educational assistant worked with Austin one-on-one as he correctly matched letters to a laminated sheet, a variation of a picture board. Then he used his iPad to say the letter aloud.
Like Cantwell, Melmer speaks highly of how the iPads have aided her students’ language development.
“It’s a huge progression,” Melmer said about Austin.
Austin runs on the track team, which Melmer coaches. One of the general education students runs with him. Austin hangs his iPad from a strap around his neck and takes off.
“You wouldn’t want to leave your voice behind when you go running,” said Melmer.
When it was time for recess, Austin hung his iPad strap around his neck, put on his jacket and headed outside.
“Austin can take his iPad everywhere,” Melmer said. “He talks to people wherever he goes.”
At home and in public
The iPad has helped Austin after school too, said his mom, Alicia Miner.
When Austin was younger and was trying to communicate with the PECS book, he often had meltdowns in public. Strangers shot Miner disapproving looks.
But once Austin starting using the iPad with augmentative communication apps, he calmed down because he could be more specific with his words.
Miner advised parents of children with special needs to take their children into public and not worry about what other people may think about your child’s behavior.
“You’re trying to help your child make sense of the world in the best way you can,” Miner said. “They have to be able to go to the store with you. You can’t live in a bubble. Even if it’s just two minutes, you walk in the store and walk out. That’s a step. You just keep trying a little bit more every single time. You don’t stop trying. It might take your child three times to get it. It might take your child 372 times to get it. If you keep trying, eventually, they will. You get to see these small accomplishments that other parents don’t recognize because it’s just a different life. But it brings you even more joy to see your child do those small things.”
The iPad has opened the doors of communication between Miner and her son. One of the first things he told her on the iPad is that he had a headache.
“I didn’t know,” Miner said. “He didn’t have any way to tell me before that.”
Miner said the iPad has helped Austin develop a sense of humor. He has intentionally given a wrong answer on his iPad, then looked at his mom and grinned to see if he’d tricked her.
Dylan’s mom, Teayona Smith, also credits the iPad for helping her son develop his personality. The family knew Dylan liked to play on the swings, but he used his iPad to tell them he wanted to spin on the swing.
“He loves to spin,” his mom said. “He’s a real jokester. The iPad has really opened him up.”
In addition to being on the autism spectrum, Dylan has sensory processing disorder and cerebral palsy. He’s delayed as far as many development milestones, Smith said.
“Communication is one of the big ones. Once we got the communication going, then it’s really speeding everything else up,” she said. “It’s like that puzzle piece that you’ve got to have to be the main base for the rest of his learning.”
Research indicates that augmentative communication — whether it’s the PECS book, an iPad with specialized apps, or some other device — helps students verbalize more, Farley said.
“For some individuals, they may no longer need to rely on augmentative communication after a while, but my thought is that most will still need it as part of their lives,” said Farley. “They can become very fluent in the ‘language’ of augmentative communication to where they are speaking in sentences and giving speeches.”
Looking ahead at how her son likely will communicate in the future, Smith said, “I think Dylan will always have an iPad or a smartphone or some device that he can text to people or autotalk for him. I think that’s probably his future.”
With the help of technology, as his father urged, Dylan will use his words.