Use of Augmentative and Alternative Communication Device
with
Non-Verbal and Speech Delayed Preschool Child
Suzanne I. Hoey
Table of Contents
Abstract
3
Chapter One: Introduction
4
Importance of Study
4
Background
5
Description of the Program
6
Statement of the Problem
7
Research Question
8
Definition of Terms
8
Summary of Research Design 9 Assumptions 11
Chapter Two: Review of the Literature 12
Chapter Three: Research Design and Methodology 21
Sample 21
Materials 21
Procedure 23
Analysis of Data 26
Limitations of the Study 27
Chapter Four: Results and Conclusions 29
Discussion and Conclusions 38
Implications for Teaching 39
Implications for Further Research 40
References 42
Appendices 46
A. Baseline Data Recording Sheet 46
B. Teacher/Therapist Observations and Notes 48
C. Treatment Data Recording Sheet 49
D. Teacher/Therapist Observations and Notes 51
E. Pre-treatment Interview Questions for
Parent(s) 52
F. Post-treatment Interview Questions for
Parents(s) 54
G. Pre-treatment Staff Survey 56
H. Post-treatment Staff Survey 57
I. Permission Letter to Superintendent 58
J. Permission
Letter to Early Childhood Coordinator 60
K. Letter to
Parents 62
L. Blank
Informed Consent Letter for Parents/Children 63
M. Blank
Informed Consent Letter for Staff/Adults 65
Abstract
The purpose of this study was to determine whether or not the implementation of assistive technology in the Integrated Preschool Classroom, specifically, “Go Talk”, an augmentative and alternative communication device, would enable a non-verbal, speech-delayed student to better access the Preschool curriculum.
The treatment plan implemented “Go Talk” with Jimmy, a preschool student who is non-verbal and has been diagnosed with a severe language delay. Participants in the study included, Jimmy, his classmates, his parents, therapists and classroom paraprofessional who provided direct services to Jimmy.
Qualitative data was collected over six weeks through teacher and therapist observation to record anecdotal notes, and quantitative data was collected through record keeping to record the number of independent choices, peer interactions, episodes of frustration, and responses to posed questions.
At the conclusion of the data collection period, “Go Talk” proved to be an effective form of intervention as increases in all targeted areas were noted. A further analysis of episodes of frustration noted a large number of episodes during the first two weeks of the treatment and a decrease thereafter, with no episodes of frustration recorded during the final week of treatment. Peer interactions were increased and anecdotal notes discussed meaningful peer interactions.
Introduction
Importance of Study:
Within the context of an Integrated Preschool classroom, the casual observer may see only one thing happening, children playing. When looking beneath the surface, there truly is a lot more going on inside the classroom. Children are learning the give and take of conversation, exploring socially accepted rules and boundaries, problem solving, sharing, and taking advantage of the opportunity to role-play in many different roles. Happy sounds are heard, children laughing, talking and singing. At times there are other sounds, the sounds of discontent. A toy has been taken from one child or someone is just missing his or her mom. Is this learning? It most certainly is! Empathy, sympathy and compassion are learned each and every day.
One of the most exciting and interesting aspects of the Integrated Preschool classroom is the underlying current of conversations that go on between the children. “I’m five now, so is Kelly, and Mary. We are the oldest.” “I went apple picking this weekend.” “I’m helping my Dad after school.” “Do you want to play in the blocks with me?” “Can you help me find the map on Putt-Putt?” (a computer game). Two children working together to complete a floor puzzle of the alphabet, solving the problem of which letter comes next by singing the entire alphabet each time!
Being able to communicate with one’s peers, to be able to express ideas, wants, and needs is basic in our daily lives. Yet for some children, being able to communicate is not a reality. How does this inability to communicate affect the child? How are peer interactions affected? Is the child’s self-esteem compromised? Will assistive technology help the child communicate ideas, wants, and needs?
Addressing these issues was the focus of this research proposal. Assistive technology was introduced into the Integrated Preschool classroom to determine if use of a specific assistive device, “Go Talk”, would assist a non-verbal student in communicating wants, needs, and ideas in the classroom. Additionally, peer interactions were studied to see if the use of the assistive device increases peer interactions. The Preschool curriculum was discussed and data was collected to determine if the assistive device enabled the student to better access the curriculum and fully participate in the activities in the classroom during large and small group activities.
Background:
Prior to the enactment of the Individuals with Disabilities Education Act (IDEA) in 1997, approximately one million children with disabilities were not being provided the services needed and many were not allowed to attend school (IDEA ’97). IDEA provides a Free and Public Education (FAPE) for all with disabilities and special education services designed to meet their individual needs (IDEA ’97). Included in the law is a provision that young children should be educated in the most natural, least restrictive, and most inclusive environment that can support play and interactions with peers and parents (Langone, Malone, Kinsley, 1999). Many school districts include Integrated Preschool classrooms in their districts to provide these services to their youngest students.
IDEA discusses assistive technology and further defines an assistive technology device as, “…any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability” (IDEA’ 97, 1997, p. 5).
Studies
have shown that the use of assistive technology devices to assist children with
disabilities in the area of communication have been successful (Parette,
Hourcade, & VanBiervliet, 1993; Beck, 2002; Cameron &
Description of the program:
The Integrated Preschool Program consists of three separate sessions per teacher. Children may attend a two-day morning class, a three-day morning class of a four-day afternoon class. Each session is two and one half hours a day. Regulations allow a total of fifteen children in the classroom in each session, eight typically developing children and seven Special Education children. Services provided by the district include Speech and Language services, Occupational Therapy and Physical Therapy. Children are referred to the program through parents and Early Intervention. Typically developing children are chosen through a lottery due to the limited number of spaces available in each session.
The preschool curriculum is aligned with the Massachusetts Department of Education Guidelines for Preschool Learning Experiences (Massachusetts Department of Education, 2002). All areas of curriculum are addressed within the classroom, including, language development, mathematics, science, social studies, health, and technology. The program is accredited by the National Association for the Education of Young Children (NAEYC) and developmentally appropriate practices are employed.
Statement of the problem:
Jimmy is a five year old child who is currently enrolled in the Integrated Preschool program and is receiving services under an Individual Education Plan (IEP). Jimmy is currently in his third year as a student in the Integrated Preschool program. At this time he is not using words to express his wants, needs, and ideas in the preschool classroom. Through teacher observation and assessment, it is determined that Jimmy is not accessing the preschool curriculum at the same rate as his typically developing peers.
Jimmy was seen and evaluated at Early Intervention and it was determined that he was eligible for services, yet his parents elected not to attend Early Intervention. It is unknown as to the reason why Jimmy’s parents decided not to seek services through Early Intervention. Jimmy’s parents were concerned about his lack of speech. Jimmy’ mother brought him to the public school to be evaluated.
Jimmy was evaluated by the Speech and Language, Occupational and Physical therapists. Jimmy was eligible for services in all three areas and was eligible to attend the Integrated Program as a Special Education student. Jimmy started school in the two-day morning class and an IEP was developed. Jimmy currently attends the four-day afternoon session of Preschool and continues to receive services under and IEP.
Jimmy has made gains in many areas since starting school. He is able to sit during large group activities, an activity that was difficult for him when he first started school. He is participating in large group activities, mostly those activities that do not require a verbal response, such as matching shapes and colors, and using manipulatives. Jimmy is provided with pictures when making choices. In the small group, Jimmy is able to complete most activities independently.
The cause of Jimmy’s language delay is not known. His peer interactions are compromised because of his language delay. It is important for Jimmy be able to fully access the Preschool curriculum and interact in positive peer interactions. “Go Talk”, a communication assistive technology device, will act as an accommodation to enable Jimmy to access the curriculum and assist him in demonstrating his abilities, knowledge, and ideas.
Research question:
Assistive technology is a resource that may provide individuals with a disability the assistance needed to interact with their environment. Children with a communication disorder may benefit from the use of an assistive device that aids in communication. The purpose of this study is to determine whether or not the implementation of assistive technology in the Integrated Preschool Classroom, specifically, “Go Talk”, an augmentative and alternative communication device, will enable a non-verbal, speech-delayed student to better access the Preschool curriculum.
Definitions of terms:
IEP: Individual Education Plan- a legal document between the school district and the student or student’s parents that describes the educational plan for the student. Each IEP is written for each child, no two are the same. IEP’s are reviewed annually, and re-evaluations of the child are completed every three years or until Special Education services are no longer required.
NAEYC: National Association for the Education of Young Children, a national program that accredits Early Childhood programs. Programs accredited by the NAEYC practice developmentally appropriate practices and embrace anti-bias curriculum. Programs are reaccredited every three years.
Occupational Therapy: Occupational therapy focuses on the development of fine motor skills and sensory skill development.
Physical Therapy: Physical therapy focuses on the development of gross motor skills.
Summary of research design:
The research design is as follows. One student, Jimmy, will be the main focus of the study. A baseline will be determined over two sessions of preschool, taken at Circle Time and throughout the entire session of Preschool. To determine the baseline, during each preschool session, the number of peer interactions will be recorded, as well as the number of independent choices, episodes of frustration, and the number of responses to posed questions. After a baseline is determined, the assistive device, “Go Talk”, will be introduced to the student. The entire grid of nine blocks available on the device will be used. Each session, data will be collected during Circle Time as well as throughout the school day. The number of peer interactions will be recorded, as well as the number of independent choices, episodes of frustration, and the number of responses to posed questions. At this time, it is being considered whether or not to have the device available for Jimmy to use at home. Data collected at home may not be valid and in the event that “Go Talk” is left at home and not brought to school, data could be affected.
Involved in the study are the twelve members of Jimmy’s preschool class, the teacher and paraprofessional, Speech/Language Therapist, Occupational Therapist, Physical Therapist, and Jimmy’s parent(s).
An interview with Jimmy’s parent(s) will be conducted prior to the start of the study. Questions will be asked to determine the number of words spoken at home, level of frustration when not understood, and parent goals for student. A parent interview will also be conducted after the study is complete to determine the number of words spoken at home, level of frustration when the child is not understood, and goals for student.
Staff interviews will also be conducted. Included in the staff interviews will be the paraprofessional working in the classroom, the Speech/Language Therapist, Occupational Therapist and Physical therapist, all who provide direct service to Jimmy. Collaboration between the researcher and the therapists will ensure carryover of the assistive device into the therapy sessions. Picture boards will be designed unique to each therapists needs when servicing the child.
Teacher observation and anecdotal notes will be taken during the data recording times.
Assumptions:
It is assumed that Jimmy will be able to use the assistive device to express his wants, needs, and ideas in the preschool classroom. Using “Go Talk” will help Jimmy to better access the preschool curriculum and assessment of his skills. It is further assumed that by using the assistive device, Jimmy will begin to speak to express his ideas, wants, and needs. Peer interactions should increase; a peer interaction picture board will be developed for this express purpose. The other children in the class will be interested in the device and will interact with Jimmy by asking questions and waiting for an answer. The goal of this study is to assist Jimmy in access the preschool curriculum, develop social interaction skills, and help develop his readiness skills for Kindergarten.
Review of Literature
" ~Ralph Waldo Emerson~
“How silent the woods would be if only the best birds
sang.”
This quote, written by an unknown
source, speaks for the children and adults with communication disabilities who
would not have a voice without assistive technology communication devices. How much “music” is being missed because
these children do not have an effective form of communication? Assistive technology can provide children
with significant developmental challenges an opportunity to express ideas, play
with a toy, or demonstrate understanding of a development concept (Mulligan, 2003).
The Individuals with Disabilities
Education Act Amendments of 1997 (IDEA ’97) was developed to strengthen
academic expectations and accountability for the 5.8 million children in the
United States who have disabilities (IDEA ’97).
According to IDEA ’97, prior to the implementation of the Individuals
with Disabilities Education Act (IDEA), approximately one million children with
disabilities were not allowed to attend school.
Additionally, hundreds of thousands of disabled children were denied
appropriate services. Today, children
with disabilities are integrated into the regular education classroom and as a
result, many are learning and achieving at levels not previously considered
possible (IDEA ’97).
All children in the
"Now
they have protection under the law. They can't be excluded."
--
Assistive technology (AT) is a tool that may assist children
with disabilities to become more independent, participate in games and other
activities with peers, and communicate wants, needs, and ideas (Mulligan,
2003). It has been reported in the 1994
National Health Interview Survey on Disability (NHIS-D) that 433,000 children
under the age of six use some form of assistive device (Benedict, Lee, Marrujo,
& Farel, 1999). Assistive technology
has been demonstrated to improve the educational functioning and independence
of people with a variety of disabilities including visual and hearing
impairments, communication, and physical disabilities (Bigge, 1982; Enders,
1984; as cited in Parette & VanBiervliet, 1991). Children with disabilities are able to
participate in activities that otherwise may not be accessible to them through
the use of Assistive technology (Parette & Murdick, 1998). Individual Education Plan (IEP) Team members
do not always consider assistive technology when making accommodations for a
child with a disability (Judge, 2000) and the Team should consider if there is
technology available to assist the child and provide the child with a free and
appropriate public education to which he or she is entitled (Judge, 2000). Schools districts are required to provide
assistive technology services to eligible students with disabilities at no cost
to the student or his/her family (Parette, Hourcade, & VanBiervliet 1993;
Parett & Murdick, 1998).
"The
decision means Benjamin will finally be provided the education he's had a right
to all along."
--Julie Carter, attorney representing
the family of Benjamin Sutton, who sued an Indiana school district so the boy,
who has Down syndrome, could stay in his first grade classroom (Dec. 11)
(“Quotes of the Day (from Inclusion Daily Express),”
2000).
Play is children’s work.
Through play children learn to participate in the give and take of
conversation, how to work through a problem, and play provides children with
the opportunity to role-play many of life’s roles. For children with disabilities, play may be
replaced with therapies and special instruction (Lane & Mistrett,
1996). Assistive technology can provide
children with disabilities the opportunity to engage in play situations that is
similar to the play situations of their non-disabled peer (Lane & Mistrett,
1996). Children with disabilities
should be provided with toys they can manipulate, explore, and interact with
(Lane & Mistrett, 1996).
Assistive technology (AT) has helped
to lessen the gap between typically developing children and those children with
disabilities. Assistive technology
devices have provided young children with the opportunity to play, learn,
communicate, and interact with their environment (Judge, 2000; Judge, 2002). “…Assistive technology will certainly
mainstream more and more children in wheelchairs, children who cannot
physically speak, see, or hear, and children who need computers to write,
organize, think, and function educationally” (Behrmann, 1998, p.3).
AT devices are generally categorized into two categories,
high-tech and low-tech. AT can be a
simple as using a pencil grip, glasses, a child’s toy microphone, and picture
boards, all considered low tech devices, or AT can be complex, such as, high
tech devices that could include motorized wheelchairs, laptop computers, and
augmentative communication devices (Langone, Malone, & Kinsley, 1999). IDEA ’97 defines an assistive technology
device as, “any item, piece of equipment, or product system, whether acquired
commercially off the shelf, modified, or customized, that is used to increase,
maintain, or improve functionally capabilities of a child with a
disability”. Assistive technology can be
any device or equipment that helps children with disabilities to develop and
maximize their skills to the best of their ability or potential (Judge,
2002).
The American Heritage Dictionary defines communication
as. “1.
The act of communicating 2. The
exchange of thoughts, messages, or information. 3. Something communicated” (1994, p.177). Communication is key to sharing ideas, wants,
and needs. For many children, spoken
language is not always possible. It is
important to provide these children with a form of communication that will
effectively assist them to communicate with their families and peers. “Every child needs some type of communication
for personal expression and to interact with others” (Lane & Mistrett,
1996).
Augmentative
communication devices or aids are available for children and adults who cannot
speak (Parette, Hourcade, & VanBiervliet, 1993). Augmentative and alternative communication
devices (AAC) foster independence, self esteem, and increase opportunities for
individuals with disabilities to participate in daily activities, and children
to participate in classroom activities (Parette, Hourcade, & VanBiervliet,
1993; Beck, 2002; Cameron &
AAC devices are classified into two types of systems: aided and unaided (Mirenda, 1999 as cited in Sigafoos & Drasgow, 2001). Aided systems, including those devices that include voice-output communication aides are considered to be aided systems, along with communication boards that included photographs or line drawings (Sigafoos & Drasgow, 2001). Unaided AAC systems include any system that does not involve the use of any external devices or materials (Sigafoos & Drasgow, 2001). American Sign Language (ASL) and other manual gestures are considered to be unaided AAC devices (Sigafoos & Drasgow, 2001).
Hutinger (1996) as cited in Weikle
& Hadadian (2003) has shown evidence that supports the use of assistive
devices for communication with young children as functional tools, to promote
social outcomes, and as retention aids for learning activities. Children with limited or no communicative
resources have been noted to be at significant risk for developing challenging
behavior (Frea et al., 2001). AAC
devices may provide children with communication disorders a form of
communication for expressing personal choices (Frea et al., 2001). Computer activities have improved language
development in preschool children with Down’s Syndrome, and may be used as
social facilitators for children with significant social interaction deficits,
and as assistive devices for children with speech and language impairments
(Meyers & Beckwith, 1988; Shaperman, Howard, & Kehr, 1989;
Spiegel-McGill, Zippiroli, & Mistrett, 1989; Zippiroli, Bayer, &
Mistrett, 1988; as cited in Weikle & Hadadian, 2003).
Nonverbal children and children with
physical disabilities may have limited opportunities to engage in literacy
activities, such as learning to read or interacting with others during literacy
activities (Beck, 2002). Additionally,
according to Beck (2002), these children may be provided with fewer
opportunities to read and write with typically developing peers. Augmentative and alternative communication
devices (AAC) provide children with disabilities the opportunity to participate
in group activities and increase, maintain, or improve skills needed for
reading (Beck, 2002).
The Massachusetts Curriculum
Standards for Preschool, Guidelines for Preschool Learning Experiences,
provided standards for learning experiences in Preschool. Ideas for learning experiences are discussed
in all areas of the curriculum, including English Language Arts, Learning
Guideline 2 which states that children should be able to, “Participate actively
in discussions, listen to the ideas of others, and ask and answer relevant
questions” (Massachusetts Department of Education, 2002, p.5). Additionally, adaptations for children with
disabilities are discussed and the use of special or adaptive devices to
increase a child’s level of communication and/or participate is recommended for
children with language disabilities (Massachusetts Department of Education,
2002). In the Integrated classroom, all
children, typically developing and special needs, are provided with many
opportunities to learn. Children need to
be provided opportunities to: “develop autonomy by expressing their own
preferences and interests, learn the social nuances of engaging in group learning
experiences, and deepen their language skills and become effective
communicators” (NCIP, 1994, p.1). A
teacher in
In conclusion, assistive technology
has provided children with disabilities the opportunity to better access
curriculum, improved opportunities for peer interactions, and with the use of
AAC, children have been provided with a method of expressing wants, ideas, and
needs. Parents of children with
disabilities face many challenges daily, and like all parents, they want their
child to be included in activities in school.
After experiencing integration and inclusion in a Preschool setting, it
is apparent that integration is the model for schools to follow. The children involved in an integrated
setting learn so much from each other.
It is important to note that all children need a way to have their voice
heard, and assistive technology and augmentative and alternative communication
devices can provide young children with this voice. Parents of children with disabilities want
their children to be accepted and to have friends. It is wonderful that technology has provided
society, educators and families with a means of assistance to allow children
with disabilities access to all they want and deserve.
Literature and studies on the
effectiveness of the indented AAC device for this research study (“Go Talk”) is
not available. “Go Talk” is a
lightweight device that is constructed from durable plastic. It operates on a double A sized battery. “Go Talk” has a nine panel grid which
provides a divided area for display of graphics and/or photographs. Each one of the grids or buttons allows for a
message to be recorded. There are four
levels for recording messages for a total of thirty-six messages. Different amounts of time are pre-set for
each of the buttons; therefore the ability to record a longer message is
available. The user presses a square
(button) with a picture representation or a word, and a pre-recorded message is
then heard. By pressing a series of buttons,
the user will be able to communicate wants, needs, and ideas with others. Overlays are created to correspond with the
recorded messages. The overlays may be
stored within the “Go Talk” and are easily moved between levels. A button is pushed to switch between levels
and a light indicated which level the “Go Talk” is set on.
As there is limited research with this particular AAC, it
is the hope of this researcher to provide Integrated Preschool professionals
with research and data to provide an effective method of implementation and
integration in the classroom, of an augmentative and alternative communication
device for nonverbal students.
Research Design and Methodology
Sample:
For this case study, an assistive
technology treatment was provided to one subject, Jimmy, a 5-year-old child who
has been diagnosed with a severe language delay. The goal of this study was to provide this
child with an augmentative and alternative form of communication through the
use of an assistive technology device.
Also included in the study were the classmates of the subject, eight
typically developing children, three special education children receiving
services under and Individualized Education Plan. The setting was an Integrated Preschool
classroom in a public school system.
This was a sample of convenience; the researcher was the classroom
teacher. The class met four consecutive
afternoons a week, Monday through Thursday, and followed the school calendar of
the school district. The children
attended school 2½ hours a day for a total of ten hours a week.
Materials:
Augmentative and alternative
communication (AAC) device, “Go Talk” was the instrument provided to the
student for his use during the study.
The device is constructed out of lightweight durable plastic and
operates using a double A sized battery.
“Go Talk” has a nine panel grid which provides a divided area for
display of graphics and/or photographs.
“Go Talk” allows for a voice to be recorded and saved to be used in one
of the nine grid blocks available. The
user chooses and presses one of the nine available graphics to ask or answer a
question and the pre-recorded message will speak for the user. There are four levels that provide
availability for up to thirty-six messages to be pre-recorded. Picture or written representations of the
recording can be included through the use of the “Go Talk” overlay software or
through the use of the software application “Boardmaker”. The researcher used a combination of the
pictures provided by the “Go Talk” manufacturer and pictures available through
Boardmaker. Boardmaker pictures are used
in many areas of the classroom and were familiar to Jimmy and his
classmates. As research suggested, a
male child’s voice was used to record messages whenever possible. At times, if it was not possible to record a
male child’s voice, the researcher used her voice to record messages.
Data recording sheets (Appendix A
and Appendix C) were used to record data and record teacher anecdotal notes and
observations (Appendix B and Appendix D).
A pre and post-treatment interview was administered to the subject’s
parent(s) (Appendix E and Appendix F).
Additionally, a pre and post-treatment staff survey was distributed to
the staff members in the school that provided direct services to Jimmy
(Appendix G and Appendix H).
Participants in the staff survey included: Speech/Language Therapist,
Occupational Therapist, Physical Therapist, and Classroom Paraprofessional. The staff survey was important to the study
to gain information concerning the attitude towards assistive technology (AT)
and the experience the staff had with AT.
Staff attitude was assessed to determine the willingness of staff to
integrate and implement assistive technology.
Also, the staff survey helped the researcher determine if the success
(or lack of success) of the assistive technology device may be generalized to
included use in areas outside of the classroom and different providers, with
Jimmy, the subject of the study.
Procedure:
Letters of introduction and
permission to conduct this study through the school district were sent to the
Early Childhood Coordinator (Appendix I) and the Superintendent of Schools
(Appendix J). Upon receiving approval to
continue with the study from the Early Childhood Coordinator and Superintendent
of Schools, the entire project and Informed Consent forms (Appendix K) were
submitted to the Bridgewater State College Institutional Review Board (IRB) for
review and approval. Once approval was
received from the IRB, consent forms and a brief discussion (Appendix L) of the
intended study were sent home to the parents of all children in the class, as
well as the subject of the study, Jimmy, and staff who provided direct service
to Jimmy.
A personal interview with Jimmy’s parent(s) provided the researcher with personal, in-depth reflections concerning Jimmy and his language development at home. The researcher has known Jimmy and his family for three years and a good rapport has been established. Questions were asked to determine the number of words spoken at home, level of frustration if not understood, types of interventions in which the family has participated and short term and long terms goals of the parents for the child. A pre and post-treatment staff survey to determine type of service provided, level of communication during therapy/classroom session and attitude towards assistive technology and augmentative and alternative communication devices were administered. A four point Likert scale, (1=Strongly Agree, 2=Agree, 3=Disagree, 4=Strongly Disagree) was used to determine respondent’s attitude towards assistive technology and AAC. All questions carried equal weight. Informational questions included on the questionnaire do not carry any weight yet are important in the discussion of the results.
Baseline data was collected over two sessions of Preschool before the introduction of the augmentative and alternative communication device “Go Talk” to Jimmy. Peer interactions were recorded by making a tally mark on a prepared data recording sheet (Appendix A) along with responses to posed questions, independent choices, and episodes of frustration, all recorded with a tally mark on a prepared data recording sheet. A positive independent choice was identified as a choice made by the subject that was not prompted by another individual. As clarification, during Circle Time, the group routinely discussed the weather and two types of weather are determined (sunny & cold; rainy & windy). Jimmy received a positive independent choice when he chose an appropriate weather without prompting from others.
The number of times Jimmy appeared frustrated when not understood were also recorded through teacher observation (Appendix B) and a tally mark on the data recording sheet (Appendix A). Crying, refusal to participate, temper tantrum, or any type of aggressive behavior towards self or others was recorded as a positive sign of frustration.
After a baseline was determined, the assistive technology augmentative and alternative communication device (AAC) “Go Talk” treatment was introduced to Jimmy. Jimmy was given visual cues and hand over hand assistance when needed to operate the AAC. Initially, hand-over-hand assistance was provided, if needed, for four sessions of Preschool. It was determined by the researcher and therapists providing direct services to Jimmy, that he would benefit from additional hand-over-hand assistance, therefore, it continued to be provided to Jimmy, but no longer than eight sessions of Preschool. Any additional hand-over-hand assistance would have impacted the outcome of the data in determining if the AAC device “Go Talk” was effective with Jimmy. Data was recorded (Appendix C) to determine the number of peer interactions, independent choices, responses to posed questions, and episodes of frustration. Teacher observation and anecdotal notes were taken (Appendix D). Baseline data and treatment data were collected during each session of Preschool attended by the subject (four sessions, four afternoons a week) for a total of six weeks. The AAC traveled with Jimmy to therapy sessions in Speech/Language, Occupational Therapy, and Physical Therapy. The therapists were provided instruction as to how the device works, and overlays were developed in conjunction with the therapists so that the device would be used during therapy sessions.
Once baseline data was collected, it was determined whether or not to allow Jimmy to have the AAC device, “Go Talk” available to him home, in addition to class time. Reliability of the data collected at home cannot be determined; therefore, if “Go Talk” was available to Jimmy at home, data will not be collected. Another concern if Jimmy had “Go Talk” at home was that he would have time to experiment with the device and this additional time could affect the outcome of the experiment. Additionally, if the device was left at home and not brought to school, it would affect the data collection procedure. Unless the parents expressed an interest in having “Go Talk” available to Jimmy at home, it would be used only at school. Yet, since the goal of this study was to provide this child with an effective form of communication, at home and at school, this aspect of the study must be open to adjustment.
Analysis of the Data:
The AAC used in this study was a constant; it provided a verbal response when a button was pushed. The messages may change but the overall structure of the device was to voice a response to a pushed button. Dependant variables included, the attitude of staff who provided direct services to Jimmy, Jimmy, and his classroom peers, towards the use of the AAC, as measured by the pre and post-treatment staff survey, and the pre and post-treatment data collection of the number of peer interactions, responses to posed questions, episodes of frustration, and independent choices.
The responses of the parent(s) on the pre/post interview (Appendix E and Appendix F) were incorporated into the discussion and provided qualitative data. Anecdotal notes and observations by the researcher and other staff members (Appendix B and Appendix D) who participated in the study provided additional qualitative data.
The staff pre/post survey (Appendix G and Appendix H) results were analyzed and graphed to demonstrate staff attitude and willingness to implement assistive technology in therapies and classroom activities, as well as the staff’s opinion as to the effectiveness of the AAC.
Limitations of the Study:
As this study is a case study, the results may not be generalized to the population. All steps possible will be taken to ensure interrater reliability, yet it must be considered that staff members, Speech/Language Therapist, Occupational Therapist, Physical Therapist, Classroom Paraprofessional, and Speech/Language Intern, will collect data during therapy sessions and classroom activities. Additionally, the sample is a sample of convenience, and is familiar to the researcher. It must be considered that another group of children may affect the results of the treatment.
A threat to external validity exists in the area of peer interactions. The other children in the class may be interested in the new “toy” that Jimmy has rather than interacting by asking a question of Jimmy. It would be reasonable to assume that in the beginning the children will be mostly interested in the AAC device and how it works, but it is hoped that Jimmy will start to use the device to communicate and this will encourage the other children to interact with Jimmy by asking him questions and waiting for an answer.
Because this is a case study, additional subjects may need to be considered in the event that the intended subject decides to withdraw or is unable to participate for the entire study. In such an event, a language delayed child who is a student in another session of Preschool will be the subject of the study (Plan B). The children in this child’s class will be included in the study. Also, if needed, a non-verbal child who is a student in another Preschool classroom in the same school building may become the subject of the study if needed (Plan C). It is the hope of this researcher to continue with the intended subject, Jimmy.
Results and Conclusions
Jimmy, a non-verbal and speech delayed child was introduced to an assistive technology device called, “Go Talk”. Research was implemented to determine whether or not implementation of assistive technology in an Integrated Preschool Classroom, specifically, “Go Talk”, an Augmentative and Alternative Communication Device (AAC) would enable a non-verbal, speech delayed student to better access the Preschool curriculum.
Baseline and treatment data were collected throughout the Preschool day, in all settings, which included, Circle Time, Free Play, Small Group Activity. Data was also collected during Therapy Sessions, Occupational Therapy (OT) and Speech/Language Therapy (S/L). The targeted areas of research included, peer interactions, independent choices, responses to posed questions, and episodes of frustration, and were recorded by the researcher and therapists. Tally marks were used to record data. Staff were provided instruction by the researcher as to how to record data to reduce the effect of interrater reliability.
Prior to starting the treatment, a pre-treatment staff survey (see Appendix G) was administered to school staff who provided services to Jimmy. Included in the survey were the classroom Paraprofessional, Speech/Language Therapist, Occupational Therapist, and Physical Therapist. The survey was implemented to assess staff attitude toward assistive technology devices. A four point Likert Scale with a score of 1 for “Strongly Agree” to a score of 4 for “Strongly Disagree” was used. Two of the respondents answered “Strongly Disagree” that Jimmy is able to express his ideas, wants, and needs, and two answered “Agree”, that Jimmy is able to express his wants, ideas, and needs. When asked about prior experience with Augmentative and Alternative Communication devices (AAC), one staff member answered “Strongly Disagree”, one answered “Disagree”, one answered “Agree” and one answered “Strongly Agree” indicating varied experience with AAC devices. Yet when asked if AAC and assistive technology was an effective form of intervention, all four answered “Strongly Agree”. It can be inferred that the staff working with Jimmy viewed AAC and assistive technology as a positive form of intervention and assisted the researcher by using the AAC and collecting data (See Figure 1).
A post treatment staff survey was administered at the conclusion of the data collection period. The same four point Likert Scale was used in the post-treatment staff survey. The results of the post-treatment survey (See Figure 2) demonstrated a change in staff attitude towards assistive technology. To better assess attitude change, a mean score for the pre and post-treatment survey was calculated (See Figure 3).
Figure 1 –
Pre-treatment Staff Survey
|
Staff Survey Questions |
|
4. Jimmy is able to express wants needs and
ideas during therapy and classroom settings |
|
5. Jimmy uses language to express wants,
ideas, and needs when I am working with him. |
|
6. Jimmy demonstrates frustration when he is
not understood. |
|
7. Interventions to assist Jimmy to express
his wants, ideas, and needs have been effective. |
|
8. I have experience with assistive
technology. |
|
9. I have experience with Augmentative and
Alternative Communication Devices. 10. Assistive technology is an effective
form of intervention. |
|
|
Figure
2 – Post-Treatment Staff Survey
Figure 3 – Staff Survey Questions
The most prevalent change in attitude towards assistive technology can be seen when asked if, “Assistive technology is an effective form of intervention.” In the pre-treatment survey, all four respondents answered the question “Strongly Agree”. After the treatment and experience with an AAC, two respondents answered with “Strongly Agree”, one answered, “Disagree”, and the fourth answered, “Agree”. It is interesting that staff attitude towards the effectiveness of assistive technology is varied after the treatment was implemented. The two staff members who provided services to Jimmy most often continue to view assistive technology as an effective form of intervention. The two staff members who provided services to Jimmy once a week demonstrated an attitude change towards the effectiveness of assistive technology as a form of intervention in the negative. In the pre-treatment staff survey, all four staff members surveyed chose “Strongly Agree” when asked about the effectiveness of assistive technology as a form of intervention.
Baseline data, across all areas, was collected over two sessions of Preschool. Peer interactions, independent choices, responses to posed question, and episodes of frustration were tallied and tabulated at the end of the two sessions (See Figure 4).
Figure 4 – Baseline Data Collection Totals
The “Go Talk” was introduced to Jimmy after baseline data was collected. Data was collected in the targeted areas of peer interactions, independent choices, responds to posed questions, and episodes of frustration.
Jimmy appeared to be very interested in the device and immediately started pressing all the buttons to see what would happen. Boards were created prior to the implementation of the AAC. Each board was created for a specific purpose, peer interaction, Circle Time activities, Weather (also used during Circle Time), and two for Therapy Sessions. Also, academic boards, to further develop readiness skills needed for Kindergarten were created. The first board introduced to Jimmy was the peer interaction board which included verbal responses for “Hello, My name is Jimmy”, “Can I Play”, “My turn”, “Yes”, “No”, “Thank You”, and the three standard blocks on all the boards, “I need help”, “I’m all done”, and “I need to use the bathroom”. When Jimmy indicated, by physically pointing toward the bathroom in the classroom, that he needed to use the bathroom, the researcher provided hand-over-hand assistance to demonstrate the bathroom icon/block. As he was pressing the block, Jimmy imitated verbally, “yes, please”. Many prompts, with hand-over-hand assistance were needed on the first day.
By the middle of week two of the treatment, Jimmy was consistently and meaningfully using the “I’m all done”, and “I have to go to the bathroom” icons/blocks. The researcher had to continually present the AAC to Jimmy, as he was not at the point where he would carry the device with him as he moved about the classroom. As the researcher presented the “Go Talk” to Jimmy he was instructed to carry it around with him wherever he went. He pressed the “no” button, but later when he left the area he was working in, the researcher noticed he took the AAC with him.
Jimmy was involved in more peer interactions after the introduction of the AAC. One peer interaction may not have been one expected from this treatment, however, it was a peer interaction. The interaction was between Jimmy and another student who joined Jimmy in the Dramatic Play area. Jimmy looked at his peer and said “No” as the peer tried to go into the refrigerator in the Dramatic Play area where Jimmy was playing. One of the goals of introducing the AAC was to have Jimmy verbalize his ideas, wants, and needs, and in this case that is exactly what he did!
Anecdotal notes were collected to provide qualitative data not represented by tally mark on data recording sheets, which would be noteworthy to assess the effectiveness of the AAC device. It was noted by the Speech/Language Therapist that Jimmy was mumbling at a peer for a turn on the swing during a therapy session. This represented an initial verbal peer interaction. During week three, many of Jimmy’s responses to posed questions were verbal, with six verbal responses and nine responses with the AAC. His episodes of frustration dramatically decreased. Another goal for providing Jimmy with an augmentative and alternative communication device was to decrease his frustration by providing him with a form of communication. Jimmy more consistently carried the AAC device with him as he traveled from one area to the next. A verbal reminder from the teacher, “Jimmy, don’t forget your “Go Talk””, was all he needed to be reminded to carry the device with him.
S/L Therapy sessions were geared toward providing responses to questions. The S/L therapist encouraged Jimmy to use both his voice and the AAC to respond to questions. She was working with Jimmy and helping him use the AAC so that he can express his ideas, wants, and needs in the classroom and in the community.
Throughout the treatment, increases in all target areas are noted, except in the area of episodes of frustration, this area has seen a decline, as was hoped. Jimmy recorded many instances of frustration in the first two weeks of the treatment, with the highest number of episodes occurring during week two, at a total of seventeen episodes of frustration. An increase in episodes of frustration during week five could have been attributed to illness as Jimmy’s mother reported to the researcher that he had a head cold and was not feeling well. During the final week of data collection, Jimmy recorded zero episodes of frustration (See Figure 5).
Figure 5 – Episodes of
Frustration
Through the course of the treatment, Jimmy’s peer interactions increased; he was making eye contact and attempting to interact verbally with his peers. As the treatment period came to an end, as noted in the anecdotal notes, Jimmy was independently and spontaneously interacting with his peers. He was pointing at his classmates, making eye contact, turning towards his peers, and moving his mouth and vocalizing sounds (See Figure 6).
Figure
6 – Peer Interactions
Jimmy consistently used the AAC to ask to use the bathroom, or to ask for help, and to answer questions about the weather during Circle Time. Jimmy was also more willing to imitate words after using the AAC device, such as pressing the “I need help, please” icon/block, having his request honored by staff, and then imitating staff as they model, “Help, please”.
Figure
7 – Baseline Total Compared to Treatment Totals
Mean scores of the baseline totals and the treatment totals were calculated (See Figure 8). The results of the mean score comparison demonstrated in increase in peer interactions, responses to posed questions and independent choices after the AAC treatment was introduced. Episodes of frustration also reflected an increase in mean score, yet individual analysis of that data demonstrates a decrease in frustration over the course of six weeks (See Figure 5).
Figure
8 – Baseline Mean Compared to Treatment Mean
The greatest increase in mean score (15 points) was in the area of responds to posed questions. The S/L therapist, through consultation with the researcher, indicated that S/L therapy sessions are geared toward having Jimmy respond to questions. Additionally, the S/L therapist’s willingness to implement the use of the AAC device in her lessons also contributed to the increase in mean score in the area of responds to posed questions.
Another large increase in mean score (14.15 points) was in the area of independent choices. Through the use of the AAC, Jimmy was able to effectively communicate his choices in a variety of settings. Having the use of the AAC throughout the school day also provided Jimmy with unlimited opportunities to make choices.
The threat to external validity noted in the limitations of the study, did not prove to be a concern in this case. Although the other children in the classroom were initially very interested in the AAC device, their interest in the device switched from curiosity to helpfulness as they would encourage Jimmy to make choices or remind him to carry the “Go Talk” with him as he traveled around the classroom. It should be noted, however, that in the beginning week of the study, the other children in the classroom, through their curiosity, would inadvertently press the record button and the messages previously recorded in a male child’s voice would be erased. Having the messages re-recorded after school easily solved this issue. Additionally, newer versions of the “Go Talk” have the record button on the back of the device and not as easily accessible to being inadvertently pressed.
Discussion and Conclusion:
In conclusion, although the research conducted and data collected over a six week period was a case study, the effectiveness of an AAC device in a Preschool classroom for use by a speech delayed or non-verbal child is demonstrated through the qualitative and quantitative data collected, to be an effective form of intervention or treatment. The subject of the study demonstrated an increase in mean score between baseline data and treatment data, of at least five points in all targeted areas. The device was effective in helping Jimmy better access the preschool curriculum. In this case study, staff willingness to implement and include the AAC device in therapy sessions, or when working with Jimmy, contributed to the effectiveness of the device. The subject was also willing to use the AAC to express his wants, needs, and ideas in the classroom and during therapy sessions. As he become more familiar with using the device and getting a response from an adult or a peer, his willingness increased. Jimmy was purposefully using the device, not just choosing a button to get a response. He would review the choices and make an appropriate choice. However, it must be noted that the results of this study cannot be generalized across the population, as this was a case study with one subject.
Implications for teaching:
“Go Talk” an augmentative and alternative communication device is an effective form of intervention for a non-verbal or speech delayed child. It would be ideal to have “Go Talk” available in all Integrated Preschool Classrooms to assist young children with their expressive and receptive language development. The six-week period of data collection did not adequately reflect the impact of the device on the language development of the subject. Since the conclusion of the study, the subject is continuing to use the AAC device effectively. He is engaging in more positive peer interactions, most of which he is initiating himself. Jimmy is imitating more and more words each day, and he is beginning to use two word utterances to express himself. His episodes of frustration have decreased and he is using language meaningfully. Quite an accomplishment from a five year old child who was not able to express himself in an effective manner before the introduction of the “Go Talk” AAC device!
Attainment Corporation, the manufacturer of “Go Talk”, has made improvements to the device since the start of this study. The newer device has dedicated blocks for items that would be consistent across all areas. This is important when using this device in teaching as it allows more blocks for other choices.
As a result of this research project, a Kindergarten teacher met and consulted with me to discuss and demonstrate “Go Talk”. After seeing the device and hearing of its effectiveness in the Preschool classroom, the Kindergarten teacher decided the use “Go Talk” with two of her children and two devices were purchased. The device is appropriate for younger and older children and can be used both at home and at school. It can be used as the child moves from grade to grade.
I enjoyed using this device and I can see many uses for “Go Talk” in my preschool classroom. Many of my colleagues have asked me about the device and I would definitely recommend “Go Talk” to my colleagues as well as assist them to implement the device in their classrooms.
Implications for Further
Research:
The effectiveness of “Go Talk” in my classroom, in this case study, would encourage me to use the device again. “Go Talk” is being introduced in a Kindergarten classroom and I would like to follow the progress of these children and the effectiveness of the device in the Kindergarten classroom.
A six week period of time for research does not adequately reflect the effectiveness of the “Go Talk” AAC device. More time is needed, especially with young children, to fully see the implications and progress of individual students when using an AAC device. This study needs to be continued over the rest of the school year and possibly longer to fully demonstrate the effectiveness of AAC device in language development and how it affects the subject’s ability to better access the curriculum.
In order to generalize the results of this research, more subjects need to be included in the study. Data needs to be collected as other subjects access and use the device and their progress should be monitored to fully determine the affect of AT in the Preschool classroom. No two children present with the exact same disability, therefore it may be difficult to ever generalize the data. It would be interesting to see however, how different subjects with differing disabilities are impacted and empowered by the use of “Go Talk” in the classroom.
References
Beck, J. (2002). Emerging Literacy Through Assistive Technology. Teaching Exceptional Children, 35(2), 44‑48.
Behrmann, M. (1998, May 1). Assistive Technology for Young Children in Special Education [Special section]. Association for Supervision and Curriculum Development, 1‑3. Retrieved October 3, 2004, from http://www.glef.org
Behrmann, M. (2004). Assistive Technology for Young Children in Special Education. The George Lucas Educational Foundation, 1‑3. Retrieved October 3, 2004, from http://www.glef.org
Benedict, R. E., Lee, J. P., Marrujo, S. K., & Farel, A. M. (1999, January). Assistive devices as an early childhood intervention: evaluating outcomes (pp. 79‑90). Chapel Hill, NC: Department of Maternal and Child Health, School of Public Health, The University of North Carolina.
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Cameron, L.,
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Mirenda, P. (2001, Fall). Autism, Augmentative Communication, and Assistive Technology: What Do We Really Know? . Focus on Autism & Other Developmental Disabilities, 16(3). Retrieved October 3, 2004, from Academic Search Premier database.
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Appendices
Appendix A
Baseline Data
Jimmy
Circle Time
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Free Play
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Peer interaction= any time that Jimmy interacts with a
classmate, either verbally, joining a child in an activity, or tapping a peer
to get their attention, or using AAC to communicate with another child.
Independent choice= A positive independent choice is identified
as a choice made by the subject that is not prompted by another individual,
pointing, using AAC device, verbally.
Response to posed question=any time Jimmy answers a
question posed to him by someone with a verbal answer, using the AAC, or
nodding/shaking his head.
Small Group Activity
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
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|
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|
|
Therapy Session Speech OT PT (Please Circle)
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Peer interaction= any time that Jimmy interacts with a classmate, either verbally, joining a child in an activity, or tapping a peer to get their attention, or using AAC to communicate with another child.
Independent choice= A positive independent choice is identified as a choice made by the subject that is not prompted by another individual, pointing, using AAC device, verbally.
Response to posed question=any time Jimmy answers a question posed to him by someone with a verbal answer, using the AAC, or nodding/shaking his head.
Appendix
B
Teacher/Therapist Observation and Notes:
Date:____________________________
Appendix C
Treatment Data
Jimmy
Circle Time
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Free Play
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Peer interaction= any time that Jimmy interacts with a classmate, either verbally, joining a child in an activity, or tapping a peer to get their attention, or using AAC to communicate with another child.
Independent choice= A positive independent choice is identified as a choice made by the subject that is not prompted by another individual, pointing, using AAC device, verbally.
Response to posed question=any time Jimmy answers a question posed to him by someone with a verbal answer, using the AAC, or nodding/shaking his head.
Small Group Activity
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Therapy Session Speech OT PT (Please Circle)
|
Date/Time: |
Peer
Interactions |
Independent
Choices |
Responses
to Posed Question |
Appears
frustrated (crying, refusal to participate, temper tantrum, or aggressive
behavior towards self or others) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Peer interaction= any time that Jimmy interacts with a classmate, either verbally, joining a child in an activity, or tapping a peer to get their attention, or using AAC to communicate with another child.
Independent choice= A positive independent choice is identified as a choice made by the subject that is not prompted by another individual, pointing, using AAC device, verbally.
Response to posed question=any
time Jimmy answers a question posed to him by someone with a verbal answer,
using the AAC, or nodding/shaking his head.
Appendix D
Teacher/Therapist Observation and Notes:
Date:____________________________
Appendix E
Use of Augmentative and Alternative Communication Device with
Non-Verbal and Speech Delayed Preschool Child
Interview Questions for Parent(s)
Pre-treatment
(Read out loud to parent(s)): Thank you for taking the time to talk with me today.
I am researching a method of Augmentative and Alternative communication that I believe will be helpful to Jimmy. To set up a program that would be most beneficial to him, I’m going to ask you questions about his language development at home and what your goals are for Jimmy.
- Approximately how many words does Jimmy use at home?
- Is he speaking in sentences at home?
- How does Jimmy express his wants and needs at home?
- Do you understand Jimmy when he wants to tell you something?
- If no, does Jimmy demonstrate frustration when he is not understood?
- In what ways, if any, does Jimmy demonstrate frustration?
- What interventions have you been involved in with Jimmy?
- In what ways have these interventions been helpful to or possibly ineffective for Jimmy?
- What are your short-term goals for Jimmy, especially in the area of language development?
- What are your long-term goals for Jimmy?
- At home, does Jimmy interact with children other than family members in play situations?
- In what ways does Jimmy communicate with other children?
Appendix F
Use of Augmentative and Alternative Communication Device with
Non-Verbal and Speech Delayed Preschool Child
Interview Questions for Parent(s)
Post-treatment
(Read out loud to parent(s): Thanks again for taking time to talk with me. To fully assess the effectiveness of the Augmentative and Alternative Device, “Go Talk”, I’m going to ask you similar questions as I did in the initial interview. Since the introduction of “Go Talk”:
- Approximately how many words does Jimmy use at home?
- Is he speaking in sentences at home?
- How does Jimmy express his wants and needs at home?
- Do you understand Jimmy when he wants to tell you something?
- If no, does Jimmy demonstrate frustration when he is not understood?
- In what ways, if any, does Jimmy demonstrate frustration?
- What interventions have you been involved in with Jimmy?
- In what ways have these interventions been helpful to or possibly ineffective for Jimmy?
- What are your short-term goals for Jimmy, especially in the area of language development?
- What are your long-term goals for Jimmy?
- At home, does Jimmy interact with children other than family members in play situations?
- In what ways does Jimmy communicate with other children?
- Do you feel that the AAC was beneficial to Jimmy? In what ways?
- Would you recommend the use of this AAC, “Go Talk” for other children and their families?
