Monday, June 10, 2013

AAC Week: Speech and Language Therapy for Preschool Students with Severe Special Needs

This post originally appeared as a guest post for Smart Speech Therapy, LLC.  I am reposting because I am bringing you a week dedicated to Augmentative Alternative Communication and Assistive Technology.  I hope you enjoy!

Across the country, school department budgets are shrinking.  Because of this, many schools are choosing to create classrooms and accommodate the IEPs of students with severe special needs rather than contracting out to “Day School” programs.  As a result, SLPs are finding more and more children with challenging disabilities on their caseloads.

My district is no different.  In 2007, I found myself working in a preschool classroom for children with severe special needs.  The terminology for this type of classroom varies across the nation, but the dynamics are pretty similar:  small class size, smaller student to teacher ratio, children with multiple impairments, and a great deal of related services.  In the five years I spent working in this classroom, I saw children with many different disabilities:  Autism, Down Syndrome, Cerebral Palsy, Myotonic Dystrophy, Agenesis of the Corpus Callosum, Chromosome Deletion Syndromes, William Syndrome, etc.  Most of the students’ IEPs specified speech and language services several times per week. 

What does that therapy look like?

Clearly therapeutic objectives and methods will vary based on the child’s presentation and speech and language needs.  However, I have found a total communication approach to be most beneficial overall.  Some students responded better to ASL, others responded better to PECS, and some became verbal communicators.  You never know which approach a child will gravitate toward until you try them all! 

Facilitating a total communication approach can be time consuming…learning ASL signs (if you don’t already know a lot), creating picture symbols, creating overlays for communication devices, setting up assistive technology on the classroom computer, dealing with switches and switch access.  This type of approach really does not work unless the staff works together!  I was very fortunate to be able to work with PTs, OTs, and a classroom teacher who were more than willing to collaborate. 

What are some total communication approaches that can be used in the classroom?

1.  American Sign Language

One of the simplest augmentative/alternative means of communication is ASL.  This is partly because it does not require anything extra…no extra resources, materials, or cost.  Using this form of communication to supplement language development is common practice for SLPs working in early childhood settings.  However, it does presuppose adequate motor abilities, so it will not be sufficient for all students in this type of classroom. 

Some ASL/Hearing Loss resources:

·         ASL Browser (Michigan State University):  Video ASL dictionary
·         Hear My Hands ASL Blog:  Load of information and resources!
·         Handspeak:  ASL dictionary, resources, and research.

2.  Pictures/Picture Symbols:

Pictures and picture symbols can be used for a variety of reasons/activities.  You can use them as part of a communication system (see #3), for scheduling purposes, for social stories, and to support literature (to name just a few).  I like to use a combination of real photos and picture symbols.  Some kids will need the concrete nature of the photographs, and others will pick up the abstract drawings without difficulty.  In all honesty, many times I use photographs because I can’t find a picture symbol that adequately illustrates the item I want to represent. 

Pictures of toys I commonly use in therapy.

If I’m creating a whole page of picture symbols, I’ll use the feature of my photo printing software that creates small wallet-sized prints.  If I have one or two, I’ll add them in with picture symbols.  Where do you get picture symbols?  Here are the most common resources:

  • Boardmaker Software Family (  The possibilities are endless with this traditional program by Mayer Johnson featuring PCS.
  • LessonPix Custom Learning Materials ( This is a web-based program that allows users to create picture symbols and a large variety of other materials for learning.  I often get asked about the difference between LessonPix and Boardmaker.  My short answer is this:  Boardmaker requires a top-down design (create your board, add your images), while LessonPix is bottom-up (select your images, choose your design template).  With LessonPix, you cannot create your own board designs, but they offer a ton of pre-made activities.
  • Pics for PECS (  This is a CD that contains nearly 3000 images that you can add to MS Powerpoint, MS Word, or just about any other program.
  • Picto4me Communication Board Editor - Free communication board creator/editor that works with Google Drive.  

3.  Picture Exchange Communication System (PECS)

Ok, so this is probably should be numbered 2.5 since it utilizes pictures and picture symbols!  I have used this program with much success with many of the students in the severe special needs classroom!   PECS by Pyramid Educational Consultants is a six-step process of learning how to use an “exchange” method to communicate.  Here are some of the picture symbols I use for favored PECS reinforcers (to find out why they’re in a box lid, you can read my blog post HERE).

 Some PECS resources:

·         The Autism Society has an article that's a great overview of the PECS process.
·         This run-down from DePaul University outlines the six phases in a simple and clear manner.  Perfect for printing and keeping in your room!
·         There's even a Wikipedia article on PECS!

4.  Low(er) Tech Assistive Technology:
In this type of classroom, you may run across children who do not have sufficient motor skills to pick up picture symbols and pass them to an adult.  For these students, I have utilized both pointing/tapping the desired picture symbol and eye gaze methods.  Here are some display options I’ve used for eye gaze:
Acrylic frames:  These stand up on their own (horizontally or vertically) and are great for providing a limited number of choices.  I used this with a child who needed to be fed.  He could let me know if he wanted a bite of food or a sip of his juice. 

 Large eye-gaze board:  This was a fixture in the classroom in which I worked.  It’s made out of acrylic and is very easy to see through.  Because of this, you can monitor the student’s eye gaze quite easily.  The problem is that it’s cumbersome and not portable.

Activity specific eye gaze boards:  Smaller and more portable than the version above, I created these in Boardmaker by creating a 9-square grid and deleting four of the cells.  Once printed, I cut out the center square, laminated, and re-cut the center.  For this option, you can peek through the center at the child, ask them to look at the option they want, then look back at you to confirm their response.  The boards I have here are for selecting a song during circle time, blowing bubbles, and indicating emotion.  You can see, I kept a blank board as well.  Because these are small, I can store them in a folder and bring them with me to different classrooms, I can also store them in areas where they are most likely to be utilized (e.g., song board in the circle area of the classroom).

Recordable Voice Output Switches:  There are so many different types of switches that you can use.  I love the ones that you can record easily and use in any activity so that all children can participate…Record the chorus of favorite songs so that the child can fill in (e.g., “E-I-E-I-O” during “Old MacDonald”).  These are the ones I use.  You can add icons to the clear plastic sleeves.

5.  High(er) Tech Assistive Technology:  These resources are technically the most expensive and more difficult to come by in a school setting.  However, these can be extremely beneficial to students in a severe special needs classroom.  Here are some of the activities I have used:

Switch Activated Toys:  These may seem simple, but they are great for teaching cause/effect, a necessary precursor for using switches for communicative means!  I couldn’t find the digital files for these photos, but these are the picture symbols I created for some of the switch toys we used in the classroom:

Intellikeys:  Intellikeys is an alternative keyboard.  You can create your own overlays and program them to use on your classroom computer.  The Intellitools site also has an activity exchange section where you can access pre-made materials.

Powerpoint:  You can easily set up slide shows on Powerpoint to be switch activated.  Set up your slide show to have forward advancing buttons.  Place the cursor over the advance button and allow the child to advance pages using a switch.  You scan story book pages, add them to slides, and record yourself reading.  Create your own versions of popular stories!  I did a “Teddy Bear, Teddy Bear, Who Do You See?” featuring all the children and staff in the classroom.

The iPad and Communication Devices:  I’m not going to go into detail on these since it could take a whole book!

Some AT resources:
  • Click HERE to see a step by step tutorial for creating Powerpoint talking books.
  • Try these free downloads from Children's Hospital Boston.  Scroll down a bit and check out the Dynamic Display Examples!  I had a student who absolutely LOVED the "Chase Me" activity!
  • Tar Heel Reader:  Create and read switch-compatible stories (written by other students/teachers)
  • Tumblebooks Library:  This is a subscription service, but my local library has access through its website.  It’s worth a shot to see if yours does as well!
I hope this post provided you with some new information regarding servicing students with severe special needs in the school setting!  Stay tunes for some more information on AAC and AT later this week!

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