Monday, 2 February 2015

How Do I Get This Kid to Communicate? - Part 2 (Next Level)

Welcome to 2015!

Well its been a long time coming this blog post.  Mostly because I couldn't think of just HOW we got to this point and remember back to just when he started using the iPad.  We were early adopters of the iPad buying it from Apples Online store and waiting a good month for it to arrive from China.  It was one of the early iPad 2's.  Back then I had seen a few iPads in stores with Proloquo2go on it and other AAC (Augmentative and Alternative Communication) Apps.  I didn't think our son would ever really use one let alone understand it back then.  My Husband 'gifted' the Talking Cards App to us via iTunes and we installed it.  I originally set it up with just a few of his favourite food items, and used some of the buttons that came with it.  It was a good simple App, and back then his iPad2 had a reasonable microphone.  It was tricky having both the inbuilt voice (an american female voice) and my own saying the words I had against each button.  Back then it was simple words like FOOD, DRINK, MUNCHOS, CHEESE etc.  Even though we showed the app to him he never really understood it or used it.  We had a bigger problem back then - tactile defensiveness  with his hands.  He also lacked motor control or any sort of fine motor understanding.  So he could barely get past a fly swat type thump of the iPad screen and certainly couldn't individually point a finger and stroke or touch easily.  So we had to work on finger isolation first and that was going to take time.

Finding our Fingers

When we first got the iPad we were using a PC computer and a switch we borrowed from the special needs toy library to play simple switch based games.  All those games required just a 'smack' of the big button switch so he never had to isolate a finger and even though he could pick up crackers, hold a cup or bottle etc.  we were still in the process of helping him to hold onto spoons, cup handles etc and he really didn't have the strength to do that easily.  We were SO excited when he reached out and unfolded his fingers and picked up a cracker using a scooped hand one day.  So thats where we were at, working on motor skills of using his hands properly.  He had no easy pincer grip so that had to be taught too.  So instead I installed simple cause and effect Apps on the iPad like 'Baby Finger' and 'Sound Touch' .  We also purchased 'Injini' which was expensive but has turned out to be worth more than we paid for it over the years.

I spent a quite a few times during the day sitting with my son on my lap grasping his right hand and prying out his index finger and then getting him to touch the iPad hoping the cause and effect apps would motivate him.  At first he got grumpy, resisted, pulled his hand away, and sometimes cried.  I kept at it over the months and eventually he got more and more interested at playing with it.  During that time it was always hand over hand help, although as time went on I was able to leave him for a moment or two to 'flyswat' the screen and it didn't matter as Apps like Baby Finger were so forgiving and any touch on the screen would result in a response and that was motivating for him.
At this time we weren't really doing much Low Tech communication apart from a few cards and the labelling of items around the house,  but nothing formal.  I was doing some Makaton sign language at him but really getting no response, he was quite passive in his world and allowed me to dictate whatever he wanted to eat and do.  He did have his favourite foods, yes even then Munchos were a favourite.  I was also helping him eat finger food whilst sitting in a highchair and would put small items like Munchos in front of him and assist him to eat them.  Slowly but surely we got to understand his hands and he got better and better at isolating his fingers and I needed to help him less and less.  Even now 4 years later he still has trouble with his fine motor skills and can have difficulty in touching buttons on the iPad, he tends to use his second finger rather than his index finger.

Early iPad Communication 

So now to our initial foray into iPad AAC.  Well as mentioned above we had 'Talking Cards' Installed modelling' how to use it.  What we did was setup a series of expectations.  If he wanted cheese then we would sit there with the cheese nearby but out of his reach.  He would obviously get agitated and vocalise rather loudly! When he did that I would go to his iPad in front of him and press the FOOD folder and then touch the CHEESE button whilst explaining to him why I was doing that and what I wanted him to do.  I would then grab his hand and get him to do the same steps.  He would often resist and get a bit annoyed.  But I would persevere and once he had allowed me to get him to touch the CHEESE button then I would hand him a piece of cheese.  Slowly he seemed to understand what was expected.  It wasn't always consistent, when he was at preschool they didn't tend to follow through or remember to ask him to use his iPad and I never insisted they use it and encourage him to communicate.  So eventually he got bored with the whole thing and gave up using his iPad to communicate.  There was a dispute with his then SLT who believed he was just being random and appeared to have no understanding of what he was doing or what the buttons meant.  She thought we were pushing him too fast and needed to take a step back to the Low Tech method first.  In some cases she was right, but we totally believed in our son and his ability to 'get' things and being much smarter than others gave him credit for.
and did spend a little bit of time '
In those early days it was more a choice board system of desirable items that he tended to eat or want to watch on TV.  We threw in a few other important words like Cuddles, Swing etc but it was basically a menu of 'wants'.  He was never consistent and began fly swatting and never really stuck with it. So we gave up using the iPad to communicate and went back to a mix of signs, cards, and worked on him having a consistent YES or NO instead.  Quite by chance we worked out he was clapping for YES and that changed everything because we were finally able to ask him direct questions and get a YES response.  Because of that we used the iPad even less and instead concentrated on reinforcing his clap for YES response whilst trying to encourage a NO.  Generally a NO for him was a non-response or a look away and disinterested.  So we go onto giving him physical choices in front of him instead of picture cards.  If he wanted toast we put a jar of jam and a jar of honey in front of him and asked him to touch which one he wanted on his toast.  We still sometimes do this with him but expect him to choose now on his iPad!

Giving up on the iPad and going back to Low Tech

So by now we had decided the iPad was only going to be used as a toy with education items and motivating cause and effect apps and the Talking Cards was forgotten.  In tears I went to his SLT and agreed I wasn't getting anywhere and could she help?
It was at this point we decided on PECs and starting a formal series of lessons implementing PECs and going through the phases with our son.  So over a few months we spent a day a week with the SLT doing proper PECs phase training with him, and he responded pretty well quite quickly.
 Eventually just before he transitioned to school at the age of 5 1/2 years old we discovered he couldn't make it past phase 3 as he was unable to physically move so couldn't grab a PECs card go find a communication partner and hand them the card to get what he wanted.  We tried other methods to test if he was capable of doing that but never found a useful way to make it work.  Then we had the problem of him becoming fixated on the sound and feeling of the velcro dots on the back of the cards and he started to rip the cards off the PECs book and throw them away or just enjoy pulling them on and off! So at home we gave up on PECs cards and looked for another solution.  It was then we went to the Low Tech placemats and started modelling those as mentioned in our first Blog entry on our communication journey.

So how did we eventually get to using the iPad to communicate?

I will leave that to another blog entry as thats another LONG story!
Keep posted for Next Level - Getting him to want to use the iPad

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