All Photos and Videos Have Been Removed

from this Presentation to Protect the

Identities of the Children who Participated in
this Project

A Picture’s Worth 1,000 Words

An AAC Intervention to Increase Participation for Children
Jamie B. Boster, M.A.
John. W. McCarthy, Ph.D., CCC-SLP
ISAAC 2016, Toronto, Canada
 Overview of
the
Presentation
•  Background
•  Methodology
•  Data Collection
•  Results
•  Extension Activities
•  Questions
 Introduction & Review of
Literature
—  Approximately one million children in the United States
alone have complex communication needs (CCN)
(Binger & Light, 2007)

—  AAC can provide benefits related to language and social

skills (Light & Drager, 2010)
—  Social communication, language, and literacy skills are
fundamental for participation in interactions across
settings (Light & McNaughton, 2012)

—  Peers often take more opportunities in communication

exchanges compared to children with CCN (Light &
McNaughton, 2014)
 Introduction & Review of
Literature
—  Development of intervention programs that target
necessary AAC skills as well as children’s
interactions with same-age peers is needed
—  Development of such skills will allow children to
express wants and needs, share information, and
develop social relationships (Light, 1989)
—  Flexibility in interventions can allow children to
develop competencies across multiple skills sets
—  Integration with same-age peers can promote
children’s language and social skills
 Introduction & Review of
Literature
—  Programs based in arts and creative activities can
offer potential for integration and skills
development (McCarthy & Light, 2001)

—  Current communication technologies and social

networks rely on digital photos and media

—  AAC devices have media capabilities to capture,

integrate, and share, photos (Light & McNaughton,
2012)

—  Opportunity to capitalize on technologies

 Aim

—  Design, implement, and evaluate an exploratory

photography intervention
—  Increase communication and social participation skills
for children with CCN
—  Use photography as enhancement to increase
opportunities

—  Identify strategies and activities to increase skills

with AAC
—  Potential to address multiple competency areas
 Methodology

—  Descriptive pilot study following a single-subject design

format
—  Three Baseline Probes
—  Three Intervention Sessions followed by Probes
—  Maintenance Probe

—  Child with CCN paired with a peer for structured

photography activity
—  Activity designed to follow a short story format

—  Data collected on story elements and communicative

interactions
 Participants

—  One child with CCN and two same-age peers without

disabilities

—  Participants were classmates in a pre-school setting

—  Peers had no reported speech, language, hearing, or

cognitive impairments based on parent and teacher
report

—  Both peers completed baseline probe, one randomly

selected to participate in intervention
—  Second peer received individual instruction and
participated in a generalization probe
 Child with CCN

—  Age 5:6

—  Diagnosis: Agenesis of the Corpus Callosum

—  Rare birth defect with complete or partial absence of

the corpus callosum

—  White matter connecting hemispheres of the brain

fail to develop during pregnancy
—  Shows unsteady gait, visual, and fine motor
impairments
 Social Networks Protocol

Social Networks Protocol (Blackstone & Hunt

Berg, 2012)
—  Completed with mother and teacher
—  Family, teachers, and therapists as
primary communication partners
—  Participated in horseback riding
—  few interactions with same-age peers
identified beyond classroom
—  Primary modes of communication
included:
—  vocalizations, gestures, one word
utterances, and some use of her SGD
 Receptive Vocabulary Test

—  Peabody Picture Vocabulary Test, Fourth Edition (Dunn &

Dunn, 2007)
—  Raw Score: 52
—  Standard Score: 75
—  Percentile Rank: 5

—  Standard score falls two standard deviations below the mean,

moderately low score
—  Strengths in following directions and identifying range of
nouns and verbs
—  Concepts missed included items not currently represented on
her AAC device (tornado, peacock, annoying)
—  Such concepts may be unfamiliar and are also difficult to
represent graphically
 Current AAC Device

—  iPad with LAMP (Language

Acquisition through Motor
Planning) Words for Life™
application

—  Key guard and Case with Handle

—  Previously used GoTalk on iPad
mini
—  Parent and teacher reported
inconsistent use of the device
—  Primarily produce one-word
messages
 Materials

—  Toys: 6 items in each session

—  Probe: Horses, Bugs, Baby
Doll
—  Intervention: Vet, Cats, Safari

—  Polaroid Camera
—  Idea Cards
—  Coin (Storyteller vs.
Photographer)
—  Easels
—  Paper and Crayons
 Baseline Probes

—  Pairs were seated in small classroom with primary

investigator
—  All materials were made available
—  Pair asked to tell two stories
—  Provided with a visual timer and given reminders to
complete two stories
—  Stable baseline was achieved in three sessions with
peer independently telling stories and no interaction
with child with CCN
 Baseline Performance
Communicative Utterances Story Elements

Probe 1 Probe 2 Probe 3 Probe 1 Probe 2 Probe 3

Coin Flip 0 0 0
Child with CCN
Select Materials 0 0 0
Peer-Peer 0 0 0
Who 1 1 1
Peer-Adult 0 0 2
Oh No! 0 0 0
Self 0 0 0
Fix 0 0 0
Peer
Switch Roles 0 0 0
Peer-Peer 0 0 0
Who 0 0 0

Peer-Adult 15 14 14 Oh No! 0 0 0

Self 0 0 0 Fix 0 0 0
 Intervention Sessions

—  Three intervention sessions conducted followed by

probes

—  Taught pair series of steps to tell a story

Select Choose Select Provide Switch

Fix it
Role Materials Who “Oh no” Roles
 Intervention

—  Intervention sessions 30 min. each

—  Step by step instruction to scaffold process

1.  Practice flipping the coin and choosing materials
2.  Teaching how to pick a Who, Oh No, and Fix
3.  How to operate the camera, waiting for the pose,
printing

—  Models were also provided on the AAC device

 Main Results

—  Child with CCN increased use of vocalizations and

gestures directed to her peer, investigator, and self

—  Peer increased utterances towards child with CCN

and self

—  Increased story target achievement

 Communicative Utterances
Child with CCN to Peer Utterances
16 Baseline Intervention Maintenance

14

12

10

0
Probe 1 Probe 2 Probe 3 Probe 4 Probe 5 Probe 6 Probe 7
 Communicative Utterances

Child with CCN to Adult U.erances

30 Baseline Intervention Maintenance

25

20

15

10

0
Probe 1 Probe 2 Probe 3 Probe 4 Probe 5 Probe 6 Probe 7
Communicative Utterances

Peer to Child with CCN U.erances

30
Baseline Intervention Maintenance

25

20

15

10

0
Probe 1 Probe 2 Probe 3 Probe 4 Probe 5 Probe 6 Probe 7
 Story Elements

Story Elements
6
Baseline Intervention Maintenance

0
Probe 1 Probe 2 Probe 3 Probe 4 Probe 5 Probe 6 Probe 7
 Discussion

—  Child with CCN became more vocal and used

combinations of gestures and vocalizations with
peer and investigator

—  Peer directed more statements and questions to

child with CCN

—  Structure of the activity may have allowed peer to

support child with CCN

—  Increased opportunities for child with CCN

 Discussion

—  Child with CCN had most difficulty when in

storytelling role as more support was needed

—  Switching roles did not occur

—  Exchanging camera after each turn could potentially
be more readily understood
—  Peer spontaneously suggested this option despite
intervention sessions

—  Story elements were included more but complexity

of peer’s stories appeared to decrease
 Limitations

—  Activity may have been too complex and feature too

many components for the time allotted
—  Technical difficulties and access barriers with
camera
—  Baseline period potentially enforces the current
pattern and was not readily changed by the
intervention
—  Three intervention session only with 30 min.
—  No 1:1 intervention with child to CCN or peer prior
 Future Directions

—  Photography appears to be an engaging avenue for

children

—  Support for exploring options for peer and group

activities for children with CCN

—  Implication with additional technologies

—  Potential inclusion of AAC device camera

—  Greater integration of AAC device in interactions

—  Interventions with small group and classroom activities

—  Exploring additional photography avenues
 Variety of Photography
Tools
—  Activities may be implemented with a variety of
cameras
—  Polaroid
—  Digital
—  Disposable
—  GoPro
—  Drones
—  iPod, iPads, Tablets
—  AAC device cameras
 “Selfie” Day

—  Following the study the pairs also participated one

additional photography activity

—  Pairs engaged in dress-up activity and posed for

“selfies” with a selfie stick

—  Required:
—  iPod Touch
—  Bluetooth Switch
—  Bluetooth Printer
 Let’s Take a Selfie

—  Also provided opportunities for communication

between peer and child with CCN

—  Switches for cameras can allow for participation

despite motor impairments

—  Flexible activity

—  No right or wrong answers

—  Engaging for both children
 Extensions

Scavenger Hunts
—  Find and Take Photos

—  Thematic hunts

—  Scale with age

—  Inclusion in community
 Extensions

Filters
—  Make use of photo apps
and programs

—  Vocabulary to add effects

—  Change photos or create

stories
 Extensions

GIFS Sharing
—  Apps can allow search and —  Integration across social
sending media platforms

—  Find and create GIFs —  Sending photographs to

others
—  Personalize stories
—  Communication tool
—  Communicate messages
 Conclusions

—  Short photography based activities with peers can

benefit children with CCN and their participation

—  Providing structured activity can provide

communication opportunities for children with
CCN

—  Can begin to even proportion of turns

—  Provides a space for language learning, social

interactions, and operational skill building
 References

Binger, C. & Light, J. (2007). The effect of aided AAC modeling on the expression of
multi-symbol messages by preschoolers who use AAC.

Light, J. (1989). Toward a definition of communicative competence for individuals using

augmentative and alternative communication systems. Augmentative and Alternative
Communication, 24, 29-42.

Light, J. & Drager, K. (2010). Improving design of augmentative and alternative

technologies for young children. Assistive Technology, 14(1), 17-32.

Light, J. & McNaughton, D. (2012). Supporting the communication, language, and

literacy development of children with complex communication needs: state of the
science and future research priorities. Assistive Technology, 24(1), 34-44.

Light, J. & McNaughton, D. (2014). Communicative competence for individuals whore

require augmentative and alternative communication: A new definition for a new era of
communication? Augmentative and Alternative Communication, 30(1), 1-18.