Saturday, July 27, 2013

Tried and True part 2: Tools To Increase Communication And Decrease Frustration

The ability to communicate our wants and needs is probably the most significant thing we learn in early childhood. Imagine the frustration if no one, not even your parents could understand what you needed. If day after day every time you wanted something, or wanted to express yourself to someone else, you couldn't. Even worse, imagine if you couldn't understand what was being said to you. Like being in a foreign country where no one spoke your language and you were forced to walk through life not knowing what was going on around you. Not knowing what was coming next. Unable to transition from one task to the next because you couldn't understand the steps. Andrew refused to use any sign language except "eat" and "all done", so his ability to express himself without behaviors was almost non-existent.

This was Andrew's life before he was introduced to the Picture Exchange Communication System. PECS for short. This system is used as an augmentative and alternative way to communicate. Many children with Autism and other special needs are very visual learners. Andrew is no exception. As soon as he was diagnosed, we were told that he might respond to this form of communication, as he was completely non-verbal. I immediately proceeded to download the free version of the Boardmaker Program. It gave me access to over 900 widely used pictures that I could print, laminate, and cut into squares. The picture above is a sample of what the Boardmaker icons look like. Andrew made this "schedule" years ago. He wanted to do some really fun stuff this day. :) 

I spent days finding all the icons I needed, formatting them onto pages in 2 inch by 2 inch squares, printing them out in sheets, cutting each square, and laminating them, and cutting them again. Andrew used Boardmaker icons for years, until we decided he would benefit more from real picture icons instead of stick figures. He is so visual, and real pictures have so much more detail and color. You should have seen him when I made all these new icons. I mean, it was like Christmas to him. He was so happy that I was giving him new words. It was amazing. 

I took all of the icons that I had cut and laminated, and put them into a communication binder I made. All of the icons had Velcro on the back of them so they could be fixed to the binder over and over again. I would put the icons in order starting at the top and continuing down the side of the binder. Andrew could easily see what were doing for the day so that he would know what was coming next. He would move an icon into the All Done envelope to help him transition to the next thing. All of his icons were in a 2 inch thick full size binder at all times. The schedule below was the one we used on the day Andrew had to have his sleep study at the hospital.

Before we figured out that Andrew's frustration stemmed from his inability to communicate and be understood, he had so many aggressive and violent behaviors. It was constant. He was so upset and it manifested in terrible ways. However, once he understood the system we were trying to implement, he jumped in with both feet and never looked back. He loves his visual schedule more than anything else. We would have to take the binder every where we went. It fell apart more than once and I would have to make new ones often with sturdier material.We would loose icons often and they would have to be remade, but it was still the best way we had found to communicate.

Less than a year ago, we were able to slowly switch Andrew from his homemade communication book, to having his entire schedule on his iPod touch he wears around his neck. He is such a tech savvy child. He had become a whiz and the iPad, so learning how to use the iPod touch was pretty simple for him. I found an app called First Then Visual Schedule HD that allows me to put all of Andrew's icons and visual schedule in one place. I can take any picture from google images to make icons and put them right into his schedule as long as I have a wifi signal. It allows me to say the words in my voice so when he touches the icon he can hear the word. It also allows me to make a video of steps for him for more difficult tasks like brushing his teeth so that he can be told each step in the process.

This app has changed his life. It has opened up a whole new world for him. We use it all day every day. He always has it around his neck, so he has very little anxiety since he always knows what is happening. No more loosing icons and ransacking the house in the middle of the night looking for them. No more printing, laminating, and Velcro. No more binders. It has made my life so much easier. 

Perhaps the most significant change that has occurred in Andrew's life with respect to communication is the addition of an AAC device. After a very long process of getting assessed for the need for a device to help him communicate effectively, and trials with multiple devices, we found that Andrew responded the best to an iPad with an app called Touch Chat. It is a very intuitive program, and it will grow with him indefinitely. It provides the ability, like his scheduling app, to make your own icons with pictures downloaded from Google. I can make icons of every single place we go, every person we visit, every food he eats, etc. It has unlimited capabilities and speaks for him. See a video of him using it below:

He has only been using it since the beginning of March, and it has decreased so much frustration. Especially when he has been sick, and looses the minimal language he does have. Without his talker, he wouldn't have been able to tell us what he wants to eat or drink, or how he is feeling. He has learned to use the talker to tell us when he is mad, so it has decreased his self-injurious behaviors a lot. 

Coming up next. The final part of this 3 part series: Tried And True Part 3: How We Improved Andrew's Sleep.



  1. I've never used a scheduling app, and I think this would be a GREAT addition for Moe.

  2. I have used visual scheduling apps with the kids that I work with.

  3. I am so glad I saw your blog post on Facebook! Love hearing about successes with FTVS :) We have a similar story...FTVS has been a game changer in our house. It has brought so much independence for my son, Ty (10 y.o. with Down syndrome).
    Good luck with the giveaway!