Verbal Behaviour goes Techno

On Friday I am giving a presentation to the Global Autism Public Health group on my not so secret project - the iPhone app I developed with my daughter and iPhone wizard Steve Stroughton-Smith

Since the news item on 11th December, the App has been picked up by a number of blogs world wide and as a result, some interesting comments. I have also had people say it to me personally - "why did you bother when there are already so many autism apps - like Proloque2go?"

Believe it or not, I had the iPhone for almost 18 months before we loaded the finished version of Grace. So I was playing around with the existing functions and apps for a good while. What I ended up developing with Steve was something that suited my daughter's particular communication needs and my personal philosophy.

I am a strong believer in Verbal Behaviour.

"BF.Skinner refers to "verbal behaviour" as "...behavior reinforced through the mediation of other people ...and specified that "... the 'listener' must be responding in ways which have been conditioned precisely in order to reinforce the behavior of the speaker"

In other words:

"The Speaker" - which is in this case YOUR CHILD- understands that what they are communicating is having an effect on YOU the Listener.

The moment a toddler falls, looks around, then gets up and comes to find you BEFORE crying – is the moment of Verbal Behaviour.

A lot of kids with autism don't get this naturally.

And please understand, that this is not “speech” or vocalisations as we understand it.

Many children with Autism and Aspergers are quite capable of echolalia and may be able to recite an entire episode of their favourite TV show.

However, when it comes to getting their basic needs met – they may resort to climbing, “foraging” or even self injurious behaviour rather than simply asking for what they want.

This is because they have understood the relationship between hitting themselves, and getting a reaction.

Whereas the relationship between reciting Spongebob in a corner, and getting a cookie has not been established.

So we need to use a prompt-able means of communication – such as sign or pictures to teach the relationship between getting a listener's attention, making a request, and getting that request met.

We cannot breathe air through another persons vocal chords to prompt their request – and then reward it. But we can physically prompt a sign or the giving of a picture – and instantly grant that request to teach the value of Verbal Behavior.

In my case and therefore my daughter's case - we chose pictures.

This could have been based on a cool assessment of her ability to imitate, her level of babble and her cognitive ability, visual memory etc. But in truth it was chosen in the vacum of qualified clinical support - The Good Old Health Service and their Ghost Posts in other words.

And the only available comprehensive parent training was in the system of Picture exchange.

It worked for my girl in that it gave her a voice and over the years, while her speech remained very delayed; her discriminative communication vocabulary became very sophisticated. Like any 8 year old she was able to use a lot of words to express her specific needs, but unlike most 8 year olds, this meant a lot of pictures on cards.

It was all getting very unwieldy. And so we came to look at the newly release iPhone and how that might help us.

Don't know the story, go HERE to read it:

Grace - RTÉ News Six One from Steven Troughton-Smith on Vimeo.

So again with the  "Why invent a new App?" Well, back to the story of Verbal Behaviour:

To teach Verbal Behaviour, we established a promptable means of communication which ensured that my child understood that she had to persist to get my attention before presenting her request. In otherwords:

The engagement with the listener – in order to have needs met is the key.

A machine that "talks" for a user is not going to teach or reinforce this. It can actually lead to prompt dependence, where the user stops bothering to initiate and demand the listeners attention through their own appropriate means.

I use the analogy of those room service breakfast menus that you hang on the door in the expectation that someone will eventually collect it and at some point bring you your breakfast - more or less as you have requested it.

(less in the case of my days as a room service waitress when I routinely dropped the full english in the service lift and had to go back and patch something together in the office)

It may also discourage attempts at vocalisation and developing verbal ability.

This is where the Grace App is pitched. Because the user must engage the listener and physically share their message.

The user creates a sentence expressing their need or feeling and then presents it to the Listener – who will prompt or speak each word as the user points. The attempt at a word is encouraged and rewarded with praise and enthusiasm. And if the listener knows what they are doing, with the speed of getting the item.

The user clearly “owns” the sentence as they have created it independently, but they understand they must share it in order to have their needs met.

This App has the advantage of maintaining consistency in the vocabulary across listeners - and therefore encourages the development of vocabulary beyond the phone.

My daughter has increased fluency and frequency of 3 word discriminative Vocal Requests independent of the phone, since she has been using the App.

She can stand at the cupboard and request "I Want 2 drinks" or "I want Green Crisps" without the picture prompts, because they were used so consistently over a period of time.

Without the App - it was really hard to keep the consistency with that giant book after 7 years - her vocabulary would drop down to two or even single word requests.

This is not to diss on Proloque2go or other Alternative Augmentative Communication Devices or Apps. I think they are fantastic for non-verbal adults with a sophisticated vocabulary and complicated needs. And with the full on AAC device costing a minium of €3,000 - Proloque2go is a god send at only €130 for the App that can be loaded on to 5 devices.

However, they should not be the "First Stop" intervention for pre-verbal autistic children and their families.

The test group have also taken greater ownership of their individual vocabulary with the iPhone. Once they have made a new descriminative selection they can take a photo and store it instantly for next time. This seems to teach them that taking a photo of what you want MAKES IT HAPPEN.

Of course, in the first few weeks these requests must be met in order to effectively embed the usefulness of the device.

HOWEVER!

Once this is established you can then use the photograph to teach the difference between

Permission and Understanding

e.g.: yes I know you want the gold chocolate or “Crunchie” as we have it photographed here
But NO you may not have it. I understand. But I say No.

The difference in tantrums is measurable. Frustration at being misunderstood is much higher, than the objection to having permission refused. Believe me. I have been there!

xx