Thursday, January 14, 2010

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:





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


20 comments:

Jean said...

What you describe speaks volumes to me. I want my son to "speak" for himself so the forth-coming app is very exciting for us.
This is the future of giving our kids a version of their voice (should they chose to use it). We are first in line xxx

K.Line said...

What you have done here is nothing short of phenomenal. Your parenting - and autism activism - are profound.

I saw a segment on TV the other day speaking about how the challenge of non-verbalness with autism is perhaps based on an auditory delay - a hearing issue that makes all sound blur. I'm not sure of your thoughts on this, esp. in light of this new app, but it's an intriguing idea.

drwende said...

This sounds incredibly cool! Congratulations on the positive news coverage as well.

Anonymous said...

You really are the chosen one Hammie....i truly believe u are.....u were chosen to be mother to 2 children with autism because you were never going to sit back and just take it and whinge about it....you fought every step of the way to get the best for and out of your adorable children and now not content with keeping all the valuable experience u have gained to yourself you single handedly are going to be responsible for giving so many more children a voice to be heard. Genius....you're an inspiration to us all....congratulations on the app...

Sesame xx

Taz said...

You are MY hero! I am so proud to know you. I think that this app will change so many lives for the better. Thank you for being a champion for our children xx

Petunia said...

I am so excited that Grace is about to go live and proud to know the person responsible for making it happen. You are an inspiration to us all :) Not dissing the other "talking apps" but no voice app can intuitively prompt and fade the way a tutor can using Grace In an echoics program depending on the level the child is at. I look forward to seeing this app take off when it's released in a few weeks xxx

Petunia said...
This comment has been removed by a blog administrator.
Nan P. said...

Hammie, Great work! So "simple"! - I know it's not but it is, if you see what I mean.

Best of luck for your presentation.

Hammie said...

Jean: want to get it to you as soon as Steve finishes his exams!

K-line: at one stage they thought Bratty had that "immitance" but it turned out she just wasnt bothering her arse to listen properly as it had no meaning. Sounds can be very distorted - too loud, too high, too fuzzy and speech doesn't necessarily come through clearly. so yes, it makes sense. xx

drwende: thanks again for your encouragement. xx

Hammie said...

Sesame: Oh YOU! xx

TAZ: you are My Hero, no you are, no you are. I didn't choose this life, it chose me. You chose and you would do it again. you win! xx

Hammie said...

Petunia: thanks so much for your help in checking over my presntation last night and giving me those tips.

I agree with you. I think there is a place for the voca apps - for sophisticated adult users with a large vocabulary. But for the early to mid learner, I think we need to keep trying to teach V.B. Hopefully the novelty of the gorgeous iPhone will send the parents and therapists back in their to try to get that independent understanding of engaging a listener.

xx

Hammie said...

oh Nan: thankyou. And simple works. xx

Make Do Style said...

Absolutely brilliant. You were so clear and as someone who had little knowledge of the condition I grasped a lot from this post.

I'm glad you broke down the issues instead of opting for an obvious well one solution does not fit all.

I am amazed and humbled by your qualities and care towards yoru children. Truly through your blog I've learnt to be a better mother not because I think mothers should be perfect but because even non autistic children have verbal and other communication issues.

You always fill me with hope for mankind and I could not believe the restaurant incident - I would have been so angry towards the guy and the stupid waiter!

So glad this is a success and congratulations xxx

jazzygal said...

Well from reading this I have no doubt thaT you explained your presentation very well!

Well done Hammie..... you are an inspiration. xx Jazzy

TheShoeGirl said...

This is SO beyond amazing. What a great thing you've done!

kayla said...

Hammie I want to say thank you so much. I cant wait to really dig into your blog. M,y son got diagnosed with Autism and he is 8. It is very challenging. I also have a daughter with epilepsy who is 6 and my 2 year old was born with down syndrome and esophageal atresia. So I am thrilled to find any information on these topics that will help me out. Thank you so much. O and I found you through Nick!

Avril said...

You are an inspiration and I totally agree with about the verbal behaviour.Hope your presentation went well. Avril x

ds.mama said...

Wow, this sounds awesome. Hope it becomes available for the Droid too.

Suzy said...

Just found out about this now. Wait till the Ipad arrives! I'm an advocate for people with disabilities and know several clients with cerebral palsy who would love this - far better than the communications systems that they are currently provided with.

Hammie said...

Hi DS Mama: that could happen. It really depends on my developer Steve who is the iPhone wizard.

Suzy: Steve had an iPad simulator up and was laying out the App on it THE same DAY that the iPad was launched!

We always saw it that way for people who might have fine motor difficulty with the smaller device, but the same need for sophisticated personalised vocabulary.
xx