The Clackamas Educational School District’s (CESD) Life Enrichment Educational Program (LEEP) provides educational programming to students who require AAC devices and services. As an employee of LEEP, I provide comprehensive speech and language therapy services to forty students as a licensed Speech and Language Pathologist and AAC Specialist. The students who attend LEEP are diverse, but share the common characteristic of presenting with complex communication needs. According to Justice (2006) complex communication needs result from impairments related to speech, language and/or cognition. These individuals are rendered unable to produce speech, or their speech intelligibility or reliability is compromised secondary to such disorders as Cerebral Palsy, Autism Spectrum Disorder (ASD), apraxia or dysarthria. As a result, the individual may benefit from AAC devices and strategies (ASHA, 2005). These devices and strategies, at their most basic level, provide an individual a way to express a want or a need without the use of spoken words. Instead, the individual communicates by selecting a written word, a symbolic pictorial representation, a manual sign (such as American Sign Language), a miniature representation of an object or an object that represents the word.
There is a category of AAC devices referred to as Speech Generating Devices (SGD). These devices produce audible words and phrases at the command of their user. The tablet computer called the iPad™, when paired with the dynamic communication App called Sonoflex, create such a device. It is one of the most technologically sophisticated SGDs available to date. Sonoflex uses Picture Communication Symbols (PCS) that consist of color line drawings representing single words or phrases. These PCS allow individuals who cannot yet decode words, or are not likely to develop this literacy skill, a way to translate their thoughts and ideas into a symbolic form that can be spoken. PCS are designed to have a high degree of saliency and, visually appear as similar to their referent as possible. Sonflex provides organization for the PCS, much like an other semantic networking tools described by Jonassen (1995) designed to emulate the structure of human memory with an emphasis on semantic memory. This is accomplished by organizing PCS into categories and sub-categories, similar to the building of schemata. Schemata are a construct for how our memory system networks and interrelates knowledge as described by Rumelhart (1980). This strategy assists the student in locating stored PCS to produce expressive language quickly and as grammatically accurately as possible. Sonoflex color-codes PCS by their part-of-speech and makes use of a strategy called forced syntax, similar to the Fitzgerald Key. For example, pronouns appear on the left, followed by verbs, adjectives and nouns. The student does not need to use this strategy, he ultimately has an infinite capacity to combine words into sentences and generate novel utterances. Sonoflex essentially provides a PCS database that can potentially reduce the student’s cognitive load (Jong, 2009; Kirshner & Erkens, 2006) as they engage in the complex task of translating their thoughts into words, phrases and sentences with the stored PCS.
Consider the following example. A student, I will call him “Joey,” uses the SGD described. He takes the SGD to the cafeteria at school and speaks to the cafeteria helper by selecting the following PCS with his finger tips: “I” then “want” then “lunch” then “hamburger” then “please.” The helper hears his request and fills his order. He then carries his hamburger over to a group of his peers, selects several PCS and says, “What’s up everyone?” This example demonstrates a level of communication competence. It is an example of what the LEEP seeks to achieve with its students, but, rarely in fact does. So, what do LEEP students who use AAC need, to achieve this level of competence, given a SGD with the affordances the iPad with Sonoflex provide?
Teachers and parents are charged with the day-to-day realities of educating students who use SGDs. Some teachers have the responsibility of learning a different communication system for each user. This can be a daunting task when considering factors such as: teacher retention, teaching-assistant training and retention, student transition between grade levels, changes to technology and time allotted by districts for staff training. Light & McNaughton (2012) have suggested that teachers and caregivers do not necessarily understand how to teach students how to use their AAC devices, how to teach their students with complex communication needs language skills or what to expect from students who use these devices, without receiving direct training themselves. I have observed teachers initiate communicative interactions with students by speaking to them with words, with an implicit expectation that these students will understand those words, and respond appropriately using sign language, PCS or written words, without the benefit of receiving a model of these alternative communication methods. The SLPs in the LEEP do provide training to the teaching staff regarding SGD use. Could the teacher’s epistemological beliefs about language acquisition, as it relates to student use of SGDs be fundamentally different than that of the SLP? If so, what should the SLP do to make these implicit beliefs between the two professions explicit and find common ground?
Hypotheses on the process of language acquisition have been theoretically grounded in the research of Behaviorists, Nativists, Cognitivists, Social-Communicativists and Connectionists (James,1990). Poll (2010) argues for a theory characterized by finding a middle ground between Nativist and Social Interactionist Theory, that focuses on the learning capacities within the child as well as the language input from the environment that that child receives. The works of Vygotsky and Piaget are at the heart of this theory. Both argue in varying degrees: that children are born with some innate ability to learn language, children are active in their construction of knowledge through the use of artifacts and symbols, and knowledge is gained in a social context by interacting with the environment and with people (James, 1990; Vygotsky, 1978). In summary, the leading theories suggest that children do not learn language and cognitive skills by simply watching and listening to adult models, that they need to interact with those adults, the environment in which they occur, and with the artifacts or symbols that they are associated with. This could also be explained while considering a traditional feedback loop; when some of the output is returned as input. Consider the following example. A child points to a cat and says, “Dog.” His mother attends to his point and says, “That is a cat.” The child repeats mom and says, “Cat.” Based on the theory of schemata construction (Rumelhart, 1990) the child said “Dog” because the cat fit his prior schema for “Dog” which included furry, four legged animals. Because the child could speak, his mother was alerted to his misconception of “Dog” and provided him feedback, his conception of “Dog” was instead a “Cat”. In this verbal exchange with his mother, the child likely used the new information provided by his mother and the artifact, the presence of a cat, to reconstruct his schema to include cat within the concept of furry, four legged animals. Please consider the diagram below:
Students can engage in a cognitive learning task with technology, such as a computer, to offload some of the cognitive demands of the task (Jonnasen, 1995). This is one element of a cognitive tool. Students can learn from the technology they engage with (Jonassen, 1995) by looking up words and concepts they do not understand in educational Wikis, for example. Students can also learn with the technology. The student and the technology each fulfill an essential role for a specific task that would otherwise be impossible without this partnership (Jonassen, 1995). Consider an example of such learning with technology as opposed to from it. The student uses computer software that allows for the generation of cognitive maps (Jonassen, 1995). The user brings his knowledge to the computer, but the computer program provides him a way to represent his knowledge in a way that then allows him to manipulate the information for higher-level cognitive tasks such as analyzing the information to develop new insights. This example demonstrates technology used as a cognitive tool. When the student works with the technology, the technology affords him enhanced performance on the task as well as the possibility of lingering cognitive changes positively associated with learning (Kim & Reeves, 2007).
If language is one of the most compelling cognitive technologies as Jonnasen (1995) suggests, used to express ourselves, but also as a cognitive technology to construct our knowledge about the world we live in; the SGD is the ultimate cognitive tool. I would argue that it meets Kim & Reeves’ (2007) three characteristics of a cognitive tool. First, the technology provides affordances to the student that could not exist without the tool (Kim & Reeves, 2007). The SGD provides the student with access to spoken words. It allows the student the ability to communicate with his peers symbolically. Without the tool, the student with complex communication needs does not have access to words to express himself and must resort to some other inferior method such as pointing to make his wants and needs known. Another characteristic suggests that the user and the tool share the demands of the cognitive task (Kim & Reeves, 2007). The SGD provides the symbols and the organization needed to assist the student in retrieving words to create phrases and sentences to communicate for its various pragmatic functions; to greet, request, protest, inquire, inform, and question. It is a sophisticated database. Lastly, the partnership between student and cognitive tool must provide evidence of learning as a result of the student’s use with the tool (Kim & Reeves, 2007). If language is learned in a feedback system, if students construct their language and cognitive skills by interacting socially within their environment, with artifacts and symbols, then the SGD provides the symbols deemed essential to this learning. The student now has all the components of the language learning feedback loop. Anecdotally, I have observed increased receptive language and cognitive skills as a result of this partnership between student and SGD when used as a cognitive tool. What I need now is empirical evidence to back up my observation.
Every student in the LEEP program requires the use of AAC in some form. The iPad is quickly changing these students’ access to SGD’s. If individuals with complex communication needs were provided with a SGD for use as cognitive tool, and not just for making simple choices, and it was integrated into every language and cognitive task asked of the student, not intermittently throughout the student’s day, the result would be increased communicative competence. It has been argued that students require access to a SGD to construct their language and cognitive skills, and that increased receptive language and cognition will improve the student’s ability to use the SGD to communicate for all pragmatic functions.
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