Step 10. Increasing the Number of Environments Where SGD is Used

Charlie

Case Study: Charlie

Charlie is a 7-year-old first grader with ASD. He was diagnosed at age 3, and has received speech therapy, occupational therapy, and special education services since that time. He is presently included in a general education first-grade classroom but frequently leaves the room for breaks and some therapies. A special education assistant in his classroom provides support for Charlie and another student with disabilities. Charlie is nonverbal, but he uses an SGD to protest and to greet. He points and/or leads an adult by the hand to request. Charlie sometimes imitates signs and inconsistently uses "more," "swing," and "eat" spontaneously. However, it can be difficult to discriminate these signs from his extraneous hand movements, and his teachers have struggled to get Charlie to use more signs independently. Charlie has used a BIGmack switch occasionally in his preschool and kindergarten classrooms to make requests at snack and to participate in circle time. He usually needs an initial prompt to use it by having a teacher or an assistant point at the device. Charlie uses a picture schedule (with photographs) during the day and responds well to the pictures. Charlie's parents hope that he can learn to make specific requests, especially when he gets home from school and is hungry for a snack. Finally, Charlie's first-grade teacher, Mr. P, is excited to have peers read to Charlie during DEAR (Drop Everything and Read) time (i.e., free reading time) and has wondered if there is any way to support Charlie's participation more in this activity.

Charlie's speech-language pathologist, Ms. K, decides that a more complex SGD may help increase Charlie's expressive language. She knows that he has had some success with the BIGmack and that he is motivated to make requests. He responds well to the pictures on his daily schedule, and Ms. K. wonders if he would respond as well to line drawings from Boardmaker(^TM). She asks his assistant to find out if Charlie can match line drawings of snack items to actual snack foods by presenting the line drawing to Charlie and asking him to put it next to the matching food item (with four items on the table). After just a few trials, Charlie is successful with very familiar foods, such as cookies, chips, and a juice box. Ms. K decides that she will try a GoTalk4 with Charlie because it is portable (can be used at school and at home) and affordable. The district already owns one of these devices, so Charlie can try it out for a while to see if indeed it is a good fit.

The GoTalk4 stores four overlays with four messages on each. In preparing for the new SGD, Ms. K reviews Charlie's day and talks with his parents and teachers about when they think he may use the device. She decides to start with two overlays: one for snack choices and one for DEAR time. She uses Boardmaker^TM to make a snack board with the following messages: "I want chips," "I want a cookie," "I want apple slices," and "I want popcorn." The DEAR board contains these messages: "Will you read me a book?" "Read more, please." "I'm all done reading." and "Thank you!"

During snack time at school, Charlie's assistant ensures that all of the choices are available. Ms. K introduces the device by setting it on the table in front of Charlie. She waits for him to explore the device. After a minute or so, she asks, "Charlie, what do you want?" and points to the device. Charlie points to the chip and activates the voice output. Ms. K gives Charlie a chip, and he is quite pleased. He touches the GoTalk4 again, this time activating the apple selection. Ms. K gives Charlie an apple slice, and he protests by pushing it off the table and vocalizing. Ms. K decides to play dumb and simply says, "You said you wanted apple slices. What do you want?" while pointing to the device. Charlie looks at the pictures and pushes the chip. This continues for the duration of snack. Charlie does not select apple slices again, but does ask for a cookie. Charlie continues to use the GoTalk4 during snack time at school and at home. At this time, the GoTalk4 is introduced to Charlie's classmate. They learn how Charlie communicates with the device and how to respond to him. They learn that talking with a peers who has a communication device is very similar to talking to any classmate.

During DEAR, Charlie's assistant helps him use the GoTalk4 to ask a peer to read to him by leading him over to a pre-selected peer and using hand-over-hand to push the "Will you read to me?" button. The peer agrees, and they go to the corner to read. At the end of the book, Charlie gets up to walk away. The assistant says, "Charlie, do you want another book or are you all done?" and points to the "all done" and "more reading" pictures. Charlie pushes "All done" (with questionable purposefulness). The assistant says, "OK ... we're all done. Tell Brian, "Thank you!" She takes Charlie's hand to push "Thank you" before he walks away.

Charlie's team continues to use the overlays for snack and DEAR. Charlie quickly becomes independent in requesting snack choices. He requires a physical prompt to use the DEAR overlay, although he does request, "Will you read to me?" with a simple verbal cue. Ms. K decides to make another snack overlay to give Charlie more choices. She also makes an overlay for break choices, including "I want to swing." "I want to jump." "I want to go for a walk." and "I want to do a puzzle." As with the snack requests, Charlie quickly learns these choices and uses the board purposefully.

Charlie and his team continue with the GoTalk4 consistently for six months. Because most of Charlie's highly motivating choices are already represented, the team agrees that the GoTalk4 has met his needs. However, Ms. K wants to increase his field of options. She is able to obtain a GoTalk9+ for Charlie, allowing him to have all of his snack choices available at the same time. It also has room for five overlays, and Ms. K develops a new overlay Charlie can use during one of his new jobs: delivering mail to staff in the afternoon. She puts several messages on the board, any of which would be an appropriate greeting when Charlie hands over the mail, like "Catch ya later!" "Have a great day!" and "See ya!" Charlie is pleased to activate these buttons after his assistant provides a visual prompt by pointing at the device. He also enjoys the smiles and verbal replies he gets from staff members.

Charlie's parents also have been using the GoTalk9+ at home for snack. Previously, Charlie arrived home tired and hungry, and he quickly became frustrated when his mom gave him the wrong snack. The GoTalk9+ has allowed their after-school time to be much more pleasant. His mother also reports that they have occasionally taken the GoTalk9+ to church and that they have used the "mail delivery" page to say goodbye to friends and teachers at Sunday school.

The team decides that the GoTalk9+ meets Charlie's current needs and has capacity to build on his skills in the future. He uses the GoTalk9+ independently to make choices for snack and breaks and for social greetings during a routine part of his afternoon. In addition, Charlie uses it for interactions with peers during DEAR time. He has begun generalizing its use to home and the community. Although the level of prompting required for each communicative function varies, the SGD allows Charlie to verbally participate throughout his day. Because a fifth overlay is available and not all nine buttons have pictures on all the overlays, Ms. K feels that there are opportunities to increase both vocabulary and environments in which the SGD can be used.