1

Children with Special Children with Special Needs can Listen, too!Needs can Listen, too!Children with Special Children with Special

Needs can Listen, too!Needs can Listen, too!Kimberly C. Jenkins, M.A., CCC-SLPKimberly C. Jenkins, M.A., CCC-SLP

Emily C. Noss, M.A., CCC-SLPEmily C. Noss, M.A., CCC-SLPChild Hearing ServicesChild Hearing Services

University of TN, Health Science CenterUniversity of TN, Health Science Center

Co-occurring conditions• It is estimated that 30-40% of children with deafness

and hearing loss have additional disabilities such as:– Cognitive impairments– Learning Disabilities– Autism– Cerebral Palsy– Sensory Integration Disorder– ADD/ADHD– Feeding and swallowing disorders– Oral-motor problems– Syndromes– CMV– Vision impairments

It’s all about Expectations

• Our experience with these children leads us to strongly believe in appropriate amplification (hearing aids, cochlear implants, and FM systems)

• Hearing may or may not be the primary disability, but may end up being one of the child’s biggest strengths

• Several benefits of addressing auditory skills can be observed

• Success is defined by the family and the team working with each child

• Expectations must be realistic and everyone must be on the same page

• Address the child as a whole – not just each specific disability

• Recognize when referrals should be made to professionals with specific expertise

• Require professionals from many disciplines

•SLP•OT•PT•Medicine•Education•Psychology•Social Services

Team Approach to Assessment and Intervention

Auditory Skills Hierarchy:

• Awareness• Discrimination• Identification• Comprehension

• We want to improve or maximize the child’s auditory and communication abilities

• Develop a communication mode (complete communication approach can be used)

• Find approach that incorporates best practice for each disability.

Benefits that can be defined as success with auditory skills for

Children with Special Needs– Response to environmental sounds– Response to name– Increased attention to speaking, music,

voices– Ability to recognize sounds in the home and

school environment– Ability follow a direction through listening

and then using their form of expressive communication

– Participate in their environment

Success with auditory skills

• Success may be difficult to define• Success is individual• Timeline may be longer

7

Aural Habilitation Strategies/Techniques

• Create a listening and language rich environment

• Handcue• Acoustic

highlighting• Auditory sandwich• Hierarchy of cues• Talk before

show

• Parent participation• Self talk/parallel

talk• Follow child’s lead• Be flexible• Model• 1-2-3• Suprasegmental

focus – learning to listen sounds

8

Sensory Integration Sensory Integration Dysfunction Dysfunction

Sensory Integration Sensory Integration Dysfunction Dysfunction

9

10

Sensory Integration Dysfunction Defined:

Sensory Integration Dysfunction (DSI) is a neurological disorder that resorts from the brain’s inability to integrate certain information received from the body’s five basic sensory systems.

11

Analogy• “Good sensory processing enables all the

impulses to flow easily and reach their destination quickly. Sensory Integrative Dysfunction is a sort of ‘traffic jam’ in the brain. Some bits of sensory information get ‘tied up in traffic’ and certain parts of the brain do not get the information they need to do their jobs.”

12

Sensory Integration

• SI provides a crucial foundation for later, more complex learning and behavior.

• The normal process of SI begins before birth and continues throughout life.

• Majority of DSI cases occur prior to the teenage years.

13

DSI• Different from person to person• Can vary from day to day• Factors affecting DSI: fatigue,

emotional distress, hunger• May co-exist with other handicapping

conditions (ADHD, Autism, Down Syndrome, Hearing Loss)

• Can be severe or mild• Can occur continuously or occasionally

14

Sensory IntegrationSensory IntegrationSensory IntegrationSensory Integration

Why is it important?Why is it important?

15

Sensory Integration Function-Important for:• Academic Skills• Attention• Auditory Perception• Balance• Bilateral

Coordination• Body Awareness• Fine Motor Skills• Visual Perception

• Hand Preference • Muscle Tone• Self-Esteem• Social Skills• Speech/Language• Tactile Perception• Hand-Eye

Coordination

16

Diagnosis• Qualified occupational or physical

therapist • American Occupational Therapy

Association and Sensory Integration International recommend specific evaluation and training guidelines

17

SI Therapy• Sensory integration-based OT is

highly recommended• PT• ST• School support/participation• Home environment

18

Sensory IntegrationSensory IntegrationSensory IntegrationSensory Integration

Activities for TreatmentActivities for Treatment

19

Childhood play• Years ago: Sensory-rich

experiences• Swinging, climbing trees, roller-

skating, riding bikes, jumping rope, building sand castles, throwing snowballs, stomping through mud puddles, running through the sprinkler

20

Childhood Play• 2011: “Play” is soccer or gymnastics• Staring at a TV, computer, DS, iPod

Touch• Sometimes old-fashioned is better!• We need experiences that target all

senses (sight, touch, smell, taste, etc.)

21

Tactile DysfunctionTactile DysfunctionTactile DysfunctionTactile Dysfunction

CharacteristicsCharacteristics

22

Child-Oversensitive to touch may:

• Demonstrate tactile defensiveness• Exhibits “fright or flight” response to

harmless touch• Dislike brushing teeth or having hair cut• Be bothered by sock seams, tags in

shirts, shoes, etc.• Be a picky eater, avoiding certain

textures• Have poor peer relationships

23

Child-Underresponsive to touch may:

• Touch people/things constantly• Shows little reaction to pain, gets hurt

without realizing it• Physically hurt others without knowing

it• Invades others’ space• Chews on inedible objects frequently

(fingernails, hair, collars, pencils)

24

Child with Poor Tactile Discrimination may:

• Seem out of touch with hands, as though they are unfamiliar appendages

• Have trouble holding/using tools (pencils, scissors, forks)

• Be clumsy when zipping, buttoning, tying shoes, adjusting clothes

• Squirm or sit on edge of chair

25

ActivitiesActivitiesActivitiesActivities

For the Tactile SenseFor the Tactile Sense

26

Activities: Tactile Sense• Shaving Cream: Window clings, mirror

or window, shaving cream• Auditory targets (beginning listener):1. Suprasegmentals of speech2. Vocabulary (1 vs. 2 or more syllables)3. Sound “on” vs. “off” awareness

27

Activities: Tactile Sense• Live rabbit or other pet, pet food, Easter grass• Speech/Auditory targets:1) Auditory Comprehension: Follow commands:

“Give him some (food type)” or “Show me the rabbit’s (body part)”

2) Expressive vocabulary, length, and complexity: Have child describe the way the rabbit feels (soft, fluffy), describe the sounds the rabbit makes when he’s eating (carrot-crunchy).

3) Language web (Older children): Categories (animals, types of food, habitats, etc).

28

Activities: Tactile Sense• “Buried Treasure”: counting bears, sorting

tray, bucket, tongs, sand • Speech/Auditory Targets:1) Descriptive Vocabulary: colors, describe way

sand feels2) Discriminate words varying in syllables: bear

vs. bucket3) Verbs: dig, bury, cover, scoop4) Position concepts: in, under, etc.5) Where questions: “Where’s the blue bear?”

29

Activities: Tactile Sense• Sand Dunes: dry sand, spray bottle with

water, toy beach critters, cookie cutters• Spread sand on tray, spray water until damp,

mold sand into dunes and play “beach” with toys

• Draw in sand with fingers• Use cookie cutters to cut out shapes• Speech/Auditory Targets: unit vocabulary,

descriptive language, 1-2 part auditory directions

30

Activities: Tactile Sense• DRESS UP:• Fancy clothes (bridal veils, satin fabric, etc)• Uniforms/professional outfits (nurse, doctor,

soldier, cowboy, clown, princess)• Scarves, neckties, ribbons, aprons• Feathery boas, old fur jackets, woolen shawls• Hats, caps, headbands; belts; goggles/glasses• Shoes: high heels, slippers, sandals, clogs,

boots• Costume jewelry

31

Activities: Tactile Sense• Dress-up good for children not yet ready for

wet textures• Helps improve fine motor skills: buttoning,

zipping, tying• Speech/Language: Community helpers

vocabulary, adjectives (describing outfits and textures), language webs

• Imaginary play promotes social appropriate behaviors and language

32

Benefits:• Hands-on experimenting with different

textures improves tactile perception, body awareness, and creativity

• Squirting shaving cream and manipulating small objects improves hand-eye coordination

• Pushing toys through shaving cream or other textures improves kinesthetic awareness, fine motor skills, and visual-motor integration

• If child refuses to touch textures, offer a stick, spoon, or straw to begin

33

Vestibular Vestibular DysfunctionDysfunctionVestibular Vestibular

DysfunctionDysfunction

CharacteristicsCharacteristics

34

Balance: What and When

• About 2 months: Head control• 6-7 months: Sitting• 8-10 months: Crawling• 9-10 months: Standing with support• 9-16 months: Standing independently• 9-17 months: Walking• 21-30 months: Running smoothly• 4-5 years: Hopping on 1 foot• 5-6 years: Skipping

35

Child-Oversensitive to Balance and Movement

may:• Be intolerant to movement, try to avoid

it• Overreact to ordinary movement• Dislike physical activities (running,

biking, etc)• Dislike using playground equipment• Be cautious, slow-moving, doesn’t take

risks

36

Child-Underresponsive to balance and movement

may:• Crave intense, fast, and spinning

movement• Be a thrill-seeker or daredevil• Need to constantly move in order to

function (fidgets, shakes leg, etc)• Have poor balance, falls easily• Bumps into objects on purpose

37

Child-Poor Discrimination of Balance and Movement

may:• Easily loses balance (climbing stairs,

riding bike, standing on one foot)• Move in uncoordinated, awkward

manner• Have low muscle tone (loose, floppy)• Have poor posture• Have difficulty remaining upright when

seated

38

Activities: Vestibular Sense

• Have child balance on large exercise ball• Then sing/participate in body movement

songs: Clap, Clap, Clap your hands; Head, shoulders, knees and toes; This old man, he played one

• Speech/language: Promotes sequencing, auditory memory, pitch/rhythm/intonation, receptive/expressive vocabulary (body parts), appropriate speech rate

39

Proprioceptive Proprioceptive DysfunctionDysfunction

Proprioceptive Proprioceptive DysfunctionDysfunction

CharacteristicsCharacteristics

40

Proprioception: What does it do?

• Increases body awareness• Contributes to motor control/motor

planning• Allows us to walk smoothly, run quickly,

climb stairs, carry things, sit, stand, stretch, and lie down

• Gives us emotional security (when children trust their bodies, they feel safe and secure)

41

Child with inefficient, integration of joint/muscle

sensations may:• Have poor sense of body awareness• Be stiff, uncoordinated, clumsy, falling

frequently• Lean, bump, or crash against objects and

people (invades others’ personal space)• Manipulate hair clips, lamp switches, and

pencils so hard that they break• Pull/twist clothing, chew sleeves/collars• Difficulty climbing/going down steps

42

Activities: Proprioceptive

Dysfunction• 1) Jump rope rhythms (Ex. Cinderella)• 2) Rope activity: child walks along rope

on ground, adult plays drum while child marches with beat (Ex. Ten Little Indians)

• Speech/Language: Rhythm/intonation, auditory memory, sequencing, loud/soft concepts, thematic vocabulary (Ex. Thanksgiving)

43

Activities: Proprioceptive Sense

• Pound Cookies: prepared cookie dough, sweet/hard candies, gallon-size, zip-up plastic bags, small hammer or wooden mallet, cookie sheet, cookie cutters, and other cookie baking items

• Activity: Child opens bag of candies, count 5-10 candies, put them in plastic bag. Let air out of bag, then zip it up. Pound candies with hammer/mallet until they are sprinkles. Sprinkle pounded candies on top of cookies.

44

Activities: Proprioceptive Sense

• Pounding with vigor improves proprioception and force, releases energy, and increases gross motor skills

• Counting candies, sprinkling sprinkles, and using tools all improve fine motor skills

• Speech/Language: Counting, cooking related vocabulary, language webs, adjectives (describing cookies: taste, smell, etc).

45

Activities: Proprioceptive Sense

• Perform household chores: sweep, mop, dust, wipe off the table after snack, clean windows, put large toys away

• While on hands/knees, color a “rainbow” with crayons on large butcher paper on the floor or with sidewalk chalk outside

• Play “cars” under the therapy table, pushing with one hand, while creeping/weight bearing with the other hand

• Do animal walks (crab walk, bear walk, army crawl)

46

Classroom Classroom AccommodationsAccommodations

Classroom Classroom AccommodationsAccommodations

Children with Special NeedsChildren with Special Needs

47

Reduce Background Noise Level

• Close doors when background noise present• Use screens, dividers, etc. to isolate various

classroom areas• Practice good “turn taking” so that only one

voice is used at a time• Make classroom acoustically friendly• Have child listen with hands in his lap. This

will help reduce distractions, thus allowing him to be more “focused” on the teacher or therapist

48

Children with Special Needs

• For over-stimulated child, provide quiet, “time-out” spaces to help child regroup and become organized (ex. A reading corner behind the bookshelf, under a table with pillows or bean bag chair in a quiet corner)

49

Children with Special Needs

• For the child with tactile defensiveness, allow for minimal classmate contact (ex. Put child at end of line, arrange classroom seating so that he/she is not jostled/touched by classmate)

50

Children with Special Needs

• Tactile defensiveness: Modifications to art activities

• Be aware of materials such as glue, finger paints, clay, etc.

• Use tools (i.e. hammer, paint brush) to help keep child involved

51

Sensory Processing• Minimize auditory distractions (making

classroom acoustically friendly)• Notify child of any upcoming loud

noises such as fire alarm • For the “active” child, allow her to

stand at the table while working (or help teacher pass out papers….walking around the room)

52

Children with Special Needs

• For children with low oral/postural tone, allow gum chewing or hard candy to suck during writing activities (check with parent/school)

• This helps to encourage more fine motor control

53

Fine Motor Skills: Writing

• Working on vertical surfaces (helps child strengthen shoulder/wrist muscles for writing) (blackboard, easel, paper taped to wall)

• Provide spray bottle to squirt water onto a picture

• Tweezers to pick up cotton balls• Beads, sequins to make collages

54

Fine Motor Skills: Control

• Hole Punch• Push pegs into

clay• Cut cardboard• Pick up small

objects with tweezers

• Legos• Tinkertoys• Origami• Find “hidden”

objects in Silly Putty

55

Motor Planning and Organizational Strategies• Give simple step-by-step directions• Demonstrate task or ask another child

to “model” the activity first• Help child with task planning “What

materials do you need?” “What do you do first?”

• Play “Simon Says” or other sequencing games

56

Motor Planning and Organizational Strategies• Use timer to prepare child for

transitions• Use pictures or written list on

blackboard (daily routines); Helps makes transitions smoother

• Supplement handwriting with other methods of written expression (typing on keyboard; computer games)

57

Work ActivitiesWork ActivitiesWork ActivitiesWork Activities

For children requiring For children requiring “increased” input“increased” input

58

Work Activities• Place chairs on

desks at end of day• Take chairs off desks

at beginning of day• Wash desks or

chalkboard• Rearrange desks in

classroom• Help empty

trashcans

• Take chewy candy breaks (licorice, fruit roll-ups, Tootsie Rolls)

• Take crunchy food breaks (popcorn, pretzels, dry cereal)

• Sharpen pencils with manual sharpener

• Staple paper onto bulletin boards

59

Work Activities• Climb on the

playground equipment• Perform sports

activities that involve running and jumping

• Run around the track at school

• Have students “push” against the wall (make it a game: “Let’s make the room bigger!”)

• Jump on a mini-trampoline

• Stack chairs• Do animal walks

(crab walk, bear walk, army crawl)

• Allow the child to use “squeeze toys” silently at his desk

Feeding Disorders Feeding Disorders and Treatmentand Treatment

Feeding Disorders Feeding Disorders and Treatmentand Treatment

60

Oral-Exploratory Play• Encourages the child to self-discover his

or her own oral mechanism• Requires visual input (mirrors and

shadowing)• Auditory input (amplification)• Oral-proprioceptive input (pressure,

tapping, vibrating)• Oral-tactile input (ice, dry/wet/chewy

snacks)61

What to use in oral play• Ice• Dry snacks• Wet snacks• Chewy snacks• Liquid snacks• Warm/cold snacks• Washcloths• Rubber toys

• Toothettes• Tongue depressors• Toothbrushes

(manual/electric)• Chew toys• Straws• Toothpicks• Dental floss• Dental floss holders• Baby toothbrushes • NUK toothbrushes

62

What to do• Let the child explore his

mouth (parts and functions)

• Encourage an increase in the number and types of objects a child will tolerate.

• Mutual imitation by doing what the child is doing at the same time.

• Comment on what the child is doing using verbal descriptions (suprasegmentals, self talk and parallel talk)

• Encourage a great number, variety, and range of oral movements (jaw, lips, and tongue)

63

How often and where to perform oral play

• Can be done in therapy, the classroom, or home!

• Therapy: 5-10 minutes of a 30 minute session/15 minutes of a 60 minute session

• Home: 5 minutes to 1 hour depending on the child

• Classroom: 10-20 minute activity in a group or individually, a center, 5-10 minutes of a snack

64

Oral-Motor Grocery List• Strengthen suck and blow: sugar

is not good for droolers and citrus encourages suckingApplesauce, orange wedges, peanut butter popsicles, puddings, Caramel suckers, Jello cubes, Charleston chews , juice barsCran juices, lemonade

65

Increasing jaw control, facilitate munch, and 3-

dimensional chew• Munch-crunch

– Apples– Carrots– Cheerios– Chips– Corn chips– Graham crackers– Granola– Pretzels– Popcorn

• Chew– Bubble gum– Cheese– Dried fruits– French fries– Fruit roll-ups– Gummy bears– Jerky– Licorice sticks– Raisins– Skittles

66

Jaw control, munch, and chew continued…..• Nonfood items

– Balloons– Blowers– Cotton balls– Harmonicas– Bubbles– Pinwheels– Sports bottles

– Straws (variety)

• Arousal/alerting– Fireballs– Hot tamales– Hot gumballs– Ice chips– Red hots– Sour fruit popsicles– Sour fruit gumballs– Sour gum balls

67

Oral-Motor Classroom Activities : Blowing

• Bubbles• Whistles• Feathers• Cotton balls• Ping pong balls• Breath on a mirror• Party blowers

• Soap bubbles with colored water

• Painting with balls• Soap and water

painting• Kazoos• Pinwheels• Mobiles• kleenex

68

Oral-Motor Classroom Activities : Sucking

• Sucking laminated materials with various sized straws

• Use straws to drink liquids (milkshakes, pudding, yogurt, Jell-O, etc.)

69

Alternative and Alternative and Augmentative Augmentative

Communication with Communication with Children who are Children who are Deaf or Hard of Deaf or Hard of

HearingHearing

Alternative and Alternative and Augmentative Augmentative

Communication with Communication with Children who are Children who are Deaf or Hard of Deaf or Hard of

HearingHearing

70

Communication Methodologies:

• Auditory-oral• Auditory-verbal• Total Communication• Cued speech• American Sign Language

Alternative/Augmentative

communication (AAC)• If needed, Alternative/Augmentative

Communication may be warranted, explored, or investigated such as:– Picture Exchange Communication

System (PECS)– Picture Exchange/Visual Schedules– Speech Generating Devices– Switches

Why might we need to pursue AAC?

• A poor rate of progress with spoken language skills

• Oral –motor impairments impact speech production

• Poor motor control if using sign language (no one can recognize signs produced by the child)

• Extreme frustration from the child because he/she can’t communicate

• Defined by ASHA:– AAC refers to an area of research, clinical and

educational practice. – AAC involves attempts to study and when necessary

compensate for temporary or permanent impairments, activity limitations, and participation restrictions of persons with severe disorders or speech-language production and/or comprehension, including spoken and written modes of communication.

– Involves the use of multiple components or modes for communication.

– AAC has 4 primary components:• Symbols, aids, strategies, and techniques

What is AAC?

• According to ASHA:– Symbols – graphics, auditory, gestural, textured or

tactile symbols– AAC aid – a device, either electronic or non-electronic,

that is used to transmit or receive messages.– Technique – the ways that messages can be

transmitted– Strategy – the ways in which messages can be

conveyed most effectively and efficiently• 3 different purposes (timing, grammatic formation,

rate)

Terms defined

• To communicate messages to interact in conversations

• To participate at home, school, and recreational activities

• Learn native language• Establish social roles (friend, student,

child, sibling, spouse)• Meet personal needs

Central Goal of AAC:

• Require support to learn that through communication, they can have a positive impact on their environment and the people who surround them

• Focus on strengths of the child. Build intervention based on natural contexts. What do peers do in certain situations? What could child do?

• Use of routines is important

• May exhibit problem behaviors.

Beginning communicators

– Rely primarily on nonsymbolic modes of communication such as: • gestures, vocalizations, eye gaze, and body

language• may be intentional or unintentional

– Are learning to use aided or unaided symbols to represent basic messages for communicative functions such as:• requesting, rejecting ,sharing information, and

engaging in conversation– Use nonelectronic communication displays,

simple technologies, or pictures (switches/electronic devices with limited message capabilities) to communicate.

Beginning communicators

Nonverbal communication and

play– Joint attention– Eye contact– Gestures– Eye gaze– Body language

– Also important are: • Pretend play• Symbolic play• Adaptive play - AAC

Gesture dictionaries• What the child does• What does it mean?• What should the interventionist

do?• Is it consistent across settings?

80

• Applicable to individuals who have developed the basic skills of attention getting, accepting, and rejecting

• Being introduced to symbolic communication

• Expand their repertoire to include basic skills such as following a symbol schedule, engaging in simple social routines

Symbolic Approaches

Where to start…..• Start with Objects• Match object to picture/picture to object/object

to object• Use photographs• Use symbols (boardmaker, line drawings,

picture this, etc.)• Combine symbols (2 words)/ Use Carrier

phrases• Switch• Speech generating device??? Trials with

different types

82

• Requesting is one of the most basic and essential communication skills

• Facilitators need a systematic approach to teach it.

• Relationship to problem behavior (inappropriate requesting behaviors)– Make generic requests (more, please, want)

• Naturalistic teaching interventions- generalized and explicit requesting within natural contexts using a behavioral framework

• Generalized • Self-initiated generalized requests (gain attention from

partner)

Teaching Basic Requesting

• PECS – behavioral approach– Teaches requesting as the 1st skill without requiring

other skills– Exchange symbols for desired items– Phase 1 – person learns to pick up a single symbol

and hand to facilitator who give the associated item (can use an assistant for physical and gestural prompts but no verbal)

– Phase 2 – assistant gradually moves away to the person learns to find the picture and take to the facilitator)

– Phase 3 – the number of symbols is increased and one of the comprehension check procedures is used

– Upon based requesting mastery, may progress to phases 4-6 to build sentence structures

Teaching Basic Requesting

• Functions as an escape to terminate an ongoing event

• Relationship to problem behavior – aggression, tantrums, self-injury

• Teaching generalized and explicit rejecting– Generic: indicate “no” by gesturing, symbol, etc.– 5 main steps for generalized rejecting:– 1. an approp. AAC modality selected– 2. Nonpreferred items or activities are identified

across a wide range of routines and contexts– 3. need for rejecting is creased in each of the

identified positive situations– 4. prompts are provided and gradually faded over

time– 5. remove the nonpreferred item or activity

following the appropriate rejecting behavior

Teaching Basic Rejecting

• BIGmack and LITTLEmack switches• Small battery-powered communication aid that is

programmed with a single/short message• Record voice messages, music, or other sounds• Recorder should be same age, gender as user• Activation may be direct or via remote• Context should be within a preferred activity• Examples (circle time, transition times,

continuation, turn taking, cheering, greeting, initiating conversation)

• Step-by-Step Communicator – series of messages (tell a joke, recite scripted lines in a play

• AbleNet, Inc. Adaptivation, Inc., Enabling Devices

“Talking Switch” Techniques

• Calendar system, schedule system, activity schedule

• Represents each activity in the day with symbols

• May serve several purposes– Introduce the individual to the concept of

symbolization (the idea that 1 thing can stand for another)

– Provide an overview of the sequence of activities across a day

– Provide specific information about what happens next

– Ease transitions from one activity to the next– Serve as one component of a behavioral

support plan for predictability

Visual Schedules

• Used with a variety of disabilities• Can be effective in home, school, and

community settings• Can be used with a variety of ages and

abilities• Can use real objects, tangible symbols,

photographs, or line-drawing symbols • Hierarchy of prompts that are gradually

faded• Creating and using a visual schedule• Book “Schedule It! Sequence It!” Mayer-

Johnson / Boardmaker

Visual Schedules

Case Example • 10 year old• Profound hearing loss/ CP• Utilizes a Cochlear Nucleus 5 CI• Nonverbal• Uses gestures, vocalizations, few signs, and Dynavox to

communicate• Participates with his typically developing peers at school • Has increased awareness to participate in his everyday

environments• Is able to reject and request nonverbally and with the use

of his Dynavox.• Consistently navigates and selects preferred activities with

at least 5 buttons.

89

References• Functional Communication training and/or visual schedules interventions for

persons with developmental disabilities – Bopp, Brown, & Mirenda, 2004; Mirenda 1997

• Behavior chain interruption strategy – Carter & Grunsell, 2001• Graphic symbol techniques and/or manual signing for individuals with autism -

Goldstein, 2002; Mirenda, 2001, 2003b• Efficacy of AAC interventions with person with chronic severe aphasia – Koul &

Corwin, 2003• Effects of AAC on natural speech development – Millar, Light & Schlosser, 2002;

Schlosser, 2003a• Presymbolic communication interventions – Olsson & Granlund, 2003• Effectiveness of aided and unaided AAC strategies for promoting generalization and

maintenance – Schlosser & Lee, 2000• Selecting graphic symbols for requesting – Schlosser, Sigafoos, 2002• Use of speech-generating devices in AAC – Schlosser, Blischak, & Koul, 2003• AAC strategies for beginning communicators – Sigafoos, Drasgow & Schlosser, 2003

90

References• Beukelman, D.R. & Mirenda. Augmentative and Alternative Communication:

Supporting Children and Adults with Complex Communication Needs, Third Edition. Brooks Publishing.

• Pamela Marshalla, M.A., CCC-SLP, Speech-Language Pathologist. The Oral-Tactile System and Developmental Apraxia,, Kentucky Speech and Hearing Association, Lexington, Kentucky, March 9, 1994.

• Oetter, P., Richter, E.W., & Frick, S.M. M.O.R.E. Integrating the Mouth with Sensory and Postural Functions (2nd Edition).

• Fraker, C., & Walbert, L. (2003). Evaluation and Treatment of Pediatric Feeding Disorders: from NICU to Childhood, Pro-Ed, Austin, Texas.

• Swigert, N. (1998). The Source for Pediatric Dysphagia, LinguiSystems, East Moline, IL.

• Klein & Delaney. (1994). Feeding and Nutrition: Oral Alerting Activities. Therapy Skill Builders.

91

References• Ayres, A.J. (1965). Patterns of perceptual-motor dysfunction in children: A factor

analytic study. Perceptual and Motor Skills, 20, 335-368.• Ayres, A.J. (1971). Characteristics of types of sensory integrative dysfunction.

American Journal of Occupational Therapy, 25, 329-334.• Ayres, A.J. (1972). Southern California sensory integration tests-Manual. Los

Angeles: Western Psychological Services.• Ayres, A.J. (1975). Southern California postrotary nystagmus test-Manual. Los

Angeles: Western Psychological Services.• Ayres, A. Jean, OTR, PhD (1979). Sensory integration and the child. Los Angeles:

Western Psychological Services. • Ayres, A.J. (1980). Southern California sensory integration tests-Manual (rev. ed.).

Los Angeles: Western Psychological Services.• Ayres, A.J. (1989). Sensory integration and praxis tests-Manual. Los Angeles:

Western Psychological Services.• Balzer-Martin, L.A., & Kranowitz, C.S. (1992). Balzer-Martin Preschool Screening-

Teachers Checklist. St. Columba’s Nursery School: Washington D.C.

92

References• Bates, E., Bretherton, I., & Snyder, L. (1988). From First Words to Grammar:

Individual Differences and Dissociable Mechanisms. New York: Cambridge University Press.

• Bradford, A., & Dodd, B. (1996). Do all speech-disordered children have motor deficits? Clinical Linguistics & Phonetics, 10 (2), 77-101.

• Cermak, S.A., & Mitchell, T.W. (2006). Sensory Integration. In R.J. McCauley & M.E. Fey Treatment of Language Disorders in Children (pp. 435-469). Paul H. Brookes Publishing Company Baltimore, MD.

• Chapple, C. W. (2005). A biomechanical approach for the improvement of sensory, motor and neurological function with individuals with autistic spectrum disorder (ASD), pervasive developmental disorder (PDD), and sensory processing disorder (SPD). S.I. Focus Magazine, Autumn 2005.

• Dewey, D. (2002). Subtypes of coordination disorder. In S.A. Cermak & D. Larkin (Eds.), Developmental coordination disorder (pp. 40-53). Clifton Park, NY: Thomson Delmar.

• Eide, B., & Eide, F. (2004). DSI in a Learning Disorders Clinic. S.I. Focus Magazine, Spring 2004, 9-11.

93

References• Estil, L., & Whiting, H.T.A. (2002). Motor/language impairment syndromes: Direct or indirect

foundations? In A.A. Cermak & D. Larkin (Eds.), Developmental coordination disorder (pp. 54-68). Clifton Park, NY: Thomson Delmar.

• Fisher, A.G., & Murray, E.A. (1991). Sensory integration: Theory and practice. Philadelphia, PA: F.A. Davis.

• Gupta, P., & MacWhinney, B. (1997). Vocabulary Acquisition and verbal short-term memory: computation and neural bases. Brain and Language, 59, 267-333.

• Haber, E., MS, OTR/L and Deanna Iris Sava, MS, OTR/L. Heavy work activities list for teachers. All rights reserved.

• Hoehn, T.P., & Baumeister, A.A. (1994). A critique of the application of sensory integration therapy to children with learning disabilities. Journal of Learning Disabilities, Volume 27 (6), 338-350.

• Holt, J.A., Traxler, C.B., & Allen, T.E. (1997). Interpreting the scores: A user’s guide to the 9th Edition Stanford Achievement Test for educators of deaf and hard-of—hearing students. Washington, DC: Gallaudet Research Institute.

• Jung, V. & Short, R.H. (2004). Organization of successive events during social-emotional interactions between infants who are deaf or hard of hearing and caretakers: implications for learning syntax. The Volta Review, Volume 104 (2), 69-92.

• Koomar, Kranowitz, Szklut (2005). Answers to questions teachers ask about sensory integration. Las Vegas: Sensory Resources, LLC.

94

References• Kranowitz, C.S. (2005). The out-of-sync child: Recognizing and coping with sensory

processing disorder. New York: The Berkley Publishing Group.• Kranowitz, C.S. (2003). The out-of-sync child has fun: Activities for kids with

sensory integration dysfunction. New York: The Berkley Publishing Group.• Massaro, D.W., & Light, J. (2004). Improving the vocabulary of children with

hearing loss. The Volta Review, Volume 104 (3), 141-174.• Mauer, D.M. (1999). Issues and applications of sensory integration theory and

treatment with children with language disorders. Language, Speech, and Hearing Services in Schools, Volume 30, 383-392.

• Neville, J.J., Coffey, S.A., Lawson, D.S., Fischer, A., Emmorey, K., & Bellugi, U. (1997). Neural systems mediating American Sign Language: Effects of sensory experience and age of acquisition. Brain and Language, 57 (3), 285-308.

• Reynolds, D., Nicolson, R.I., & Hambly, H. (2003) Evaluation of an exercise-based treatment for children with reading difficulties. Dyslexia, 9, 48-71.

• Schum, R. (2004). Psychological assessment of children with multiple handicaps who have hearing loss. The Volta Review, Volume 104 (4) (monograph), 237-255.

95

References• Shore, S.M. (2004). Perception. S.I. Focus, Summer 2004.• Snyder, L, & Yoshinaga-Itano, C. (2000). Specific play behaviors and the development of

communication in children with hearing loss. The Volta Review, Volume 100 (3), 165-185.• Tallal, P., Miller, S., & Fitch, R. (1995). Neurobiological basis of speech: A case for the pre-

eminence of temporal processing. Irish Journal of Pscychology, 16, 194-219.• Tremblay, S., Shiller, D.M., & Ostry, D. (2003). Somatosensory basis of speech production.

Nature, 423, 866-869.• VandenBerg, Nancy. (2001). The use of a weighted vest to increase on-task behavior in

children with attention difficulties. The American Journal of Occupational Therapy, 55.• Vermeer, A. (2001). Breadth and depth of vocabulary in relation to L1/L2 acquisition and

frequency of input. Applied Psycholinguistics, 22, 217-234.• Wilbarger, P. and Wilbarger, J.C. (2001). Sensory Defensiveness: A comprehensive treatment

approach. Panorama City, CA• Wood, J. (2001). Can software support children’s vocabulary development? Language

Learning & Technology, 5, 166-201.• Yoshinaga-Itano, C., Snyder, L., & Day, D. (2000). The relationship of language and symbolic

play in children with hearing loss. The Volta Review, Volume 100 (3), 135-164.

96

97

Contact Information:Contact Information:Contact Information:Contact Information:

kclift@uthsc.edu

eclark1@uthsc.edueclark1@uthsc.edu