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Beyond Please and Thank YouBeyond Please and Thank YouBeyond Please and Thank YouBeyond Please and Thank YouThe Importance of Teaching Social Skills to Children Who Use AACThe Importance of Teaching Social Skills to Children Who Use AACThe Importance of Teaching Social Skills to Children Who Use AACThe Importance of Teaching Social Skills to Children Who Use AAC

Mira ShahMira ShahMira ShahMira Shah M.S. CCCM.S. CCCM.S. CCCM.S. CCC----SLPSLPSLPSLPMicrosoftMicrosoftMicrosoftMicrosoft CorporationCorporationCorporationCorporation

Kristen Gray M.A. ECE, ATPKristen Gray M.A. ECE, ATPKristen Gray M.A. ECE, ATPKristen Gray M.A. ECE, ATPAT AT AT AT for for for for ALLALLALLALL

Oregon Speech and Hearing Association Conference 2015Oregon Speech and Hearing Association Conference 2015Oregon Speech and Hearing Association Conference 2015Oregon Speech and Hearing Association Conference 2015Portland, OregonPortland, OregonPortland, OregonPortland, Oregon

Thanks for joining us today!

*First example of strong pragmatic skills! *First example of strong pragmatic skills! *First example of strong pragmatic skills! *First example of strong pragmatic skills!

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Where are we going today?Where are we going today?Where are we going today?Where are we going today?Pragmatics instruction and adaptations for AAC users who are learning language

Foundations of social communication

Barriers to strong social communication for AAC users

Getting practical

• Theory of Mind

• Central coherence

• Executive functioning

Needs assessment and intervention planning

And, we’ll have some fun activities along the way.

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Social communication + AAC

Explicit Instruction

Complex processes

� Aided language stimulation� Low tech communication boards� Speech generating devices � Vocabulary� Narrative development� World knowledge

Explicit Instruction

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Multiple communication Multiple communication Multiple communication Multiple communication modalitiesmodalitiesmodalitiesmodalities

Health Health Health Health &&&&well beingwell beingwell beingwell being

Understanding of the worldUnderstanding of the worldUnderstanding of the worldUnderstanding of the world

Theory of MindTheory of MindTheory of MindTheory of Mind

Central coherenceCentral coherenceCentral coherenceCentral coherence

Executive functioningExecutive functioningExecutive functioningExecutive functioning

Complex Processes

Weave social thinking strategies into global AAC interventions.

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Using language

Adapting language

Following rules

PragmaticsPragmaticsPragmaticsPragmatics

ASHA, 2014

Using Language for Using Language for Using Language for Using Language for DDDDifferent ifferent ifferent ifferent PPPPurposesurposesurposesurposes

InformingInformingInformingInforming: “Me going to get a cookie.”

Demanding:Demanding:Demanding:Demanding: “Give me a cookie!”

QuestioningQuestioningQuestioningQuestioning:::: “Can you get me a cookie?”

Requesting:Requesting:Requesting:Requesting: “Me would like a cookie, please.”

NegotiatingNegotiatingNegotiatingNegotiating:::: “Get me a cookie, me will share!”

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Communication ModalitiesCommunication ModalitiesCommunication ModalitiesCommunication Modalities

NoNoNoNo----tech strategiestech strategiestech strategiestech strategies

PartnerPartnerPartnerPartner----assisted strategiesassisted strategiesassisted strategiesassisted strategies

Communication ModalitiesCommunication ModalitiesCommunication ModalitiesCommunication Modalities

LowLowLowLow----tech boardstech boardstech boardstech boards SpeechSpeechSpeechSpeech----generating devicesgenerating devicesgenerating devicesgenerating devices

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AAC:AAC:AAC:AAC: A Continuum A Continuum A Continuum A Continuum of of of of CommunicatorsCommunicatorsCommunicatorsCommunicators

Emergent

Context dependent

Independent

P. Dowden, 1999P. Dowden, 1999P. Dowden, 1999P. Dowden, 1999

Emergent CommunicatorsEmergent CommunicatorsEmergent CommunicatorsEmergent CommunicatorsLanguage Development• Early language acquisition

Communication Forms• Rely mostly on their bodies to show their feelings and preferences

Role of the Tools• Tools used to teach language

Partner Responsibility• The partner’s support is essential for the AAC user’s participation.

Communicative success is highly dependent on the partner.

KKKK. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities

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ContextContextContextContext----Dependent CommunicatorsDependent CommunicatorsDependent CommunicatorsDependent CommunicatorsLanguage Development• Expanding use of language from their knowledge base

Communication Forms• Increased multi-modal communication

Role of the Tools• Tools become a means to express the language to

which they have access.

Partner Responsibility• The communication partner and AAC user share the

responsibility for communication success.

KKKK. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities

Independent CommunicatorsIndependent CommunicatorsIndependent CommunicatorsIndependent Communicators

Language Development• Working on nuanced communication

Communication Forms• Seamless transitions between different modes of

communication

Role of the Tools• Tools are a means to an end, now primarily expressive

Partner Responsibility• AAC user participates without much support for their

part of the conversation.

KKKK. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities. Rinehart & K. Gray, Making Opportunities

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Right tool for the Right tool for the Right tool for the Right tool for the task: It’s task: It’s task: It’s task: It’s the goal not the toolthe goal not the toolthe goal not the toolthe goal not the tool

AAC MantraAAC MantraAAC MantraAAC Mantra

Communication Partner: Communication Partner: Communication Partner: Communication Partner: Here’s your mission if you choose to accept it.Here’s your mission if you choose to accept it.Here’s your mission if you choose to accept it.Here’s your mission if you choose to accept it.

Understanding all the modalities

The importance of waiting

Appropriate proxemics:“dude, don’t lean on my wheelchair!”

Supporting conversation with others

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Barriers to Strong PragmaticsBarriers to Strong PragmaticsBarriers to Strong PragmaticsBarriers to Strong Pragmatics

Strong Pragmatics Barriers for AAC UsersTalking differently to different people Lack of communication partners

Establishing shared knowledge base The time it takes to generate a message on an speech-generating device

Speaking differently in different environments

A lack of opportunities to talk with people in different environments

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Strong Pragmatics Barriers for AAC UsersTaking turns in conversation Experience limited to short

conversations

Introducing topics of conversation Lack of world knowledge

Staying on topic A lack of opportunities to talk with people in different environments

Rephrasing when misunderstood Limited use of syntax

Using verbal and nonverbal signals Motor impairments

Strong Pragmatics Barriers for AAC Users

Standing the appropriate distance from someone when speaking

Poor motor planning or proprioception

Using facial expressions and eye contact

Poor positioning in wheelchair

Joining an established conversation Inability to access the best communication system for the demands of the context

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Vision issues

Ocular motor issues

Limited ability to gesture

Reduced control over body language

Unintended body movement

Head control

Facial expression

Other Other Other Other barribarribarribarriers: Motor Obstaclesers: Motor Obstaclesers: Motor Obstaclesers: Motor Obstacles

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Taking another’s perspective

Making eye contact

Proxemics

Recognizing other people’s body language

Other barriers: social cognitive deficitsOther barriers: social cognitive deficitsOther barriers: social cognitive deficitsOther barriers: social cognitive deficits

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Orthopedic

Gastrointestinal

Seizure activity

Adjustment to medication or side effects

Undiagnosed health issues

Other barriers: Health IssuesOther barriers: Health IssuesOther barriers: Health IssuesOther barriers: Health Issues

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AAC devices fail

Technology provides distraction

The design of SGDs

SGDS limited capacity to convey suprasegmental speech qualities

Time-consuming message generation

Communication breakdown

• Vocabulary limitations

• Accidental selection of vocabulary

Other barriers: TechnologyOther barriers: TechnologyOther barriers: TechnologyOther barriers: Technology

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Think about a student who in nonverbal and/or uses AAC.

What are her/his strengths as a communicator?

Which barriers impact them the most?

What is the result?

Does their communication system support potential social opportunities?

If so, how?

Let’s ChatLet’s ChatLet’s ChatLet’s Chat

Teaching Social CommunicationTeaching Social CommunicationTeaching Social CommunicationTeaching Social Communication

Generating language is not enough

Build relationships

Social motivation

Concrete strategies

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What is social thinking? What is social thinking? What is social thinking? What is social thinking?

Social ThinkingSocial ThinkingSocial ThinkingSocial Thinking is a social skills curriculum developed by Michelle Garcia Winner.

Frames social skills development as dynamic and situational.

Strategies including considering perspectives, thoughts, beliefs, prior knowledge, and the intentions of others.

Meet CharlieMeet CharlieMeet CharlieMeet Charlie

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Meet ChristopherMeet ChristopherMeet ChristopherMeet Christopher

Central Coherence

Theory of Mind

Executive function

Foundation of Strong SFoundation of Strong SFoundation of Strong SFoundation of Strong Social Communicationocial Communicationocial Communicationocial Communication

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“The big picture”

Thinking about the parts

Relating information

Central Coherence TheoryCentral Coherence TheoryCentral Coherence TheoryCentral Coherence Theory

Barriers to Strong Central CoherenceBarriers to Strong Central CoherenceBarriers to Strong Central CoherenceBarriers to Strong Central Coherence

Limited exposure to narratives

Few conversations about narratives

Instruction about part-whole relationships

Access to vocabulary necessary to talk about relationships

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Illustrating Relationships

Teaching Categories

Why Questions

Core Words that Connect Ideas

Relating Information and Telling Stories

Building Building Building Building Central Central Central Central CoherenceCoherenceCoherenceCoherence

Addressing Addressing Addressing Addressing Central Central Central Central CCCCoherence: Illustrating Relationshipsoherence: Illustrating Relationshipsoherence: Illustrating Relationshipsoherence: Illustrating Relationships

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Addressing Central Coherence: Teaching CategoriesAddressing Central Coherence: Teaching CategoriesAddressing Central Coherence: Teaching CategoriesAddressing Central Coherence: Teaching Categories

Addressing Central Coherence: Why QuestionsAddressing Central Coherence: Why QuestionsAddressing Central Coherence: Why QuestionsAddressing Central Coherence: Why Questions

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Addressing Central Coherence: Addressing Central Coherence: Addressing Central Coherence: Addressing Central Coherence: Core Core Core Core Words that Connect IdeasWords that Connect IdeasWords that Connect IdeasWords that Connect Ideas

Addressing Central Coherence: Addressing Central Coherence: Addressing Central Coherence: Addressing Central Coherence: Core Core Core Core Words that Connect IdeasWords that Connect IdeasWords that Connect IdeasWords that Connect Ideas

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Relating Relating Relating Relating information and telling storiesinformation and telling storiesinformation and telling storiesinformation and telling stories

Addressing Central Addressing Central Addressing Central Addressing Central CoherenceCoherenceCoherenceCoherence

Central Coherence: There’s app for that.Central Coherence: There’s app for that.Central Coherence: There’s app for that.Central Coherence: There’s app for that.

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Let’s chat Let’s chat Let’s chat Let’s chat

How do central coherence issues manifest in your AAC users?

What are successful strategies you have used to address it?

Has technology been a facilitator or a barrier?

The ability to attribute mental states to oneself and others. • Beliefs • Intents• Desires• Knowledge

Understanding that others have beliefs, desires, intentions, and perspectives that are different from one's own.

TheoryTheoryTheoryTheory of Mindof Mindof Mindof Mind

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Lack of opportunities to reflect upon or express opinions

Lack of question-asking opportunities

Access to vocabulary to talk about the likes and interests friends and family

Lack of experience assigning attributes: funny, talented, awesome ….

Barriers to Barriers to Barriers to Barriers to TheoryTheoryTheoryTheory of Mindof Mindof Mindof Mind

Tracking what others know

Thinking across personal interactions

Using language to inquire about another person’s interests

Reflecting on interactions and then monitoring our personal responses

Building Building Building Building TheoryTheoryTheoryTheory of Mindof Mindof Mindof Mind

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Theory of Mind: Tracking What Others KnowTheory of Mind: Tracking What Others KnowTheory of Mind: Tracking What Others KnowTheory of Mind: Tracking What Others Know

TheoryTheoryTheoryTheory of Mind: Thinking Across of Mind: Thinking Across of Mind: Thinking Across of Mind: Thinking Across PPPPersonal ersonal ersonal ersonal IIIInteractionsnteractionsnteractionsnteractions

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TheoryTheoryTheoryTheory of Mind: of Mind: of Mind: of Mind: Using Language to Inquire Using Language to Inquire Using Language to Inquire Using Language to Inquire AAAAbout bout bout bout AAAAnother nother nother nother PPPPerson’s erson’s erson’s erson’s IIIInterestsnterestsnterestsnterests

Here’s one way to do it. Here’s one way to do it. Here’s one way to do it. Here’s one way to do it.

Theory of Mind: Theory of Mind: Theory of Mind: Theory of Mind: Using Language to Inquire About Another Person’s InterestsUsing Language to Inquire About Another Person’s InterestsUsing Language to Inquire About Another Person’s InterestsUsing Language to Inquire About Another Person’s Interests

…but it’s not only way…but it’s not only way…but it’s not only way…but it’s not only way.

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TheoryTheoryTheoryTheory of Mind: Reflecting and Monitoring of Mind: Reflecting and Monitoring of Mind: Reflecting and Monitoring of Mind: Reflecting and Monitoring

Theory of Mind: Reflecting and Theory of Mind: Reflecting and Theory of Mind: Reflecting and Theory of Mind: Reflecting and Monitoring Monitoring Monitoring Monitoring

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Let’s chat: Theory of Mind Let’s chat: Theory of Mind Let’s chat: Theory of Mind Let’s chat: Theory of Mind

Think about a student who in nonverbal and/or uses AAC.

How does the student reflect ToM?

Which barriers have prevented ToM from developing?

Do communication partners support ToM?

Does there communication system support ToM?

If so, how?

Executive Functioning Executive Functioning Executive Functioning Executive Functioning

Umbrella term for the regulation and control of cognitive processes:• working memory • reasoning • task flexibility • problem solving • planning and execution

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Poor Executive Functioning

Impulsivity

Perseveration

Difficulty planning actions

Difficulty regulating emotions

Organization

Good judgment

Flexibility

Reorganization

Supporting Executive FunctionSupporting Executive FunctionSupporting Executive FunctionSupporting Executive Function

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Executive Functioning: Organization Executive Functioning: Organization Executive Functioning: Organization Executive Functioning: Organization

Executive Functioning: Good JudgmentExecutive Functioning: Good JudgmentExecutive Functioning: Good JudgmentExecutive Functioning: Good Judgment(video) (video) (video) (video)

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Executive Functioning: FlexibilityExecutive Functioning: FlexibilityExecutive Functioning: FlexibilityExecutive Functioning: Flexibility

Giving other people choices helps build relationships

Executive Functioning: ReorganizationExecutive Functioning: ReorganizationExecutive Functioning: ReorganizationExecutive Functioning: Reorganization

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Executive Functioning: Problem solvingExecutive Functioning: Problem solvingExecutive Functioning: Problem solvingExecutive Functioning: Problem solving

Reflecting on likes and dislikes can identify areas for potential problem solving.

Executive functioning: There’s app for that.Executive functioning: There’s app for that.Executive functioning: There’s app for that.Executive functioning: There’s app for that.

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Intervention PlanningIntervention PlanningIntervention PlanningIntervention Planning

Assess, Plan, and MonitorAssess, Plan, and MonitorAssess, Plan, and MonitorAssess, Plan, and Monitor

Understand your student in the context of their abilities, communication systems, and opportunities.

Plan in a collaborative manner with an organizational structure in place.

Monitor by taking data, re-assessing and implementing changes at regular intervals.

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Student’s communication systems • Modalities• Vocabulary and messages

Communication partners• Social Networks• How do they support the communication process

Environments and Opportunities• Challenges• Facilitators

Assessment: Document Systems, People, and ContextAssessment: Document Systems, People, and ContextAssessment: Document Systems, People, and ContextAssessment: Document Systems, People, and Context

Vocabulary and messages to support conversation• Anatomy of a conversation• Good ol’ core vocabulary

High tech • Location of the vocabulary: is it buried in the device? • Does the device occlude the user?

Low tech• Is it readily accessible?• When is it better to use low tech?

Systems and ModalitiesSystems and ModalitiesSystems and ModalitiesSystems and Modalities

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Who are they? Are there any communication partners?

What are the strengths of each partner?

What do people need to know to be good communication partners?

How is that communicated to them?

How do the communication partners and the environment work with each or against each other?

What are the social opportunities with each partner: face to face, email, text messages, or photo sharing?

Communication PartnersCommunication PartnersCommunication PartnersCommunication Partners

Environments and OpportunitiesEnvironments and OpportunitiesEnvironments and OpportunitiesEnvironments and Opportunities

Physical environments• Elements such as noise, lighting, and indoor vs outdoor settings

Social dynamics • Is it 1:1? 2:1? 10:1?• Time bound? Synchronous? Asynchronous?

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Start with a good question.Start with a good question.Start with a good question.Start with a good question.

How can Anna share experiences and learn about How can Anna share experiences and learn about How can Anna share experiences and learn about How can Anna share experiences and learn about her friends and their interests?her friends and their interests?her friends and their interests?her friends and their interests?

Create a Create a Create a Create a meaningful goalmeaningful goalmeaningful goalmeaningful goal....

Anna will have a conversation with one friend 3 Anna will have a conversation with one friend 3 Anna will have a conversation with one friend 3 Anna will have a conversation with one friend 3 times a week. Each conversation will be times a week. Each conversation will be times a week. Each conversation will be times a week. Each conversation will be characterized by 3 conversational turns and will characterized by 3 conversational turns and will characterized by 3 conversational turns and will characterized by 3 conversational turns and will include expression of one question. include expression of one question. include expression of one question. include expression of one question.

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Map it out: Who are Anna’s friends? Map it out: Who are Anna’s friends? Map it out: Who are Anna’s friends? Map it out: Who are Anna’s friends? What What What What do they talk about at school?do they talk about at school?do they talk about at school?do they talk about at school?

ModeModeModeMode AlexAlexAlexAlex JohnJohnJohnJohn SaraSaraSaraSara ScottScottScottScott

Face to FaceFace to FaceFace to FaceFace to Face ● SportsSportsSportsSports● The weekendThe weekendThe weekendThe weekend● JokesJokesJokesJokes

GirlsGirlsGirlsGirls

EmailEmailEmailEmail Social outingsSocial outingsSocial outingsSocial outings CampCampCampCamp

TextTextTextText Photos of favorite Photos of favorite Photos of favorite Photos of favorite singerssingerssingerssingers

Independently Independently Independently Independently generatedgeneratedgeneratedgenerated CoCoCoCo----constructedconstructedconstructedconstructed Emerging SkillEmerging SkillEmerging SkillEmerging Skill

What’s shared or discussed?What’s shared or discussed?What’s shared or discussed?What’s shared or discussed?

Plan to address areas of social thinkingPlan to address areas of social thinkingPlan to address areas of social thinkingPlan to address areas of social thinking

Communicative Communicative Communicative Communicative opportunityopportunityopportunityopportunity

TopicsTopicsTopicsTopics Theory of MindTheory of MindTheory of MindTheory of Mind Central Central Central Central CoherenceCoherenceCoherenceCoherence

Executive Executive Executive Executive FunctionFunctionFunctionFunction

QuestionsQuestionsQuestionsQuestions SportsSportsSportsSports What’s your favorite What’s your favorite What’s your favorite What’s your favorite team?team?team?team?

Concepts: game, Concepts: game, Concepts: game, Concepts: game, players, cheering, funplayers, cheering, funplayers, cheering, funplayers, cheering, fun

Ask only 1 timeAsk only 1 timeAsk only 1 timeAsk only 1 time

StoriesStoriesStoriesStories The weekendThe weekendThe weekendThe weekend Family outingsFamily outingsFamily outingsFamily outings The main eventThe main eventThe main eventThe main event3 supporting details 3 supporting details 3 supporting details 3 supporting details

Tell the story in less Tell the story in less Tell the story in less Tell the story in less than 10 minutesthan 10 minutesthan 10 minutesthan 10 minutes

OpinionsOpinionsOpinionsOpinions SportsSportsSportsSports Yeah, Seahawks!Yeah, Seahawks!Yeah, Seahawks!Yeah, Seahawks! Say that’s not my Say that’s not my Say that’s not my Say that’s not my favorite instead of favorite instead of favorite instead of favorite instead of

“that’s dumb!” “that’s dumb!” “that’s dumb!” “that’s dumb!”

Independently Independently Independently Independently generated generated generated generated

CoCoCoCo----constructed constructed constructed constructed Emerging skillsEmerging skillsEmerging skillsEmerging skills

AnnaAnnaAnnaAnna AlexAlexAlexAlex

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Planning for Social Interactions: SETT Planning for Social Interactions: SETT Planning for Social Interactions: SETT Planning for Social Interactions: SETT

SETTStudent, Environment, Task, and Tool

It can be used and adapted AAC users and social interactions

Benefits: Collaborative, data collection, re-assess at regular intervals,and make changes as needed.

Adapting SETT with the team

SSSSchedulechedulechedulechedule MMMModalitiesodalitiesodalitiesodalities PPPPartnerartnerartnerartner SSSSocial ocial ocial ocial opportunityopportunityopportunityopportunity

BarriersBarriersBarriersBarriers SupportsSupportsSupportsSupports DataDataDataData

BiologyBiologyBiologyBiology AAC deviceAAC deviceAAC deviceAAC devicePODDPODDPODDPODDgesturesgesturesgesturesgestures

AlexAlexAlexAlex Group projectGroup projectGroup projectGroup projecton amphibianson amphibianson amphibianson amphibians• Learn about Learn about Learn about Learn about

friend’s petfriend’s petfriend’s petfriend’s pet• Ask about Ask about Ask about Ask about

likes/dislikes likes/dislikes likes/dislikes likes/dislikes

Alex doesn’t Alex doesn’t Alex doesn’t Alex doesn’t understandunderstandunderstandunderstand the the the the PODD systemPODD systemPODD systemPODD system

SLP spends a SLP spends a SLP spends a SLP spends a session with session with session with session with Alex and Anna Alex and Anna Alex and Anna Alex and Anna andandandand supports supports supports supports Anna to Anna to Anna to Anna to introduce her introduce her introduce her introduce her system to Alex. system to Alex. system to Alex. system to Alex.

LunchLunchLunchLunch

LanguageLanguageLanguageLanguage ArtsArtsArtsArts

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Data: Expanding Qualitative Assets Data: Expanding Qualitative Assets Data: Expanding Qualitative Assets Data: Expanding Qualitative Assets

Decision scales + why

Diary studies

Photo or video journals

Portfolios

ReReReRe----assess at regular intervals assess at regular intervals assess at regular intervals assess at regular intervals

Is the question still relevant?

Have the friends or communication partners changed?

Have the tools changed?

Are the interventions working?

Are the supports working?

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Thank you!

Kristen Gray M.A. ECE, ATPkristen.gray.atp@gmail.com

Mira Shah M.S. CCC-SLP mira.e.shah@gmail.com

Crooke, P. J., Hendrix, R. E., & Rachman, J. Y. (2008). Brief report: Measuring the effectiveness of teaching social thinking to children with Asperger syndrome (AS) and high functioning autism (HFA). Journal of autism and developmental disorders, 38(3), 581-591.

Dowden, P. A., Caruso, A., & Strand, E. A. (1999). Augmentative and alternative communication for children with motor speech disorders. Clinical management of motor speech disorders of children, 345-384.

Hill, E. L., & Frith, U. (2003). Understanding autism: insights from mind and brain. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 358(1430), 281-289.

Jolliffe, T., & Baron-Cohen, S. (1999). A test of central coherence theory: linguistic processing in high-functioning adults with autism or Asperger syndrome: is local coherence impaired?. Cognition, 71(2), 149-185.

Anatomy of a Conversation, (2000), Musselwhite and Burkhart, 2000, http://www.lburkhart.com/chat_ideas.htm

Winner, Michelle G. (2000) Inside Out: What Makes a Person with Social Cognitive Deficits Tick. San Jose, CA: Think Social Publishing.

Winner, M. G. (2002). Thinking about you, thinking about me. San Jose, CA: Michelle Garcia Winner.

References