Hello and welcome to this podcast, I’m Mike Marotta. This interview was recorded during the 2013 Texas Assistive Technology Network Statewide Conference at the Region 4 Educational Service Center in Houston Texas. This interview was with John Halloran. John is a speech language pathologist and is the Senior Clinical Associate for The Center for AAC and Autism. John has worded in the field of AAC since 1994. He was the primary developer of Language Acquisition through Motor Planning and presents internationally.
John presented two sessions at the conference. The first was titled, “LAMP Words for Life: A Unified AAC Approach across Abilities, Environments and Platforms.” The session description reads: The session will explore how LAMP Words for Life program can be adapted for individuals regardless of ability while providing a systematic structure for language growth and UDL support. Implementation strategies and choosing a platform, either iPad or dedicated device, based on access and function will be discussed.
His second session was titled, “Neuroplasticity: AAC as Treatment, not Just Accommodation.” The session description reads: Some AAC strategies focus on perceived strengths such as visual learning for individuals with autism rather than addressing neurological weaknesses contributing to communication impairment. Strategies that mimic the multisensory convergence occurring in typical language development may improve neurological functioning, leading to greater gains in communication rather than just providing accommodation.
Mike Marotta (MM): Ok we are here talking with John. John had two different sessions at the conference that we are going to talk about. The first one was the LAMP Words for Life and we will let John go into a little detail about that. Then we will talk about the second one he had. So John, welcome!
John Halloran (JH): Thank you for having me. LAMP Words for Life was the presentation I did. It is just a vocabulary that goes on communication devices or an iPad and that’s what we were talking about. The fact that the Words for Life could cross environments, it could go at home and at school. It can go across devices because it could be on a tablet or it could be on a dedicated device. It is also a vocabulary for kids who are just beginning to learn their first words to kids who are very high functioning and communicate at a very high level. So it basically goes from one hit, one word cause and effect to being able to communicate at a very high level.
So what we did, is we tried to explain why we did what we did when we designed it. What made us decide to pick those words, why did we put the words where we did – so that was the main training. I will try to go over some of the reasons now for what we did. When we first started looking at it, we were very excited about Universal Design for Learning. We realized one size doesn’t fit all and we understood that. We had to give people an opportunity to learn through their sensory systems – both if they see and feel and hear. Then give people a way to express themselves through the communication device – maybe they want to write, they want to email or do Facebook. We made sure we did all those things in designing it. One of the things we were very aware of was that none of us really has all the answers when it comes to helping someone do it all on an AAC device and then really, as much as we are making progress, I still think we have a long way to go working with kids with autism. So we gave some statistics – one of the ones I just saw – in 2012 study from California said that 40% of people with autism couldn’t even tell you when they were sick. So I thought we have a long way to go. In developing this app, we are hoping that it gets out to more people. That was our goal – to make an app that people could use on lots of different platforms, across lots of different environments and make it accessible to everybody.
One of the neat things about Words for Life is it keeps the motor plan the same. Sometimes it is hard for people to understand what we mean – how pure we are on that. The best way is to just ask somebody if they know what it is like to play a piano or if you ask somebody where the q is on the keyboard. Often you will see them move their hands –
MM: I just did it as you said it!
JH: That’s right! So Words for Life keeps the motor plan the same. So you start out with a one hit and then that motor plan can grow – it goes from one button to another. So we do that very quickly so you never get stuck thinking that one button means one thing. The other thing we try to do is teach children to generalize – adults also – we try to teach them that words have new meanings based on context. So when you say eat – you may see somebody respond to you saying “It’s not time to eat” or you may get a cookie but there is not a one to one correlation. It is important that we made people understand that there is a difference between LAMP the method, which can be done on any communication device and Words for Life the vocabulary. So LAMP is a method, Words for Life is a vocabulary. Words for Life vocabulary can be found on all PRC devices, the Saltillo products now, on iPad and you can use it on manual boards.
In looking to get back more to the method and not the Words for Life – if you understand the method, if you understand why we made the vocabulary the way we did. One of the things we talk about is making sure the child is at a readiness to learn but if a child’s device doesn’t have enough vocabulary on it or it doesn’t have the words they wish they could say – they are not going to get readiness to learn. We start with lots of buttons, which sort of confuses people. They see a screen with so many buttons on it but it is sometimes hard for us to see that a lid doesn’t necessarily look at it that same way you or I would. You and I look at and try to figure out why do those buttons say what they do – and kids just play, touch and see.
MM: Right, and experience it and then learn from that.
JH: Correct. They don’t necessarily know what they are even saying when they press the button. If you think about the old phones where more buttons meant easier. When a phone used to have j k l and a b c – how many times did you have to hit that – more buttons means easier. In order to keep the motor plan the same, we start with a grid that is 84 buttons. When we designed our devices, we had to make sure that the auditory feedback was immediate. So when you touch something – you are consistent in your motor movement – when you touch something the auditory signal has to be immediate. If it didn’t we would not have allowed it to have Words for Life on it – or released it. Lots of devices – if you try to put our vocabulary on there, when the screen re-draws the speech is too slow and you get this touch that does not match the auditory.
MM: Yeah, and that affects the motor plan that you have strived so hard to maintain.
JH: Correct. I am glad you said it – it is something else we are after. Using all three sensory systems together where motor movement creates something then they see something happen. When you use three sensory systems together you get this connection – they call the multisensory convergence. If there is a delay in the output, then you would have this like watching a foreign movie where lips don’t match.
MM: Right, exactly. That’s a great analogy. It is just that second off and it is – why am I not getting what I thought I would.
JH: Right. Many kids who got the first Words for Life on the iPad 1 – they will touch the first button, the speech synthesizer was too slow and it was redrawing the screen and you would touch the second button but you would hear the first button. Now they are confused and they didn’t do well.
MM: Exactly, now the whole communication is thrown at that point.
JH: Correct. Any time I hear about a company coming out with a new high quality synthesizer and no one is testing it, they are just doing the synthesizer without understanding how it works in the real world with a kid with autism.
The last thing is we provide – try to provide – natural consequences because something happens when you say it. It is important that we don’t always give them a one thing – when we say eat the apple and they get an M&M. Sometimes they just get told please stop saying eat. But we want them to have joy in it – because joy is what makes the learning solidify and take place. Without the joy, they won’t release the neurotransmitters to let learning take place. So that is basically LAMP Words for Life but now I am going to go into more detail on why we picked the words we did and put them where we did.
There were guiding principles. My wife and I sat down when Prentke Romich Company decided they would give us the freedom to design Words for Life – we took the Unity program they had out there for 20 something, 30 something years and even longer if you consider the Minspeak system – we had to sit down one day and say, she is an OT and I am a speech therapist, together what are the guiding principles that are going to make sure are in this app. The first one was that we learned from watching lots of kids and individuals with autism – we needed to treat the hand as if it was an articulator. We had to really treat the hand as if it was their mouth. We would say if your mouth can’t do that neither can your hand. So an example is – there is no word in Words for Life twice. If the word fish is an animal, it can’t also be stored in a sequence for food. If you think of your hand making a movement to a sound – you can’t have one movement with two different sounds. It also can’t have two motor movements producing one sound. So when you decide to treat the hand as an articulator, it changes the whole dynamics of the machine. Lots of people will say that their machine follows motor planning principles but they don’t. To this day – not one of them has even come close. If you look at them and say – we need “More” in a corner every time but you go into a sequence to get to that page, then that is a whole different motor plan to get there.
MM: Exactly.
JH: They just don’t get it. So that was the first thing we wanted to treat the hand as if it was an articulator. The other thing in doing that – we knew that we could grow motor plans but we couldn’t change them. So if you think of somebody putting their hands together to say the sign “more” – the first time they do it they can approximate it. Later they would refine it to be a double tap. So if you were writing the letter “t”, you could take your pencil and start to write down and you can add the cross. You would be adding to that motor plan not changing it.
One thing we saw happen with children we worked with in the last 20 years is we saw children fail many times with an AAC device. There was lots of research done – one was done on a kid at Arkansas State University where we did a thesis through the university. What he taught us by watching his LAM data – which is Language Activity Monitoring data – monitors every keystroke of the device. What we saw in Tyson was that every time we said eat, he said cookie and every time we said more he said music. We realized that he thought eat cookie is a word and he thought more music was a word. He wasn’t segmenting between words, he thought I want money is a word. So we learned on a communication device, you can’t hear a word to get a word. You can’t cheat the kid out of listening to each word individually. So its fine to make it say I want – and have mom show up. Then you can’t say Mom stop it because you have …
MM: Because it has to be linked together.
JH: Yeah, so we learned that there are no carrier phrases, there are no word to get a word, and no phrases until the full level. Again, we had to start with lots of buttons. But now the screens are larger so when we do 84 buttons – they are almost ¾ inch by ¾ inch – so the buttons are really quite large. There are kids with autism that can’t touch that size grid – or a kid with cerebral palsy – but you can start with bigger grids. You just have to be ready to aggressively change the size of the grids so they can stay with the consistent motor plan. It would be almost impossible to have motor planning principles on an eight location device because you have to sequence so much.
MM: Yeah, right. It goes against what you are describing.
JH: Correct. So sometimes it is good to remember what that telephone pad was like when you used to have to do j-K-L and a qwerty overlay. Really adding more buttons means more efficient communication. The way we position the vocabulary on the Words for Life, we didn’t position them by parts of speech. We didn’t say here is your adjectives, here is your verbs, here is your pronouns and color code them that way. The kids with autism that were just starting out were just learning their first words. They didn’t understand parts of speech. It didn’t do any good to color code based on parts of speech, it also doesn’t do any good to segregate them together because the words that are more likely to be needed need to be farther apart. Let me try to say that another way. If I am going to teach stop and go, I don’t want those words next to each other because the closer they are to each other, the harder they are for the kid to differentiate. So words that are likely to be taught together are spread out apart on the device not necessarily next to each other. So mommy and daddy – if you had a key that represented names – you would want mommy to the top left and daddy to the top right. The farther away the motor plan is the easier it is for the child to differentiate and learn. Most communication devices stick words together that will be – most of your pronouns are together, all of your verbs are together and all of your adjectives are together and that will put yes, no, up, down – they are all…
MM: In a pile right there!
JH: Where the kid can’t differentiate the mis-hits because it isn’t easy. So it wasn’t just that we looked at what words to start – but we look at the position of them and how they grow and how you would get to the next level. Again, you can start on any size really. You can start on a low tech board. So that is why we position it – I now want to go back to why we picked the words we did. The first thing we did is look at the studies that exist on frequency. We used words that in the study – the Mayer Binashi study. In 100% of the Mayer Binashi study – which according to their study, is 4 or 5 year olds in the study. 26 words accounted for 96% of the words they used. Then, we know that kids with autism are often hyperlexic, so what we did there was give them 100% of Dolch 1 and Dolch 2. Then basically used our own clinical experience for which words they needed to use also. Sensory seeking kids might need a little different vocabulary than the typical developing child, they also built in where you can add your favorite food with very few keystrokes. So if you want to have Cheetos, we don’t think you should have to sequence three or four buttons because it is a snack. So you can customize easily in this second row.
MM: It sounds like, as we try to weave in the second presentation you did – I am now starting to understand more of the correlation between the two as you are describing it. The second presentation talking about neuroplasticity and AAC as a treatment not just accommodation. Now that I start to understand, describe some of the discussion you had in that session as well. How did you share this with people in that session?
JH: You are really right. These two really start to bleed together over time. The one was on the vocabulary and how we pick the words and why we did it and how you teach it. The second one was what does it do for you as an intervention. What does having a motor movement, with a word attached to it, with crossing environments – what does that do for you and why do we think it neurologically makes sense and works.
MM: The implementation part that strategy on how to make it work.
JH: Correct. So what we have is really three components here. We have the actual training, the vocabulary and then we have sort of this theory on what we think it does for you neurologically. That was the second training.
MM: OK. Can you share some examples of maybe a student you have worked with that you have seen this dramatic gains in communication by using this?
JH: One thing we do – that we have been doing for 20 years – is collecting videos of children. Some children have been collected over years time. We put those on line – so one thing unique we have is longitudinal videos of children making progress. Some children have even gone so far as starting to dedicated to a device then there are 12 year olds – no 12 year olds should develop speech. If you make it to 12 years old without developing speech then developing verbal speech would be quite rare. I would rather not oversell that but if I told you the truth that most kids that get good at LAMP – if they are 4, 5, or 6 and they get good at the approach, most of them become quite verbal or they don’t want to use technology. If they are older – I am not one of those that believes that you reach a period that you cannot learn to become verbal- but the older you get the less likely it is.
MM: Your percentage chance of …
JH: You could become more verbal or have some new words. Or even new gestures – it is not what we – it is possible, it has happened but it is not very likely. I don’t want to be a pessimist – I also don’t want to oversell because we have had many kids who have tried LAMP and couldn’t make it work. But for some children, it seems that having the motor plan and having the hand and treating it like an articulator. Then hearing the word and seeing something happen – develops language where it is not about giving them a way to say something they already know but its actually developing the language itself. In some ways it is almost a more pure, beautiful way to see language. Rather than me looking for a way to say something I already know I actually learn through the babbling and hearing.
MM: Yeah, how a normally developing communicator would do that.
JH: Correct. When we treating the hand as an articulator, we were thinking the movement of the hand was going to be the critical element. What we do in the trainings is that we show lots of videos of kids seeing stuff that proves something I read – I guess he is one of the most quoted persons in the world, Chomsky. Chomsky said there were two tricks to language. He said the first trick was that we can take a finite number of words to make an infinite amount of possibilities. The second trick he said was we have to understand that the words don’t mean anything – they are arbitrary. The reason we call it a table is because it is a table. Those two little tricks to language are in LAMP – embedded right into LAMP. There are two or three videos I show in every training that Chomsky needs to prove his theory. I hope some day he sees them or I get them to him. Kids with autism proved he was right. There is one little boy I show in a video where he said – he was upset that the day before a tornado came through our town and he is in class. He interrupts his teacher and – this is on line so if you go to aacandautism.com you will see Max on line – this video is on line at our website aacandautism.com But Max interrupts his teacher and says I want fix tree on – he gets to the word golf course and he doesn’t have golf course – so he says gulf as in water and horse as the animal. I want you to fix the tree on the gulf horse. So he proved Chomsky’s theory that a finite number of words can create an infinite amount of possibilities. It didn’t matter about the representation it was arbitrary.
MM: Yeah, that’s a great example. And that is up on your website that people can see?
JH: Correct. They go to the Center for AAC and Autism or type in LAMP and autism. The actual site is www.aacandautism.com they will see we profile children and every once in a while we do a new child. We have been very proud that the Texas families have allowed us to profile them. There are quite a few kids from Texas that have been profiled over the last few years so Max’s story is on the website for you to watch that video of him saying gulf horse.
MM: Now if people want to reach out to you directly, is that the best way through your website? Do you have any email address you would like to share with people?
JH: Yeah, I will give it to them. You can email us at aacandautism.com and my email is john@aacandautism.com Either way you can reach us directly.
MM: Perfect. Thanks very much for sitting down with me.
JH: Thank you. It was wonderful.
MM: A pleasure. Thanks!
Thanks for listening. For more information about the Texas Assistive Technology Network, visit the website at http://www.texasat.net To stay current on trends in AT or to discuss consulting opportunities, visit my website at http://www.mmatp.com or follow me on Twitter @mmatp This podcast was recorded using the Recordium iPad app. The music used in this podcast is by Quincy Mumford and the Reason Why and is used with permission. Visit the band website at http://www.quincymumford.com for more information.
TATN Statewide Conference 2013 