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December, 2001

Volume 14

Numbers 2 and 3

For ConsumersDevelopmental apraxia of speech

On the WebInformation sources for parents andprofessionals

Clinical NewsDifferential diagnosis: DAS andphonologic delay

Case ExampleAn AAC program for children withDAS

University & ResearchThree empirical studies

The AAC-RERCAcross space and time: 2002Interactive Lecture Series in AAC

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Developmental apraxia

of speech (DAS) with Gary

Cumley, Ph.D., Laura Ball, Ph.D. &

Amy Skinder-Meredith, Ph.D.

What is DAS?

A diagnosis of developmentalapraxia of speech (DAS) is difficultto make, particularly in youngchildren. These children are not deafor aphonic, but their speech isdelayed well beyond what would beexpected for their age or develop-mental/cognitive level. Such childrenexhibit certain characteristics thatsuggest a motor component to theirspeech intelligibility problems, butthey are not dysarthric (i.e., there is

Clinicians consider AAC interven-tions when communication impair-ments are severe and a person’sability to communicate effectively iscompromised. Typically, adults whobenefit from AAC aids, techniques,symbols and strategies are describedin the literature as having eitherdysarthria (paralysis of musclesrequired to produce intelligiblespeech); apraxia (coordination/motor planning problems thatinterfere with the production ofintelligible speech); aphasia (deficitsin syntax, semantic, phonologic and/or pragmatic aspects of language);or aphonia (inability to producevoice as a result of removal orimpairment of organs related tospeech production, such as vocalfolds, tongue or larynx.)

On the other hand, children whobenefit from AAC strategies aremore typically described as havingcerebral palsy, autism, developmen-tal delay, Down syndrome, Rettsyndrome, severe cognitive impair-ments and so on, rather than havinga specific type of speech and/orlanguage disorder. The tendency notto label the underlying speechdisability in children who benefitfrom using AAC techniques mayreflect how intertwined speechdevelopment is in the languageacquisition process. There is,however, one group of children thatAAC specialists often do label witha specific type of disorder, thosewith developmental apraxia of

no evidence of paralysis of thetongue, lips or palate). They havespeech that is very difficult tounderstand; and their articulationproblems are resistant to traditionalphonological intervention meth-ods.1,2,3

Some children with DAS alsohave language problems. All of themhave reduced expressive languageskills compared to their receptivelanguage. Some are multi-handi-capped and have additional diag-noses of developmental delay,autism, Down syndrome, mentalretardation or other congenitalconditions. In addition, these children

speech (DAS).This issue of ACNconsiders what weknow and don’t know

about children with DAS,and the role that AAC techniquesplay in helping these childrencommunicate more effectively. ForConsumers takes a look at defini-tions of DAS and discusses thecontroversies surrounding thediagnosis. On the Web describesresources for family members andprofessionals interested in learningmore about DAS and the use ofAAC as an intervention strategy.Clinical News considers thedifferential diagnosis between DASand phonologic delays in children.

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For Consumers, Continued from page 1

Upfront, Continued from page 1

may exhibit nonspeech characteris-tics known as oral and/or limbapraxia and reduced diadochokineticrates,4,5,6 or “soft” neurologicalsigns, mental retardation andneuromuscular disorders.7 For thepurposes of this issue, DAS isdefined as a moderate-severephonological disorder that is neuro-logically-based and affects theability to program and producevolitional movements for speech.8

Children with DAS often makelimited progress and, when DAS issevere, their prognosis for intelli-gible speech is guarded.2,8,9,10, 11,12

Similar to definitions of acquiredapraxia of speech (AOS), definitions

of developmental apraxia of speech(DAS) typically focus on theinability or difficulty in carrying outpurposeful voluntary movements forspeech, in the absence of a paralysisof the speech musculature. Craryoffers a definition that takes intoaccount the fact that motor speechdisorders will affect and influencethe development of phonology andlanguage in children:

. . . the term developmental verbaldyspraxia is used to represent thedevelopmental counterpart to acquiredapraxia of speech. The hopefuladvantage gained by using this term isto project that the developmentalversion is a more ‘linguisticallyencompassing’ disorder than its adultcounterpart. . .We offer the assumptionthat similar ‘motor-linguistic’ processesmay be operating in both children and

adults; yet, because of the ‘undevel-oped’ nature of language in children,the disorder has a more widespreadlinguistic effect.13

Controversies

In the field of communicationdisorders, there is confusion andcontroversy surrounding DAS.Experts do not always agree on thedescriptive label, definition, salientcharacteristics, assessment proce-dures and intervention approaches.10

Factors influencing the controversyinclude the complexity of thedisorder, as well as the limitedexperiences, knowledge and skillsthat speech-language pathologistsmay bring to the diagnosis andtreatment of children with DAS.11,12

Terms used to describe childrenwho show unusual speech produc-tion patterns that are suspected to bemotoric in origin include: develop-mental apraxia of speech;14 develop-mental verbal apraxia,15 verbaldyspraxia;16 and developmentalverbal dyspraxia.13,16,17

Developmental apraxia is differ-ent from the verbal apraxias ob-served in adults with cerebralvascular accidents and/or traumaticbrain injuries. DAS may be causedby a genetically transmitted disor-der,18 problems prenatally or at birth,differences in the rate of develop-ment or quality of myelination(covering or sheath for the nervecells in the brain), neurologicaldisorders, developmental delays, or

While this differential diagnosismay be an important component indesigning a speech therapy program,the severity of the speech disorder istypically what triggers the need forAAC approaches, independent ofthe cause. The Case Examplesection provides a description of aMichigan program uses AACtechniques to serve children withDAS and severe language impair-ments. University & Researchgives the results of three publishedempirical studies of the use of AACtechniques with children who haveDAS. Finally, the AAC-RERCsection announces an exciting newweb cast series on AAC for 2002.

Thanks to Laura Ball, GaryCumley, Marlene Cummings andAmy Skinder-Meredith who assistedme in preparing this issue of ACN. Ihave not thought as long and hardabout DAS since 1989, when I firstwrote about it in ACN. Like every-one else, I work with many childrenwho “walk but don’t talk,” who havea diagnosis of DAS. These children

Figure 1. Neuropathology of DAS

motor functions

apraxias

language functions

language

impairment

dysarthria

struggle and, when they grow up,many still have speech intelligi-bility problems. This is a groupof people who benefit fromAAC. My experience has beenthat children with severe DASare far better off when treatmentoptions address their languageand communication disorders, aswell as their speech motor andspeech problems. We need to doa better job of using AACtechniques as a way to supportthese “partially verbal” children.

I wish you all a happy holidayseason and a very safe, happyand productive Year 2002.

Sarah W. Blackstone, Ph.D.CCC-SP, Author

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something else. The location andtype of neuropathology underlyingDAS is not well understood beyondthe fact that DAS is (1) a disruptionin the central sensory-motor pro-cesses, (2) interferes with the motorlearning for speech and (3) causesdelays or deviances in the processesinvolved in planning and program-ming movement sequences forspeech. Figure 1 illustrates thenotion that motor speech disordersin children may fall on a continuum,which helps to account for the oftenobserved disruption in speech motorand language functions in manychildren with suspected DAS.19

At this time we have only hy-potheses regarding the underlyingneuropathology of DAS. Research-ers continue to debate about theorigin of the disorder, or whether ithas a linguistic/phonological basisor a more motor/sequencing cause.20

Researchers strive to locate childrenwith no co-occurring deficits, todetermine a specific genetic pheno-type of the disorder.

For today’s children, however,these discussions do little to assistspeech-language pathologists orparents to select and implementefficacious treatment approaches thatcan both remediate the severity ofspeech impairment and amelioratethe functional impact of that speechimpairment on a child’s expressiveand receptive language development,behavior, social interactions, selfesteem and learning capabilities.

A confluence of symptoms

Another cause of confusion andcontroversy relates to defining thesalient characteristics of DAS. TableI lists a number of features used toidentify DAS. In a recent study, Ballhad three “expert” speech-languagepathologists decide whether 36children with suspected DAS had adiagnosis of DAS.21 She used the

items marked with an asterisk inTable I in her study:

Three speech-language pathology“experts,” employed at a (1) medicalcenter, (2) public school system and (3)university speech and hearing clinicrespectively, had a minimum of fiveyears of experience working withchildren with severe speech andlanguage disorders. As a group, theyestablished a list of suspected DAScharacteristics. Subsequently, eachexpert independently viewed video-taped samples of 36 children withsuspected DAS referred by SLPs in thestate of Nebraska. The experts ratedeach child on salient characteristicsusing a rating scale of 1=definitely notDAS; 2=probably not DAS; 3=possiblyDAS; 4=probably DAS and 5=defi-nitely DAS. The purpose was toconfirm a diagnosis of DAS in eachchild.

These experts confirmed thediagnosis of DAS in all 36 children.Twenty-six of the children (nearly

70 percent) were assigned a meanrating of 5.0, indicating strongagreement among the experts. Ninechildren (24 percent) received amean score of 4.0 or more. Onechild received a rating of 3.33. Ballconcluded that, contrary to thereports of some researchers, thesedata show that speech-languagepathologists can agree about whichchildren have DAS, when clearcriteria are used.21

Traditional approaches tointervention

Traditional interventions for DAShave focused primarily on increasingor improving the articulatory profi-ciency of these children. A fewdecades ago, intervention programs

Table I. Characteristics of DAS from the literature

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For Consumers, Continued from page 3

such as Prompts for RestructingOral Muscular Phonetic Targets(PROMPT),22 Touch-Cuemethods,23and Melodic IntonationTherapy (MIT)24 were developed oradapted from adult motor speechliterature as a means of improvingthe intelligibility of children withDAS. Today’s interventions alsofocus on incorporating a motorspeech perspective in interventionplanning. Examples include inter-vention methods and procedures byStrand and McCauley14 andKaufman.25 These techniquesemphasize learning and executingmotor patterns, rather thanemphazing linguistic or phonologi-cal patterns of speech production.Other body movements are oftenused simultaneously to facilitatespecific types of oral movementsconsistent with the body movement.Principles of motor learning areemphasized. More recently, clinicalinterventions based on a perspectiveof managing co-existing communi-cation, academic and social con-cerns are being proposed.11,26,27,28

Within this framework, interventionapproaches that augment speech andlanguage deficits and enable chil-dren to communicate using a varietyof AAC techniques across environ-ments are beginning to emerge.

Gestures and manual signs

Children with severe DAS oftenuse gestures to communicatespecific messages. Some developelaborate and idiosyncratic gesturalsystems. For decades, professionalsand families have introduced moreformal gestural systems, such assign language, to help youngchildren who “walk but don’t talk”to convey meaning. This approach isknown as Total Communication(TC). While TC is an effectiveoption for some children with DAS,

it also has drawbacks:1. A TC approach requires that communicationpartners become proficient in learning andusing manual signs.

2. A TC approach requires that a child formulatesigns accurately so that their signs areintelligible to others.

Many children with DAS havegeneralized motor planning difficul-ties or limb apraxia and are unable toformulate accurate signs. Few peopleoutside the deaf community areproficient at using or recognizingmanual signs. Thus, when manualsigns and gestures are considered aspart of an intervention plan, oneneeds to assess the situation verycarefully. Trying to communicatewith people who either don’t knowsign language or can’t recognize yoursign productions will only add to thefrustrations children with DASexperience in communicating.

Other AAC approaches

Children with DAS have a higherprobability of failed communicationinteractions because of their reducedlevel of intelligibility and theirdifficulty initiating and participatingsuccessfully in interactions. Theyare at risk for developing behaviorproblems and face issues related toself-esteem and failing repeatedly insocial and academic realms.26,27

Intervention approaches that focusonly on improving the articulatoryproficiency, which simply supportspeech attempts through the use ofmanual signs, can not meet theneeds of children with severe DASor children with severe phonologicaldisorders.28 As a coping mechanism,these children may avoid talking,simplify their vocal responses and/or rely on nonverbal gestures tosupport and convey the intent oftheir message.

These children need access tolanguage and they need to exercisetheir right to communicate. AACapproaches directly address the

functional communication needs ofchildren and important quality oflife issues. AAC treatments providecompensatory ways to communicateand express language.28 The desiredoutcomes of AAC interventionsrelate to a child’s ability to expresslanguage and to communicateeffectively across environments.SLPs select from a variety of AACstrategies to augment a child’simpaired speech. These includemanual signs/gestures, low techdisplays with graphic symbols orwords, high tech devices withgraphic symbols or words andconversational repair strategies.AAC treatment approaches are usedin conjunction with, not in lieu of,an intense speech therapy program.

Summary

Some children who “walk butdon’t talk” have a diagnosis of DAS.To remediate these children’s severespeech and language disorders andameliorate the myriad of secondaryproblems caused by their speechintelligibility problems, AACtreatment approaches are used inconjunction with intense speechtherapy. However, many questionsremain unanswered. Among theseare:

1. For children with DAS, what effect does theintroduction of AAC techniques have on thequality and quantity of the communicationinteractions and on overall communicativeeffectiveness?

2. What modes of AAC are used mosteffectively by which children over time?

3. What role should AAC interventions play inearly childhood, in elementary school years andduring high school?

4. What are effective approaches to remediatespeech in children with DAS? How intensiveshould therapy and how should progress bemeasured over time?

5. Given the lack of data linking oral motortreatment approaches to any improvementin speech intelligibility/production, what, ifany role, does oral motor therapy play in thetreatment programs of children with DAS?

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Table I. Ten quick andeasy things to dowhen you meet an

augmented communi-cator15

Information sourcesfor parents &professionals

Parents of children with DAS whowant to learn about DAS and relatedinterventions often find it difficult toaccess good resources. The profes-sional literature on DAS is ratherdense, and can be difficult forparents and even professionals (e.g.,Blackstone) to follow. This sectiondescribes six websites that offereasily accessible information forfamilies and professions. I wouldrecommend CASANA’s site (#6) asyour first stop. It is quite well doneand very approachable.

1. http://www.asha.org/speech/disabilities/index.cfm The AmericanSpeech-Language-Hearing Associa-tion (ASHA) site has some introduc-tory information and a few links toother sites. Pages on the site discussaspects of DAS assessment andtreatment options.

2. http://www.tayloredmktg.com/dyspraxia/das.html Thissite has articles written by speech-language pathologists for families. Aunique feature is a list of individualsfrom around the world with DAS.Go to the site and then find theworldmap and usamap pages.

3. http://www.apraxia.cc/ Hostedby the CHERAB Foundation (Com-munication Help, Education, Re-search, Apraxia Base), this sitefocuses on children with severeneurologically-based speech condi-tions. Included on the site are pagesthat describe apraxia, therapies,assessment and more.

4. http://www.dyspraxia.com.auThis site is hosted by the Australian

Dyspraxia SupportGroup and ResourceCentre located in NewSouth Wales. It has

basic information andgood links to sites in the

U.K., Canada, Ireland and Australia.5. http://apraxiaontario.home

stead.com/index.html This site ishosted by the Expressive Communi-cation Help Organization (E.C.H.O.)located in Toronto, Canada. Estab-lished by parents for parents, it hassome very nice information.

6. http://www.apraxia.org/indexabout.html Hosted by the ChildhoodApraxia of Speech Association ofNorth America (CASANA), the sitehas a useful “site map” and searchfeature. Check out the followingpages when you visit this site:

Help! Enables parents/professionals to askquestions that require quick answers.

Frequently asked questions (FAQs).

Speech Topics. Articles relevant to the treatmentand diagnosis of DAS, including an articleabout the use of AAC in treatment by Dr. GaryCumley.

The Apraxia-Kids Monthly. An on-linenewsletter with articles, upcoming seminars,latest research, new books, and articles.

Family essays. Comments from parents andgrandparents.

Resources. Lists of materials for families andprofessionals in the U.S., Canada and the UnitedKingdom.

Interactive forums. Web pages include Talk toOthers, message boards, e-mail discussion lists,an apraxia chat group and regional apraxiaparent support groups (worldwide).

Differential diagnosis:Developmental apraxiaof speech andphonologic delay

Amy Skinder-Meredith, Ph.D.

This article considers whether achild has a diagnosis of develop-mental apraxia of speech (DAS) or aphonologic delay. The diagnosis ofDAS is challenging because manyspeech-language pathologists do notfeel confident in differentiatingDAS from a phonological delay.“Phonologic delay” refers to animpaired phonologic system (i.e.,the representation of the speechsound at a linguistic level) withoutconcern for a motor planningcomponent. As noted earlier,although developmental apraxia isbelieved to be motoric in nature, ithas a widespread linguistic effect.

Continued on page 6

Thus, children with DASdemonstrate impairedphonologic systems, asdo children with

phonologic disorders.However children with DAS’s abilityto acquire the sound system of theirlanguage is undermined by theirdifficulties managing the intensemotor demands of connectedspeech.29

Finding children for a study whohave ‘DAS’ as the primary compo-nent to their communication disor-der can be very difficult for re-searchers. For example, in onestudy, 24 children with suspectedDAS were referred as participants.They ranged in age from four tonine years. Of those, only six metthe study criteria (no cognitivedelay, dysarthria, or pervasivedevelopmental disorder). An addi-tional four children had an earlyhistory consistent with DAS, but, atthe time of the study, their DASappeared to have resolved into a

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Clinical News, Cont. from page 5

phonologic delay. Six of the 24children had a phonologic delayonly. The other eight children hadadditional disabilities, whichexcluded them from the study.

Children with DAS are a hetero-geneous population. While theyshare a cluster of symptoms, there isno agreed-upon diagnostic markerfor DAS. Unlike acquired apraxia ofspeech, there is no known neurologi-cal site of lesion or any otheraccompanying hard neurologicalsign. Instead, there are soft neuro-logical signs, such as fine and grossmotor difficulties and characteristicsthat are similar to other communica-tion disorders, like phonologicdelay. These children demonstratefrequent sound omissions, poorexpressive language skills, a limitedphonetic repertoire and reduceddiadochokinetic rates.

Another factor that makesdifferential diagnosis of DASdifficult is the age of the child at thetime of diagnosis. A child mayappear to have DAS at age two, butlook quite different at age three.Differentiating between DAS andphonologic delays at a very youngage is difficult. Many characteristicswill be shared, especially the child’sdecreased phonetic repertoire andpredominant use of simple syllableshapes. In addition, inconsistency oferrors appears to be more of anindicator of severity than of eitherDAS or a phonologic disorder. In asmall study, Betz found that fiveyoung children with severe phono-logic delay had just as many incon-sistent errors as five young childrenwith DAS.30

Assessment

How does one differentiate DASfrom a severe phonologic delay?Strand and McCauley suggest that

clinicians focus on the type ofprocessing impairment (cognitivevs. linguistic vs. motor planning vs.motor execution) rather than diag-nosing a child as having or nothaving DAS.29 The clinician needs todescribe the particular set of motorbehaviors that may be responsiblefor the disruption in phonologicperformance.

Figuring out the relative contribu-tion of factors contributing to asevere speech impairment requires acomprehensive speech evaluation,including (1) history, (2) examinationof the child’s neuromuscular status,(3) structural-functional examination,motor speech examination, and (4) athorough description of the soundsystem. Once dysarthria, hearingand structural anomalies (such ascleft palate) are ruled out or factoredin, the clinician moves to differentiat-ing between a motor component anda linguistic component. The develop-mental history, motor speech exami-nation, and description of the soundsystem will help in differentiatingthese two entities.

Developmental History. Whentaking a history of speech develop-ment in a child with suspected DAS,we frequently hear the following:• Quiet baby, did not play with sounds or

babble much.

• When babbling occurred, it was undifferentiated(included few or no consonant sounds).

• Says a word, then never says it again.

• Little attempt to imitate sounds or words.

• Resists attempts of adults/others to get him toimitate sounds/words.

• Limited vocabulary for age level.

• Intelligibility of words is poor.

• Words tend to be general in use (e.g., “numnum” used to represent anything good).

• Attempts to communicate through gestures,vowel sounds or other means.

• Demonstrates frustration at not beingunderstood, but seems to understand everything.

Children with DAS may alsopresent with a history of feedingissues, such as having a tendency to

fill their mouth with food (they maydesire increased proprioceptivefeedback), difficulty with suckingfrom a nipple or drinking from acup, and immature chewing pat-terns. Children with DAS are moreapt to need other ancillary services,such as occupational and physicaltherapy, than children with just aphonologic delay.Motor Speech Examination. Amotor speech examination considersperformance during speech as wellas the length and phonetic complex-ity of sounds in words and con-nected speech. One component iscomparing different syllable shapes(e.g., V, CV, CVC, CCVC, CCCVC,CCCVCC, etc.). SLPs may conducta Syllable Shape Inventory todemonstrate difficulties when wordlength increases. The exampleshown in Table II represents thesyllable shape inventory of a childwith DAS who experienced diffi-culty on words with more complexsyllable shapes.

Children with DAS and childrenwith phonologic delay have moredifficulty as the length of an utter-ance increases. However, thedifficulty is more marked in chil-dren with DAS. For example, if thechild is asked to repeat a series oflengthening utterances, such asbase, baseball, baseball player, thechild with DAS may produce basecorrectly, but drop out sounds anddistort the vowel when producing

Table II. Syllable ShapeInventory: Child with DAS

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baseball. On the other hand, a childwith a phonologic delay may saybase correctly and then go back tothe phonological process he uses onlonger words when saying baseballand baseball player. While childrenwith DAS may also have delayedphonological processes, they aremore likely to show other types oferrors (e.g., vowel distortions andprosodic errors); and their errorswill be less consistent than theerrors of children with phonologicdelays.

SLPs can also use a techniqueknown as an integral stimulationapproach,31 which is modified fromthe Eight Step Continuum foracquired apraxia of speech.32 Thisapproach allows the clinician toassess what occurs when temporalrelations are varied (e.g., simulta-neous production vs. immediateimitation vs. delayed imitation).Integral stimulation is useful in bothtreatment and assessment of DAS,as described below:

If a child is unable to produce a word inimitation, the clinician provides a simultaneousmodel (e.g., “Watch and listen and we’ll say theword together.”) Children with motor planningdifficulties do much better when they have asimultaneous model and the rate of speech isdecreased. Tactile cueing may also be necessary.

After producing the word correctly severaltimes during simultaneous production, theclinician will see if the child can maintaincorrect articulation with just a visual model(e.g., the clinician just mouths the words whilethe child says the word).

The clinician gradually fades cues and increasesthe time between the child’s production and his/her own. Children who have severe motorplanning underlying their speech disorderdemonstrate marked differences betweensimultaneous production and delayed imitation.

In essence, when the clinicianasks the child to imitate a modelafter a pause, the clinician is askingthe child to retrieve the motor plan.This can take a lot of practice. Inusing a simultaneous productiontechnique, the clinician decides whatlevel of phonetic complexity andutterance length to start with. For

example, if the child is only speak-ing in undifferentiated vowels, theclinician may begin with differenti-ated vowels and combine them inCVs, VCs and CVCs. If the child isspeaking in CVCs with correctvowels in single syllable words, theclinician may build on the CVCwith more complex syllable struc-tures and try bisyllabic andmultisyllabic words and phrases.

Other Areas of Assessment

Davis, Jakielski, and Marquardtproposed that there are three pri-mary speech characteristics thathelp differentiate DAS from othertypes of speech delay.33 These threeareas include: vowel errors, incon-sistency of errors and prosodicdisturbances.

Vowel errors. When cliniciansdo a motor speech evaluation, it isimportant that they sample all of thevowels and hear their productions indifferent syllable shapes. A childwith DAS may be able to producevowels correctly in isolation buthave difficulty when putting thevowel in a CVC or longer syllablestructure.

Children with phonologic delaysare not apt to make vowel errors.Vowel errors consist of neutralizingvowels, reducing diphthongs tomonophthongs, tensing lax vowels,and laxing tense vowels. With theexception of rhotic vowels, typicallydeveloping children correctlyproduce vowels by age three.

Inconsistency of errors. Whenexamining consistency of errors, theclinician will need to elicit a set ofwords multiple times. The SLP canuse the formula in Table III to judgethe consistency of errors (i.e., ratioof most consistent production overtotal number of productions). Astudy by Bradford and Dodd usedthe 25 Word Test for Inconsistency.34

They considered children who

scored more than 40 percent to bemaking inconsistent errors. Assess-ing the inconsistency of errors is anarea that would benefit from moreresearch to determine (1) what ismeant by inconsistent errors and (2)at what point do we decide a child’sspeech is characterized as havinginconsistent errors. This measure isnot appropriate for children withvery limited speech.

Prosodic disturbances. Anotherarea clinicians should assess isprosody. Some researchers believethat a prosodic disorder is a diagnos-tic indicator for a subset of childrenwith DAS.18,35,36 One theory is that ifprosodic aspects of speech aredisordered, the effect on articulationis adverse. Another theory is thatchildren with DAS are struggling toplan correct articulatory movementsfor speech and this results in disor-dered prosody. Regardless, childrenwith DAS demonstrate prosodicdisturbances, while those withphonologic delay typically do not.

Clinicians can assess prosody inseveral ways:

• Observe prosody in conversational speech:measure percent of utterances with abnormalstress, phrasal stress, percent of multisyllabicwords with abnormal stress, etc.

• Observe whether child stresses the appropriatewords and syllables.

• Determine if the child uses contrastive stress(e.g., I want to go home vs. I want to go home.).

• Assess whether the child can imitate theprosodic contour of modeled sentences.

Table III. Formula for determiningerror inconsisstency

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Clinial News, Continued from page 7

• Observe what happens to the child’s prosodywhen they are attempting to produce the correctsounds. Do they produce the word or utterancewith equal stress, carefully articulating onesyllable at a time? [Note: Sometimes this can bean artifact of speech therapy.]

Careful and thorough assessmentwill assist the clinician in decidingthe relative contribution of motorplanning and linguistic impairmentto the child’s speech disorder.

Of course, it is also important toassess cognition (using a test thatdoes not require a verbal response)and hearing and oral structures, andto thoroughly assess language.Language learning and literacydeficits often occur in children withDAS. Even when children appear tohave normal language skills earlyon, they may demonstrate difficultyin “higher language processes,” suchas categorizing, organizing andabstracting, in the third or fourthgrades.37

As DAS is merely a cluster ofsymptoms, children with DAScomprise a heterogeneous group.Children who present with only amotor planning component to theirspeech disorder are rare. When achild is highly unintelligible,differentiating between a severe

phonologic delay and DAS can beeven more challenging.

Speech therapy

Regardless of the primary deficit,children with severe speech impair-ments need intensive speech therapyearly on. Young children benefit fromfrequent short sessions (e.g., up tofour times/week for 30 minutes asession). These are preferable overlonger, less frequent sessions. Ingeneral, children with phonologicdelay progress more quickly thanchildren with DAS. This means thatthe child with DAS will need theseintensive services longer.

To make speech therapy motivat-ing for the unintelligible child (DASor severe phonological delay), it ishelpful to begin by working on a corevocabulary that gives the child somepower and social gratification. Theinitial vocabulary begins with simplesyllable shapes and stimulablephonemes. Over time, the therapysystematically expands the child’sphonetic repertoire and soundsequencing ability so they can makedifferent syllable shapes. An initialvocabulary might include: ‘no’, ‘alldone’, ‘hi Mom’, ‘hi Dad’, ‘go’.These words are motivating and

Designing an AAC programfor children with DAS with

Marlene Rayner Cummings

In 1996, 22 students were enrolledin the Utica Community Schools(UCS) Early Childhood SpecialEducation program. Seven of thechildren (3 boys and 4 girls, ages 3to 5 years old) had unintelligible,limited or no verbal speech. At thetime, SLP assessments revealed that

these students haddevelopmental apraxiaof speech (DAS) andtheir expressive and, in

some cases, receptivelanguage skills were also delayed.

Within the school district therewere no intensive programs thatcould meet the needs of studentswith severe DAS who did not havethe primary diagnosis of autism orsevere physical or cognitive impair-ments. Their social and academicdevelopment was considered at risk.Therefore, staff designed a dynamicintervention plan to enable these

children to acquire language,literacy and social communicationskills, first in a self-containedpreschool classroom and subse-quently, in kindergarten and firstgrade classrooms with support fromthe AAC team.

The resulting program is knownas the Augmentative/AlternativeCommunication Program andAssistive Technology Center. Locatedin Havel Elementary School in Utica,Michigan, it received the MichiganSpeech-Language-Hearing Associa-tion award for the “Program of theYear” in March 2000.

phonetically simple. For childrenwith DAS, it is extremely importantto work on sequencing soundstogether rather than working onsounds in isolation. In other words,work on ‘go’ as one word, not ‘g-o’.Conversely, children with severephonologic delay often will general-ize and use sounds they learn inisolation in words and phrases.

Language therapy

While working on speech with anunintelligible child, it is also neces-sary to address language develop-ment issues. Therefore, augmentingspeech with picture symbols, signlanguage, and/or naturalistic gesturesis extremely beneficial and providesthe child with alternative ways ofexpressing ideas and basic concepts.Ready-made picture symbol booksallow children to participate in storytelling and other activities usingpicture symbols. As children are ableto produce more of their messagesverbally, use of alternative modes ofcommunication fades.

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To enroll in the program, stu-dents must:

• Be three to five years of age.

• Lack expressive communication and/or have speech that is unintelligible toat least some familiar partners.

• Have language delays, which may bedue to the lack of opportunities toverbally manipulate language.

• Not evidence significant cognitiveimpairment, severe physical disabilitiesor symptoms of autism.

• Demonstrate the potential to beacademically competitive.

The program is designed toinsure that the children receiveoptimum educational opportunitieswith an emphasis on communicationskill development using a collabora-tive team approach. Students receiveinstruction in the program’s specialeducation classroom and in regulareducation classrooms. Daily sched-ules are strategically arranged toallow students to participate in corecurricular content, while receivingintensive training in communication,literacy and assistive technologies.

Key components

Components of the programinclude:

1. Sensory-motor therapies. Intensiveneurologically based sensory-motortherapies address hyper/hypo sensitivityissues and motor planning problems.The sensory-motor program issupervised by an occupationaltherapist.

2. AAC therapy. Assistive technologiesand AAC strategies are used to developlanguage and literacy skills. AACapproaches used include: (a) aidedlanguage stimulation to modelexpressive communication usingsymbol supports, (b) use of symbolcommunication dictionaries to increasevocabulary and generate novel symbolbased phrases and (c) symbol basedclassroom flipbooks which allowstudents to participate in typical “circletime” routines by using visual supportsduring verbal activities. (e.g., recitingABC’s, months, days of the week,

Figure 2. Multimodal snack time

nursery rhymes and chants).

3. Speech-language therapy. Directspeech-motor therapy (PROMPT) andspeech therapy is provided individuallyand in small groups, using augmentedstories to support early literacycompetencies and concept development(rhyming, patterning, sound identifica-tion).

4. Social work services. Direct socialwork services are provided in indi-vidual and small group settings.Assistive technologies and techniques(symbol boards, speech output devices,social stories) are used to facilitatesocial skill development.

5. Early Childhood Curriculum.Monthly thematic units are chosen toexpose children to basic core vocabu-lary, early language concepts and basiclanguage structures. Stories, nurseryrhymes, and songs augmented withsymbols and low and high tech AACdevices allow students to manipulateand use language. Kindergarteners andfirst graders participate in the generaleducation curriculum with supportfrom the AAC program.

6. Parent involvement and training.Families attend staff meetings,technology trainings and AAC strategysessions. The monthly thematic familycalendar includes several familyprojects and activities, which are sentinto school to support student participa-tion and home/school communication.

Collaboration. A key componentof the program is the collaborativeteam that supports each student inthe classroom.* This team, invarious configurations, discussesindividual student issues anddevelops program parameters,methods and strategies.* Team members include family members,

classroom teacher, assistive technologyassistant, teaching assistants, general educationteachers, school psychologist, school socialworker, speech-language pathologist, occupa-tional and physical therapists and county/state/national experts.

Family involvement. Families ofchildren with DAS face manyimportant questions and decisions.Many have been encouraged to“wait and see” or to expect theirchildren to “outgrow” their speechproblem. The program staff directlysupport the families and addresstheir concerns by a) discussing eachchild’s speech prognosis, b) helpingfamilies make decisions about thefocus of intervention, c) beingsensitive to lifestyle and familypreferences and d) helping familiesto integrate communicative supportsacross environments and partners.

10

Case Examples, Continued from page 9

Transition. After first grade, thestudents leave the program andreturn to their home school. Tosupport each student’s smoothtransition from the AT Center to thelocal elementary school, programstaff shares expertise, resources andequipment with district teams whowill be working with students insecond grade and beyond. Equip-ment comes from the AssistiveTechnology Equipment Collectionand Resource Library, which hasadapted books, communicationdisplays, computer software applica-tions, AAC devices, switches andalternative keyboards, as well asjournals, books, newsletters andelectronic reference materials.

During the student’s last year inthe AAC program, the transitionteam meets three or four times toshare written, verbal and videoportfolios. Student observations,technology training and classroomvisitations are just a few of the waysstaff, families and students collabo-rate.

Emphasis on communicationskills development. The program’scommunication-based curriculum isspecifically designed to support thedevelopment of basic languageconcepts, language structures andlanguage use. As a result, studentsare given multiple opportunities todevelop, understand and expresslanguage. Symbol/word-basedintervention materials allow studentsto physically, auditorily and visuallyexplore, understand and manipulateearly language concepts and basiccore vocabulary through literature,nursery rhymes, songs, and fingerplays. Typical early childhoodactivities are chosen to provideopportunities for targeted communi-cative interactions throughout theday. Communicative expectations

and a variety of assistive technolo-gies are identified for each activity.Adult and typical peer models areutilized to provide consistent,ongoing examples of communica-tion initiations, turn taking, sentencebuilding, etc. Communicationstrategies employed include:

Use of icon displays and AAC devices.Low and high tech AAC devices areused to augment activities that involveclassic literature, nursery rhymes andfinger plays to increase core vocabu-lary, patterning and phonemic aware-ness. For example, the book BrownBear, Brown Bear is introduced alongwith: (1) single symbols so students canretell the story line and change thestory’s order and endings; (2) anaugmented book to which children canadd art and then take the book home foradditional readings; (3) single switchesthat are used to repeat lines in the storyand increase student participation; (4)symbol displays that contain additionalanimals, colors and actions to expandthe story line; (5) props that studentscan manipulate during story retellingand (6) AAC devices that allow thestudents to read the story word-for-word and line-by-line.

Augmented songs. Low-tech displaysand AAC devices allow children toexplore language concepts, rhyming,

repeating lines and enhancing socialparticipation. Examples are SongBoards by Carol Goossens’, StorytimeSongs by Patti King-Debaun and classicearly childhood songs augmented withsymbols placed on single switches,AAC devices and computer software.

Use of single and multi-level AACdevices. AAC devices can supportlanguage, literacy and social interac-tions. Some examples are the: (1) BigMac for repeated lines, (2) Step-by-Stepcommunicators for simple storyretelling, (3) Zygo Macaw to readstories symbol by symbol and changeendings, (4) CheapTalk for snack timeand simple classroom routines, (5)DynaMyte for language developmentand interactive communication, (6)Dynamo for social interaction and shortpredictable communication exchanges.

Use of symbol-based classroomcommunication books. Communicationbooks are used to help develop academicvocabulary and support expressivecommunication attempts. One exampleis a symbol-based classroom flipbookcontaining typical “circle time”vocabulary (colors, letters, numbers,months, weather, basic concepts, songchoices, chants, shapes, classroomrules). Students use these as visualsupports and as low-tech expressivecommunication tools during verbalchants and single response interactions.

Figure 3. Expressing thoughts and opinions using an AAC device

11

Use of activity-based communicationdisplays. Activity-based displays cansupport a child’s understanding and useof core vocabulary. Examples includecommunication displays from Engi-neering the Preschool Classroom byCarol Goossens’, as well as displayscreated specifically for board games,bingo and other play-based communi-cation activities.

Use of an augmented literacy series.Teaching emergent literacy skills (e.g.,developing a sight word vocabulary andmanipulating letters and sounds) isimportant. Staff uses the Learn To ReadLiteracy Series by Creative TeachingPress to provide a consistent approachto literacy skill development. Forexample, Level 1 supports basiclanguage concept development andLevel 4 has books on Science, SocialStudies, Math and Fun and Fantasy.Books are augmented with symbolsentence strips for line-by-line textmanipulation and single symbols areavailable for word-by-word storyretelling. By the end of the program,students have typically acquiredadequate literacy and communicationcompetencies to support learning.

Outcomes

The AAC Program and ATCenter were designed with a spe-cific student profile in mind. Of theseven students with AAC needs whoentered the program in 1996, onestudent moved out of district.Another student, whose speech isnow intelligible, is in 4th grade.Three students are in 3rd grade--onehas intelligible speech and two areusing DynaMytes with Gateway 54software to support their expressivecommunication and classroomparticipation. Two students are in2nd grade. Both use DynaMyteswith Gateway 54 software. Here aredescriptions of three of thesestudents.

4th grader. This student entered theprogram at age three with manybehavior, sensory and languageneeds. Since then, the student hasprogressed from being minimally

verbal to extremely unintelligibleto being understood 90% of thetime by unfamiliar listeners. Hecontinues to receive extensivelearning supports and now has adiagnosis of severe LD.

3rd grader. This student entered theprogram at age 51/2 with minimalAAC supports prior to hisplacement in the program. Hemanifested many accompanyingsensory, cognitive and languagedifficulties, and his expressivecommunication consisted of fiveto ten single word approxima-tions. This student can nowexpress single and two wordcombinations. He uses naturalgestures to greet others, expressbasic needs, protest and getlistener’s attention. He is pres-ently using a Dynamyte withGateway 54, a symbol-basedcommunication dictionary, anaugmented literacy program(AlphaSmart, Co:Writer andWrite Out Loud) to supportwritten language in his regulareducation classroom.

2rd grader. This student enrolled inthe program at age 3.At that time,the student used 10-15 wordapproximations and had markeddelays in sensory, fine and grossmotor skills. The student appearedto have typical learning potentialand made significant expressiveand receptive communicationsgains in the program. Currently,the student uses 3-5 word sen-tences with 40-70% intelligibilitydepending on context, complexityand familiarity of the listener.Speech is augmented by a symbol-based communication dictionaryand a Dynamyte with Gateway 54.The AAC device is used primarilyas a repair strategy for unintelli-gible verbal communication and to

support decoding needs in theliteracy program. The studentdepends on verbal communica-tion to communicate at homeand with peers. Co:Writer andWrite OutLoud are used tosupport written language inthe classroom.

Elder, Pamela S., Goossens’, Carol, (1994)Communication Displays for Engineering ThePreschool Environment. Southeast Augmenta-tive Communication Publications, 2430 11thAve., N., Birmingham, AL 35234

Goossens’, Carol, (1998) Engineering CircleTime. 18th Annual Southeast AugmentativeCommunication Conference Proceedings.Southeast Augmentative CommunicationPublications, 2430 11th Ave., N., Birmingham,AL 35234

Goossens’, Carol (1999) Song Boards ForEngineered Classrooms. Southeast Augmenta-tive Communication Publications, 2430 11thAve., N., Birmingham, AL 35234

King-DeBaun, Pati, Storytime Songbook I andII . Creative Communicating P.O. Box 3358Park City, UT 84060

Learn To Read Series by Creative TeachingPress, P.O. Box 2723, Huntington Beach, CA92647-0723

The PROMPT system, The PROMPT Institute,Santa Fe, New Mexico, USA, Toronto, Ontario,Canada

Dynavox, Dynamo Dynavox Systems, Inc.,2100Wharton Street, Pittsburgh, PA 45203 8-00-697-7332, www.dynavoxsys.com

BIGmack Communication Aid, Step-by-StepAbleNet 1081 Tenth Avenue S.E., Minneapolis,MN 55414-1312. 800-322-0956,www.ablenetinc.com

CheapTalk Enabling Devices, 385 WarburtonAvenue, Hastings-on-Hudson, NY 10706. 800-832-8697, www.enablingdevices.com

Macaw Zygo Industries, Inc., P.O. Box 1008,Portland, OR 97207-1008. 800-234-6006, http://www.zygo-usa.com

12

and various AAC lowand high tech aids, aswell as speech.

Preschool student:Researchers introduced the

Wolf, a voice output device,and a remnant book, which allowed thechild to initiate and reference pastexperiences with familiar and unfamil-iar communication partners. Resultsshowed the student’s mean length ofutterance increased, as did heropportunities for engaging in languageand conversational discourse.

Elementary school-aged student:Researchers focused on supportingnatural speech production andproviding effective strategies and AACaids to increase the student’s opportuni-ties for interaction. As a result, she wasable to successfully establish communi-cation topics through the use of herremnant book and repair her frequentcommunication breakdowns using asymbol dictionary.

Junior high school student: Beforetreatment, this student did not initiateor attempt to repair his communicationbreakdowns. Instead he relied on hiscommunication partners to take anactive role in the repair process. WithAAC aids, he began to take moreresponsibility and attempted to repairsome of his frequent communicationbreakdowns.

In summary, results indicatedthat when AAC tools and strategieswere introduced, these children hadgreater opportunities to initiate andmaintain interactions, as well as torepair communication breakdowns.They used these strategies acrossvarious communication situations,with both familiar and unfamiliarcommunication partners.39

Sixteen cases

Cumley reported on 16 school-age children between the ages ofthree and seven who had severephonological disorders and/orsuspected DAS.40 All had receivedongoing speech and languageintervention services through thepublic schools, but had mademinimal progress. The goals of thestudy were to determine the effects

of a low-tech AAC approach on thequality and quantity of the childrens’communication interaction. Thestudy had three phases: pre-treat-ment (no AAC boards available);treatment (AAC boards available);and post-treatment (no AAC boardsavailable).

Researchers provided only 1 hourand 40 minutes of training overthree sessions to each child. In thepre-treatment phase, no board wasavailable. Then, the researcherfamiliarized the children with acommunication board during playand book reading situations. Boardswere available to use during thetreatment phase of the study. Theboard contained graphic symbolsand was designed around contex-tual-based activities. During thepost-treatment phase, boards werenot available. Interactions betweenthe children and the investigatorduring each phase of the study werevideotaped for subsequent analysis.

After viewing the tapes, research-ers assigned each child to a fre-quency-of-use group. Assignmentswere made by calculating the totalnumber of times each child used theAAC board during the treatmentphase. Of the sixteen children, fivewere assigned to the low frequencyAAC user group and seven wereassigned to the high frequencygroup. The four children in themedium-use group were not in-cluded in subsequent analysis.Researchers noted that the childrenin the high frequency AAC usergroup tended to have more severephonological disorders than childrenin the low frequency AAC usergroup.

Proportional data were calculatedand group comparisons made acrossthe three phases and across thevariables of comprehensibility andcommunication modality, contingent

Three empiricalstudiesResearch has shown that theintroduction of AAC positivelysupports the communication interac-tions and language development ofchildren with severe speech impair-ments and can provide individualswith greater opportunities andaccess to communicative interac-tions. However, there is limitedresearch that addresses the use ofAAC devices with children whohave a diagnosis of DAS. Examplesof three studies investigating theeffects of AAC interventions onchildren with DAS are describedbelow.

Single case

Culp conducted a single casestudy with an eight-year-old girlwith DAS, her mother and schoolstaff. The intervention focused onteaching the child’s communicationpartners to use different AAC modes(i.e., sign language, gestures, and acommunication book) and tofacilitate the child’s communicativeinteractions. Results were positive.The girl’s communication interac-tions were enhanced when partnerssupported the use of AAC tech-niques and she used them.38

Three cases

Cumley and Swanson conducteda descriptive case study of threechildren with DAS: (1) apreschooler, (2) an elementaryschool-aged student, and (3) a juniorhigh school student.39 The studyinvestigated the effects of amultimodal AAC interventionapproach on communication, i.e.,the use of gestures, manual signs

13Continued on page 14

communication and communicationbreakdowns, as described:

Comprehensibility and communicationmodalities. Researchers classified allcommunication attempts as comprehen-sible (understood) or non-comprehen-sible (not understood). Then theydescribed each attempt according tocommunication modality used duringthe videotaped communicationinteractions (gestures, non-conventionalsigns, manual signs, vocalizations,verbalizations, AAC, drawing, andwriting.)

Contingent Communication. Research-ers classified partner questions as eitheryes/no or Wh question forms and thechildren’s responses as either aresponse to yes/no questions or Whquestions.

Communication Breakdowns. Theseverity of the phonological disordersaffected the children’s level ofintelligibility and resulted in a highfrequency of communication break-downs. Researchers noted all communi-cation breakdowns, how the childrentried to repair each breakdown andwhether or not they were successful.40

ResultsThe results of the study sug-

gested that children’s phonologicaldisorders directly influencedwhether children with DAS usedAAC techniques. The more severethe phonological disorder, the moreoften children used communicationboards if they were available.Characteristics of low and highfrequency users are described below.Low frequency AAC users

The low frequency group consis-tently used spoken words and/orgestures as their primary mode ofcommunication. When communica-tion boards were available, the lowfrequency group showed littlechange in the proportion of spokenwords and/or gestures used. Theboards did not have an adverseeffect on the child’s use of speech.In fact, the low frequency groupdemonstrated a marked increase intheir use of speech when the boardswere available. These individuals

showed no apparent pattern inanswering yes/no and Wh questionsand used only speech for repairingtheir communication breakdowns.High frequency AAC users

Unlike the low frequency users,high frequency users behaveddifferently during the treatmentcondition. Specifically, when boardswere available, they:

1. Were more comprehensible whencommunication board(s) were used.

2. Decreased the proportion of gesturaluse and increased the use of thecommunication board.

3. Replaced some gestures withcommunication board use.

4. Were more successful answering yes/no and Wh questions using a communi-cation board.

5. Responded to questions morefrequently when the board(s) wereavailable.

6. Replaced less symbolic forms ofcommunication (gestures) with a moresymbolic form of communication(graphic symbols).

7. Repaired their communicationbreakdowns more successfully whencommunication boards were available,than they did using speech.

The high frequency group usedprimarily spoken words and gesturesto repair their communicationbreakdowns in the nontreatmentconditions, but, when communica-tion boards were available, half oftheir successful communicationrepairs were accomplished using theAAC boards. When using the boardsto repair breakdowns, the highfrequency group showed a slightdecrease in speech and gestures as aprimary repair strategy, proportionalto their use of boards.Conclusion

The study showed that even withminimal exposure to communicationboards (a total of 1 hour and 40minutes), positive changes werenoted in the quality and quantity of

the children’s communicationinteractions during the treatmentcondition. The children with themost severe phonological disorderstended to use the AAC communica-tion modalities provided more thanchildren whose speech impairmentswere less severe.

Summary

Frequently parents and evensome SLPs worry that the introduc-tion of AAC will inhibit the use ofspeech. These studies alleviate thosefears. The empirical data fromCumley’s studies provide speech-language pathologists with a ratio-nale for introducing AAC to chil-dren with severe phonologicaldisorders and/or DAS. After a veryshort time period, children withsevere speech impairments benefitfrom using AAC techniques. Thismeans that SLPs can introduce AACapproaches and determine whetherthey will benefit a child ratherquickly. In addition, these studiesdemonstrate that children can andwill use AAC techniques for avariety of purposes, includingrepairing communication break-downs, establishing topics, answer-ing questions and using languagerather than nonlinguistic forms. Itappears that the more impaired thespeech, the more readily childrenwill rely on AAC techniques.

The introduction of AAC boardsdid not adversely affect the fre-quency with which children spoke.Instead, it appeared that communi-cation boards may have visuallysupported the children’s use oflanguage and increased their speechoutput. These studies show thatAAC not only supports naturalspeech attempts but also supportsthe use of language and enhancescommunication effectiveness.

14

Across space and time:2002 Interactive LectureSeries in AAC The Kornreich

Assistive Technology Center, the

AAC-RERC and USSAAC

The technological advances of the21st century already are changinghow we do things. As the first“virtual” RERC, the AAC-RERC isnow using a variety of new tech-nologies to facilitate collaborationsamong its partners who live andwork from coast to coast. The sevenpartners of the AAC-RERC [DukeUniversity, Pennsylvania State Univer-sity, Temple University, University atBuffalo, University of Nebraska–Lincoln, University of North Carolina-Chapel Hill and Augmentative Commu-nication, Inc.] conduct research anddevelop projects, provide trainingand disseminate pertinent informa-tion to AAC stakeholders.

The Kornreich Assistive Technol-ogy Center is a Division of theNational Center for DisabilityServices and is located in Albertson,NY. It is committed to bringing neweducational and training opportuni-ties to professionals and consumers,particularly in the area of AAC.Within the Kornreich Center is astate-of-the-art technology centerequipped with the latest technologyin web casting, video conferencingand more. These technical andhuman resources at the KornreichAssistive Technology Center willsupport AAC educational web castsby experts.

Collaboration

In what promises to be a positivecollaboration, the AAC-RERC, theKornreich Assistive TechnologyCenter and the United States Society

of Augmentative andAlternative Communi-cation (USSAAC) willoffer AAC profession-

als, augmented commu-nicators and their families trainingopportunities they can easily accessfrom their home or office. Each ofthe collaborators has a uniquecontribution to bring to the table.The Kornreich Technology Centerplays the lead role by hosting andproviding financial and technicalsupport for each web cast. TheAAC-RERC assists by developingcontent for the lecture series andworking to expand the diversity ofthe audience. USSAAC will offerASHA CEUs to participants whowish to pay for them.

Working together, the collabora-tors share a common goal: toprovide information in the area ofAAC that is high quality, up-to-date,relevant, useful and accessible. Ashared vision of the collaborators isthat the web casts be an innovativeway to involve augmented commu-nicators and family members in thetraining, research, development andtreatment discussions that tend tooccur among professionals duringconferences and workshops.

Iris Fishman, Director of theKornreich AT Center, will host theweb casts and serve as moderatorduring the live question and answerperiod following each presentation.The AAC-RERC partners [DavidBeukelman, Sarah Blackstone, DianeBryen, Kevin Caves, FrankDeRuyter, Jeff Higginbotham, JaniceLight, David McNaughton, JanetSturm, Michael B. Williams andDavid Yoder] will be among those toprovide the lectures. A total of 1.5hours is allotted for each session inthe lecture series. Questions to thepresenters are e-mailed in.

Lecture Series

In December, the Kornriech ATCenter hosted two lecturers: LewisGolinker from the Assistive Tech-nology Law Center who spoke onMedicare funding of AAC devicesand Pat Ourand of AssociatedSpeech and Language Services, Inc.who presented How to do assess-ments for augmentative communica-tion. The January lecture will bepresented by Drs. David Beukelmanand Laura Ball on the topic of AACtechniques and people who haveALS: Clinical decision making.

It is simple to join a web cast.The required technologies are acomputer and an Internet connec-tion. The Real Player software isneeded to view the web cast andShock Wave software is needed toparticipate in the discussion with thespeaker. Both Real Player andShockwave are available free ofcharge.

Participation in each web cast isoffered for free (at least for now).After each web cast, the lecture isarchived and can be viewed later byanyone wishing to see the tape.

For questions about the web cast series, pleasee-mail Iris Fishman ifishman@ncds.org TheKornreich web site is http://www.kornreich.org

You can link to the Kornreich web site and theweb cast archives from the AAC-RERC webpage http://www.aac-rerc.com.

The AAC-RERC section is partially fundedby the National Institute on Disability andRehabilitation Research under grant numberH133E9 0026. The opinions are those of thegrantee and do not necessarily reflect thoseof the U.S. Department of Education.

15

Augmentative CommunicationNews (ISSN #0897-9278) ispublished quarterly. Copyright 2001by Augmentative Communication,Inc. 1 Surf Way, Suite 237,Monterey, CA 93940. Reproduceonly with written consent.Author: Sarah W. BlackstoneTechnical Editor: Carole KrezmanManaging Editor: Harvey PressmanOne Year Subscription: Personalcheck U.S. & Canada = $50 U.S.;Overseas = $62 U.S.Institutions, libraries, schools,hospitals, etc.: U.S. & Canada=$75U.S.; Overseas = $88 U.S. Single rate for this issue = $20.Special rates for consumers and full-time students. Periodicals Postagerate paid at Monterey, CA. POST-MASTER send address changes toAugmentative Communication, Inc.1 Surf Way, Suite 237, Monterey, CA93940. Telephone: (831) 649-3050.FAX: (831) 646-5428.e-mail: sarahblack@aol.com

Continued on page 16

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16

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References, Cont. from page 15

36 Shriberg, L. Aram, D. & Kwiatkowski, J.(1997). Developmental apraxia of speech: IIToward a Diagnostic Marker III. A subtypemarked by inappropriate stress. JSLHR. 40:2,286-312.

37 Air, D., Wood, A., & Neils, J. (1989). Consider-ations for organic disorders. In P. W. Newman,N. A. Creaghead, & W. Secord (Eds.),Assessment and remediation of articulatory andphonological disorders (pp. 269-281).Columbus: Merrill.

38 Culp, D. (1989). Developmental apraxia andaugmentative or alternative communication - Acase example. Augmentative and AlternativeCommunication, 5, 27-34.

39 Cumley, G. D., & Swanson, S. (1999).Augmentative and alternative communicationoptions for children with developmental apraxiaof speech: Three case studies. Augmentativeand Alternative Communication, 15(2), 110-125.

40 Cumley, G. D., (1997). Introduction of anaugmentative and alternative modality: Effectson the quality and quantity of communicationinteractions of children with severe phonologi-cal disorders. Unpublished doctoral dissertation,University of Nebraska, Lincoln.

ResourcesLaura J. Ball, Ph.D., Assistant Professor Munroe-

Meyer Institute for Genetics and Rehabilitation,985450, Nebraska Medical Center, Omaha, NE68198, 800-656-3937/402-559-6460.lball@unmc.edu

Gary D. Cumley, Ph.D., Associate Professor,School of Communicative Disorders, Universityof Wisconsin-Stevens Point, 1901 4

th Ave.,

Stevens Point, WI 54481, USA. 715-346-4699.gcumley@uwsp.edu

Marlene Rayner Cummings, M.S., UticaCommunity Schools Augmentative/AlternativeCommunication Program and AssistiveTechnology Center, Havel Elementary School,41855 Schoenherr Road, Rochester Hills, MI48307. 586-254-8299. mrc1mucs@ucs.misd.net

Amy E. Skinder-Meredith, Ph.D., AssistantProfessor, Dept. of Communication Sciencesand Disorders, University of Minnesota Duluth,229 Bohannon Hall, 10 University Dr., Duluth,MN 55812. 218-728-9152.ameredit@d.umn.edu