This week, we are talking about High-Leverage Practice #19: Use assistive and instructional technologies. I know, Alex, for you in your work, this has looked a whole bunch of different ways. So, for you, what does this practice include?
Back as a practitioner, I think obviously the big one that most people in the ABA field would be very familiar with is AAC (Augmentative and Alternative Communication). AAC Technology. It's generally very amazing giving these children that, or even adults that didn't have a voice, would instead engage in these behaviors because they just couldn't communicate, and that was their form of communication. Be able to give them a voice and teach them that if you want something, you don't have to bite yourself, you don't have to hit mom or dad, press this button, and it gets rid of all the extra steps. It's just very quick and easy. So it was always very cool for me teaching even the kids who did have a voice, but maybe their articulation wasn't good.
You know, I had a member who I used to work with. He was awesome. He has a twin. His twin brother was so similar, but also so different. So the twin, his brother, spoke very well, but he was very hyper and like a little more devious. He was awesome. But he, on the other hand, the member that I'm talking about, he had such difficulty with articulation. And then because he couldn't communicate effectively, you would just see him engage in so many more destructive and physically aggressive behaviors because he just couldn't get out of the words compared to his brother. His brother was more chill, easygoing, like, get it out. And he'd say it, and then he would just be more frustrated. And I remember when I spoke with my former boss, and we would collaborate and brainstorm on how we could do this. We thought about even using PECS (Picture Exchange Communication System) at the time. Old school PECS, I loved using PECS back when I was an RBT. We were talking, and she's like, ‘Oh, what about AAC?’
At the time, I had very limited knowledge of AAC. I was just a fresh face in the field. And she's like, ‘take this course, read up on it, figure it out, and then we'll reconvene and figure it out.’ So I did it, and it was really cool. It was very eye-opening. And then we reconvened, and she was like, ‘All right, so how are we going to tackle this?’ I was like, ‘Well, I think the best way would be to get a list of words from mom and dad that he uses his own variation of.’ So we did. We got like a hundred-page list of things that he commonly would say, but like, it was the word, but he had his own way of saying it, and everyone understood it. But that obviously can't work in the real world because no one's going to understand a noise versus the actual word.
So I remember we got this list, we wrote out all the words, we got pictures, and we put it on the tablet. And then I explained it to mom and dad. I was like, ‘Look, in most cases, in a lot of cases, really, when AAC is used, that's going to be their voice.’ But the way we used it with him is because he did have some baseline vocal communication. He was able to vocalize certain things. He just had a difficulty with articulation. So the way we approached it was like, we want to use this device, but we don't want him to only use his device. We want him to press the word, listen to that model, and then try his best to copy it. And I will never forget, maybe like a month or two into using that device, one, he’s incredibly gifted, because he understood. I will never forget the moment he started tapping it and getting what he wanted, and people understanding him. His whole demeanor changed. A whole different kid came out. It was so cool. I was like, ‘Oh, my god.’ Actually, not being upset, not being frustrated, not trying to hit, not trying to do anything. He was actually happy because we were understanding him. Everyone was understanding him. Even people who didn't know him, who were not used to the way that he spoke, understood him.
But the cooler thing was because we had that extra step of him listening to the model, of him trying his best to give his best approximation. Listening to that model, every time he would press it, his articulation started improving. And I'll never forget other RBTs at the clinic that were familiar with him, but they worked with him maybe for a little bit, and they got transferred off the case for whatever reason. And when they would talk to him, they're like, ‘his articulation's gotten so much better.’ And I'm like, ‘yeah, it's the device.’ And then it got to a point that he knew exactly what to do. He was stringing the sentences together, hitting that little sentence bar at the top, and then he would say that sentence. And I was like, ‘Whoa, this is so cool.’ To this day, I think that is still one of the coolest uses of assistive technology. I guess that's my first time, and I got to spearhead and navigate it, and really kind of trial-and-error a lot of different things. But it was just so cool because I saw that change so quickly with him, and I saw him adapt to it so quickly. And just the look of relief on his face that he's like, ‘finally, you people are getting me. You understand what I want.’
That's such a cool example, though, because I think sometimes people think of assistive tech or instructional tech as replacing, like, so they're going to use technology instead of learning skills. And that example, that story, you can't paint a clearer picture of saying that it's a both/and. Not only are there skills to develop to learn how to leverage these technology pieces, but also, the individual was learning so many things from implementing this technology. There are so many skills that are coming from just integrating that use of technology as opposed to looking at tech as though it's replacing those skills that are being developed. It was actually doing some supplemental modeling, and you know, some of the instructional support really as they're actually leveraging it. And now their speech is also following through with it. That is such a cool example where it's augmenting, not replacing.
Yeah, literally. Literally one of the A's in AAC. Yeah, to this day, it's still one of the best examples that I could think of. And I did use that model later on with one of my more challenging cases, and it was a very similar result. He was much older than the member that I first spoke about, and he had a lot of articulation trouble as well. But when we started using the device, it was the same thing; it was to supplement his speech. It wasn't to be a crutch. It was more for him to compartmentalize everything that he was thinking because he always wanted something, but he just couldn't figure out the way to say it. You know, he couldn't find that word.
But then seeing the picture and seeing the word and pressing it and looking at you and be like, pizza. And then eventually, building up to ‘I want pizza,’ or ‘I want.’ And then it's like him doing that. You know, I'll never forget that mom; she has a very big family. He was one of seven kids. She would always tell me she was like, ‘even his older siblings, they would hear the difference in him speaking and him being more easygoing and letting everything go.’ And he really wouldn't fight for himself or advocate for himself more. Mom would tell me that he would advocate for himself more, say no when he didn't want certain things being done. Like things that he was not doing a year ago, things that he was struggling so hard with. And now, with that device, it just opened up his world. And it got to a point that, towards the end of my time with him at that clinic, before I formally moved on to a different position, he was more often than not able to request things without the need for the assistive device. It was amazing. He was just like, ‘I want bathroom.’ And I'm like, this is amazing. You're doing that without your words. You're telling me what you want. Like it's a huge, huge milestone. I've always been a proponent that melding technology and the world of ABA in some way or another is so beneficial when you can find what works. You can see so much growth and so much change so quickly, too, in some cases.
Well, we've talked a lot about leveraging technology with communication skills. What else? Like, I'm thinking instructional technologies in schools, we always talk about it like universal design for learning. If it's good for one, it's good for all, probably right? Like, there's going to be usefulness well outside just that individual who actually needs it. But I know in clinic settings where it's so hyper-focused on the individual, it's a bit of a different perspective.
But I know you guys are leveraging technology in all kinds of different ways, even within, you know, those non-school settings. So I want to give you a little bit of time to talk about what instructional technology looks like when you're really leveraging that like hyper-intensive, one-on-one, or at least individual programming.
It is very tricky because using that type of technology in a smaller clinic setting is not necessarily the norm. It really just depends on the overall clinic philosophy is the best way to describe it. At least in my clinic setting, we didn't really use a lot of that type of technology. Full transparency. We definitely tried our best to be more hands-on and do everything, grassroots is the best way to describe it. Like, we would do everything ourselves.
At my clinic, what I can say, at least when it comes to technologies, logical perspective on how we approached using technology and integrating it within our sessions. It's the most basic way, but it is a way that we did use it. You know, we would use it for circle time, something as very small and minuscule. At some point, we did get a television installed in one of our rooms, and we used that in a sense, kind of like a smart board. And really, we would do our best to find everything that clicked with the kids and just kind of leverage that. So that way, when we do that group instructional time, everyone's motivated, everyone's ready, everyone's into it, and they want more of it.
So I guess from an educational perspective, when it comes to using technology that you would use there. We didn't necessarily use it so much in a clinic setting, but we definitely did incorporate technology to some degree
For sure. And I think what you're kind of referring to as well is, like, different tasks call for different tools. And so, depending on what it is that you're trying to get your individual to learn or practice or generalize, well, then how you do that can look a whole bunch of different ways. And so I know in schools, we're constantly leveraging a whole ton of different instructional technologies, but I know we're also tasked with teaching different things than in a clinic setting, that you would be expected or potentially even required to be able to teach. So I'm thinking outside of communication and maybe those tasks, how else did you see technology get leveraged in the clinic setting?
Well, I mean, I think the most common way that most practitioners would say would be as a reinforcer. So, you know, definitely a lot of the kids that we worked with, technology was always a fun reinforcer. Now, did we use it all the time? As I mentioned before, we were very much proponents where we would use it as, like, a high-mag reinforcer. It would not be like, hey, you just did one question. Here's the iPad, or here's this, or here's that. No, no, no. We would make sure that we did some really hard work. We got this.
And I guess thinking a little more about it now, something that one of my members uses a lot of at school, we did use a lot of those programs, those educational games, and those educational websites. So if we ever did give some reinforcement time using some sort of technology, we would try to steer them towards something a little more educational. So that way it's, yeah, hey, you're having fun. You're doing something on the tablet. A lot of those games and activities that you could do on those websites were fun, but they also had, like, the component of, hey, you're learning something too.
And then, you know, also engaging with them during that time, we would never, ever just be like, here's a device, and leave you at your own devices. No pun intended. It was like, hey, here's the device. But we're gonna still keep engaging together, and we're gonna still have our moment together. While you're learning, I'm not gonna push anything on you, but I'm gonna do my best to make sure that this is, like, you learning as much as possible and getting the most out of your time while you're here, versus what you would do with a device at home. You know, at home, you probably just sit there, watch YouTube or whatever the case may be.
When we were there at the clinic, and we were there to do work, we'd always try to make sure that it was a fine balance between the two, but never ever making sure that it's going weighted down in one direction more than the other.
Well, before we sign off today, I want to give you a chance to also talk a little bit about how you would even figure out what tech was appropriate. I know we talked about communication pieces, we talked about reinforcement, and we talked about instruction. There are all these different use cases for technology. As a practitioner, how were you figuring out what was going to be a fit? And then I'm also curious, like, how do you then put that into their plan? Are there any tips and tricks from a practitioner to practitioner about how you are deciding what might be a fit for them and then documenting it in a way to make sure that they keep getting access to those supports?
The most important thing is, what is the baseline? What is their skill set? What can they do and what can’t they do? What is their deficit? First, solving that. Going back to the example of the first member that I talked about, we knew that he had pretty strong fine and gross motor movements. I would see him when he was with his parents, using a device, and I was like, okay, so he knows how to navigate it pretty well. So perfect. That's my baseline.
Okay, so then once I started experimenting with the device, I kind of figured out, okay, so I modeled it for him. He figured it out, and then he saw navigating between folders, navigating between pages. I think the most important thing, too, when we did do that with him, we made it individualized to him. At my clinic, we felt that just like with our treatment, it should be individualized to the learner. So when I first introduced it to him, I always made sure that I was not asking him to do something that's out of his scope, because then we're just going to be back to square one. We're going to be back to him getting frustrated, him not understanding, and him lashing out. And because we're now introducing this component that is aversive.
So I think that was always the most important thing to me, just understanding where my members are. What skill sets do they already have? What do I need to teach them, and then go from there. And when it came to using the device, I had a million programs for him, you know, not only just the communication side of things, but also the navigation side of things. And I made that a very important thing for all my members.
I told all my RBTs, I'm like, hey, we're using this to teach them how to communicate, but we're also making sure that they know what they're doing. I had goals of like, ‘hey, go to the next page.’ And him hitting the next page button just so he could understand that next page back page. So it's definitely just getting that skill set, breaking down to as many components as needed for that member, and then just going from there and making sure that they're understanding what they're doing. It's not just like, here's this iPad. Let me go somewhere else. No, no, here's this iPad. This is going to help you communicate. It's going to help be your words.
To some extent, we talked about how we used it as a reinforcer. I would always make sure that when we did use it as a reinforcement, it wasn't necessarily like, hey, I'm gonna go on YouTube, or I'm gonna go on this game and play that. No, it was always like, hey, we're gonna do something, but we're gonna do it, and we're gonna learn. And I'm gonna ask you things like, engage with you, not just leave you alone. Like, always make sure that the member is getting something out of it. And it's not just, this is my alone time, and I'm not gonna talk to you. It's like, ‘hey, this is time together with me. We're gonna communicate. We're gonna keep doing, but I'm gonna let you do your thing, but I'm not gonna be forceful and intrude on your time. But I also don't want you to disassociate.’
Yes, yes, of course. So thank you so much. Like, you talked about how to leverage technology in a bunch of different ways, but then also, how do we even figure out what tech may or may not be a fit? How do we introduce that and implement it in a way that we know we're actually going to get that skill development through that augmentation, that we're not just looking at technology to replace skills that our individuals don't have, that we're using it so that it can supplement and kind of fill in the gaps along the way? So thank you so much for sharing so many stories and examples and walking us through that professional decision-making piece here at the end as well. I really appreciate it.
Yeah, absolutely. It's my pleasure. Thank you for having me on.