A DIY Approach to AAC

Glen and Kristi Dobbs created the Logan^®ProxTalker^® Dan and Carey Tedesco developed iPrompts^® and Faridodin and Pam Lajvardi

designed Alexicom Tech.

When Glen Dobbs took his son Logan, at age 3, to see a speech-language pathologist, she had bad news for him: Logan was apraxic and might never talk. She recommended starting him on the Picture Exchange Communication System (PECS).

Dobbs recalled saying to her, "What do you mean? I'm not going to have my kid using little pictures to communicate. That's a cop-out. You're a speech therapist; you make him talk. That's what you do, right? Get back to work." He admits being angry and "really rude. I couldn't believe that a kid who looked normal and didn't have any physical anomalies could run, swim, and climb but not talk. I just couldn't see how that could be. Later, I realized I was wrong, and I apologized."

High-tech devices proved difficult for Logan because dynamic interfaces not only require the interaction of touching dozens of pictures on screen but also knowing how to get back to the start. Low-tech devices also were problematic because an overlay had to be removed to change the grid of one to 128 pictures that were fixed in position. "Pulling out a sheet, putting in a different sheet, and switching to a different level was not something he could do independently," Dobbs said.

He and his wife tried their best to get Logan to use PECS, which is more effective than a low-tech device because it can be used autonomously. "You don't need to switch levels or overlays in order to select a different word," he said. "A child flips a page and selects the word they want to say, puts it on a sentence strip, and hands it to you. Then you can read what they are trying to tell you."

Coming up with the idea for the Logan ProxTalker (www.proxtalker.com) was a complete accident. Dobbs, a new products design engineer manager, was having lunch one day with colleague Kevin Miller, an electrical engineer manager, when they started talking about building a device for Logan. "I explained the problem he had with technology," Dobbs said. "We discussed the idea of using radio frequency identification embedded into PECS-type pictures and creating a device to read them."

They built a prototype, filed a patent, and sought start-up capital. Once revenue starting coming in, they quit their jobs and turned ProxTalker into a full-time business. The company recently moved to an 8,000-square foot facility in Waterbury, CT, with seven full-time employees and a distribution office in England.

The ProxTalker puts a technological spin on PECS. Already familiar with that system, Logan transitioned to the new device fairly quickly, Dobbs said. "He was able to produce voice output independently, which is huge for him."

While the PECS system requires a communication partner, the ProxTalker is "verbal, autonomous and independent," he said. "That's the big difference between the ProxTalker and every other device on the market. If you go up to a stranger and hand him a sentence strip, he may not know what to do with it. With the ProxTalker you can go up to a stranger and say something."

Addressing the individual needs of his son spurred the creation of a communication device, but Dobbs' impetus for starting a business was the possibility of helping others with similar challenges.

"We knew we had a good idea, and we assumed there were other people who would benefit from it," he said of his collaboration with Miller, who is now his business partner. "Some people told us it was a really good idea, while others said, 'You're crazy. There will only be a few people who will ever need something like this.' We soon realized we might be able to make a living doing this, and it would be a noble thing that we would enjoy doing."

Logan was able to use the ProxTalker as soon as it literally fell into his hands. The whole family, including Logan's sister, was in the car at a stop light when Dobbs tossed the device to Logan in the back seat. He started flipping through it as his dad explained how he could put a photo on a button and make it talk. "He flipped it over and said, 'I want alphabet puzzle.' His eyes lit up, and he immediately was like a kid with a bag of candy," Dobbs said. "He immediately knew what to do and was totally excited about it."

Now 13, Logan has been using the ProxTalker for two-and-a-half years. He has added important phrases like "Buzz off," "I'm angry," and "When are you coming to see me?" to his vocabulary. He can even request new words. He attends a private residential school in the Boston area that specializes in applied behavioral analysis. The school is taking his language to new heights, said Dobbs.

Designed for use by parents, special educators, therapists and other caregivers, iPrompts is a downloadable application for the iPhone^® iPod touch^®and iPad^™ The customizable prompting tool is designed to help children in need of structure who may benefit from visual aids throughout the day. "Its main function is to help them transition from one activity to the next, understand upcoming events, and stay on task," said Carey Tedesco, who started HandHold Adaptive^® in Shelton, CT, with her husband after working to create technology for their 5-year-old son Evan.

At 17 months old Evan could not communicate, and his parents had difficulty getting him to transition from one activity to another. The Tedescos took him to an early intervention program in Hartford, CT, where doctors identified a litany of problems. Acting on the therapists' recommendations, they started bringing a picture schedule with them on family outings to try to phase out Evan's tantrums that were caused by frustration. Carey Tedesco recalled the notebook they were given as containing "archaic-looking" laminated text and pictures. Whenever they set out to do a new activity, they had to take new pictures or download photos from the Internet, laminate them, and affix a strip of Velcro to them so Evan could use them to communicate.

A color countdown timer also was suggested. Evan was prompted to move on to the next activity when the color disappeared from the face of the clock. "It became really cumbersome and stigmatizing," she recalled. "We would lose the pictures, forget to do it, or sometimes just not bring it because it was too much."

When she got a first-generation iPhone, she immediately recognized its potential to help Evan by acting as a picture book and countdown timer in one package. "I thought, 'Why can't I take all of that and put it in this?'" Her husband agreed they should pursue the idea.

After the Tedescos secured a developer and seed money from an investor, iPrompts was born. HandHold Adaptive (www.handholdadaptive.com) currently is a side project for the couple, but they hope to make it a full-time business. Recently, it was No. 1 among grossing apps in the medical category on iTunes.

Evan took to iPrompts pretty quickly, Carey Tedesco said. "It's not that much different from showing him a laminated card. When you rotate it to the side, the image enlarges, which is the key. The image in the countdown timer is pretty large."

The timer gets the most use in her family. For example, it will show a picture of her car, indicating that it's time to leave the park. "I'll say, 'Hey, Ev, when the green is gone, what?' And he'll look at the picture and say, 'We're going to go bye-bye. We're going to go to mommy's car,'" she said.

The latest version of iPrompts (v1.2) allows users to conduct a Web-based image search without having to connect the device to a computer.

Currently, a video library is being tested in conjunction with the Autism Center at Southern Connecticut State University as part of a recent grant from the U.S. Department of Education for HandHold Adaptive to study and enhance iPrompts. Ultimately, parents will be able to download and upload social stories and training videos on how to behave in certain settings, like a dental office, restaurant or barbershop.

"I feel like I'm an expert social story writer at this point," said Tedesco, who has a background in graphic design. In addition, a community library feature will allow users to share images with one another.

Evan's speech and pronunciation have improved over the years. Today, he is working on pragmatics, sentence organization and social relationships in therapy. His speech-language pathologist, Cathryn Hendricks, MS, CCC-SLP, helped the Tedescos choose the right images for the initial iPrompts library. "We became very friendly," Tedesco said. "It's hard not to become friends with people who are coming into your house every day."

She stresses that iPrompts is not a full-blown AAC device. "Some people think it is a basic augmentative communication device. Everyone wants to have sound to hear the words, but that's not its intended function. The purpose is more about getting kids to comprehend and transition from one activity to the next. That's what the scheduling feature is and what the countdown timer is."

Internet-based but not Internet-dependent. That is how Faridodin "Fredi" Lajvardi, a high school teacher in Phoenix, AZ, describes Alexicom Tech, the AAC system that he and his wife conceived for their son Alex.

Alexicom is a subscription-based service. Families can use it to order software, create customizable pages, set up links, select photographs, and publish communication pages on a computer. Internet access is needed only when updating a page. There is no limit to the number of cells that can be placed on a page. They can be added, deleted or modified as needed to accommodate developing communication skills.

Initially, Lajvardi and Karen Suhm, PhD, a member of the robotics team at his high school, created a website to test the software that would become the foundation of Alexicom. Alex's speech-language pathologists helped set up the communication aspects of the technology.

Alex was able to communicate before losing his language. Doctors believed he would regain it, so they did not recommend an AAC system at first. A consultant told the Lajvardis that picture-based systems would undermine their son's ability to use spoken language but sign language could trigger it. However, signing ultimately proved to be unsuccessful due to motor planning problems.

While waiting for a high-tech AAC system to arrive, the family tried to get Alex to use PECS. He didn't pick it up immediately because of visual processing problems, but he adapted to it. "We realized it was easier for him and he would never develop the breadth of vocabulary using sign language as he could with PECS," Pam Lajvardi said. "He would never be able to sustain a large enough vocabulary to empower him because of his motor planning problems."

The pictures were difficult for Alex to decipher, so his parents modified them. They went online to find pictures, which they printed and laminated to be more recognizable. By the time the high-tech device arrived, Alex had learned that pictures represent objects and could get him what he wanted. He began using the device, but it was too heavy to carry around. The Lajvardis purchased an ultra-mini personal computer online from Japan and were excited when Apple released the iPad. However, the iPad doesn't support Flash, which Alexicom uses to generate speech on its interface. Lajvardi is waiting for this issue to be resolved or for the arrival of the next generation of html, which has Flash embedded in it. "Internet tablets would be phenomenal because they have a 10- to 12-hour battery life and very basic screens with touch sensitivity," he said.

Today, a speech-language pathologist is teaching Alex how to use Alexicom to articulate emotions and opinions.

Even when children begin to use a communication device, parents should not abandon oral exercises, advised Pam Lajvardi. "People sometimes become so enamored with alternative communication that they forget to try to get the child to vocalize. Parents should continue to try to use spoken language when there is still a possibility it will develop."

If the current approach to communication isn't yielding results, seek out new solutions, Fredi Lajvardi added. "We listened to what everyone told us to do and did it, but we knew when something wasn't working. Parents are the experts on their child, but many are quick to defer to others because they feel they no longer know enough about their kid, which is never true."

One of the most important things parents can do when individualizing technology is to make sure it will benefit someone, even if their thoughts initially don't extend beyond their own child's needs, said Carey Tedescso.

Parents who want the best communication device for their child but don't believe the one they spent tens of thousands of dollars on is doing the trick should never let anyone tell them "no" in their journey to find the right resources, said Dobbs.

"If you're trying to get something for your kid and somebody tells you, 'You can't do that' or 'Your kid doesn't qualify for that,' don't take no for an answer," he said. "You have to be your child's best advocate. In my case, it was creating a device for him. In some cases it might be causing a change in the school district's program or getting them to hire a behavioral analyst. Whatever it is that needs to happen on behalf of your child, don't take no for an answer."

Jason Mosheim is a Senior Associate Editor for ADVANCE. He can be contacted at jmosheim@advanceweb.com.