It has been months since I compiled thoughts on Nathaniel's communication skills and use of augmented communication. We are headed to St. Louis Children's Hospital today to check in with the Aug-Comm team. I am excited to share Nathaniel's progress with them and thought I would use my preparation for the meeting to write a new blog post on communication. To review our communication journey and how we got where we are today, check out Augmented Communication Part 3, and Part 2, and Part 1.

We continue to use Nathaniel's talker - an iPad mini with an app called Speak for Yourself. The best way to demonstrate Nathaniel's use of the talker is to video record his use when he is unaware. In the clip below, Rich offers the talker as he asks Nathaniel what video he wants to watch during a breathing treatment. Much of Nathaniel's use of the talker is to make requests: a toy, a movie, a book... But sometimes he uses it for commenting as seen in the very beginning of the video when he shares his feelings. Nathaniel is upset at the onset because Rich took away the vial of breathing treatment medicine that he wanted to hold. When I started filming, I didn't expect Nathaniel to say MAD, but I am glad he did. The video shows both commenting and requesting uses of language.

Want to see what Nathaniel sees? Ignore my hands and camera shadow.

In order to say MAD, Nathaniel touches FEEL on the first screen:

Which opens a second screen where he can select MAD. Touching any of the buttons on this screen causes the iPad to say the word selected.

The process is similar for saying GEORGE. Nathaniel touches GIVE on the first screen, which opens a second screen (photo below) where he selects GEORGE.

GIVE is Nathaniel's fullest screen currently - he is selecting from a field of twelve. Notice the other video options Rich offered, Daniel Tiger and Cars Movie, are on this same screen. Selecting GEORGE was deliberate. Nathaniel's happy dance shows that. The last time we saw the Aug-Comm team at Children's, Nathaniel could not accurately select from a field of two very large (half screen size) buttons. Go read those Part 3, Part 2, and Part 1 posts linked at the top. Then do a little happy dance with me over how far this little one has come!

One Speak for Yourself feature I like is that every word can be found within two screens or two touches. A double touch in the same location is needed sometimes. For example, Nathaniel touches READ on the first screen and READ in the exact same location on the second screen to say READ.

However, he needs to touch READ just once (on the first screen) to find other words located on the READ second screen. Like the word BOOK. A measure of self control is needed - sometimes a word is spoken by touching twice in the same location. Sometimes a word is spoken by touching once and then moving his finger to a new location on the second screen.

The video clip below illustrates his struggle with touching READ one time to get to BOOK. He touches READ twice to say READ. He then touches READ a third time and moves his hand to the top left to tap BOOK, but unfortunately he had already touched READ a fourth time. The talker says READ again returns to the home screen. Nathaniel then successfully touches READ once and moves his hand and touches BOOK.

This video also shows Nathaniel's unique combination of talker use and sign language. He is combining the two daily.

I continue to record his words using the MacArthur-Bates Inventory. In the last three months he has increased his receptive inventory by 32% and his expressive use by 95%. Yes! He doubled the number of words he says in three months! He says forty-one words through sign or his talker. In order to be counted as a word he says on the talker, I have to see Nathaniel demonstrate using the word appropriately in context numerous times without adult modeling.

Nathaniel recently started putting two words together. READ BOOK is his most common two word phrase, but MORE SWING and MORE GEORGE and MORE DADDY are also heard. If I count combining sign and talker, he has put three words together.

In addition to the talker, I am trying to saturate Nathaniel's world with language input. I talk nonstop to Nathaniel. We all do. We talk about what we are doing, where we are going, how we feel, think, and move. We relate language to pictures and icons. Things in our house have labels now. Even the trash can. We read fifteen to twenty books a day. He is falling in love with the sounds of words. He smiles and wiggles his body in dance when we read poetry that is sing-song and rhyming. He sits for longer stories and anticipates sections of his favorite stories with eagerness. He laughs at the funny parts. He shows me daily that he is getting this complicated thing called language.

One last, much more minor feature of our multi modal approach to augmented communication, is a traditional communication book with laminated cards. Where applicable, these cards match the icons or real pictures on Nathaniel's talker. We use these most often for showing Nathaniel a visual schedule. We use pictures of the therapists and nurses to help him understand who to expect in our home each day. The therapists use the pictures of toys and activities to allow Nathaniel some choice while maintaining adult direction in therapy. Following suggestions from the Children's team, I use real pictures as much as possible for Nathaniel. I take these directly with his iPad and then create the cards using an app called Custom Boards, which also uses the Smarty Symbols that Speak for Yourself utilizes.

I am not reinventing the wheel. I follow a very active Speak For Yourself user group on Facebook, read blogs written by other moms who are few years ahead of me, have one local friend who uses augmented communication with her son, and have the support of a fantastic weekly speech therapist who starts every conversation with "we." It is powerful to hear we. It means I am not alone in the journey of helping Nathaniel learn to talk. Today, we (our weekly speech therapist is coming with us to the appointment at Children's) hope to learn new ideas for helping Nathaniel use his voice.