If I could go back in time and thank one person for their contribution to making the world better it might be Alexander Fleming. The antibiotics Nathaniel started last weekend seem to be working. My Tigger has his bounce back.

We spent Monday morning at clinic for Nathaniel's routine GI check up and a vision screening. I was thankful to get them scheduled back to back, but it took the morning. Since we were starting the week with medical appointments, and I didn't know how Nathaniel would be feeling, I simplified our daily scheduled and focused on my highest priorities. I hope we can spend time on some of the extras this weekend. 

AAC Core Words of the Week:
My primary goal with these posts about teaching Nathaniel at home is to share how I am incorporating augmentative alternative communication (AAC) into our daily lessons. I use PrACCtical AAC's Core Word of the Month twelve word list. I focus on four words each week. Our words for this week were: ANY, KNOW, SICK, FALL.

I will be honest. These were hard words to incorporate into our activities. Just to be clear - Nathaniel is not mastering these four words each week. Nor is he incorporating them into his spontaneous expressive vocabulary. There is delicate balance between going at a pace slow enough to achieve this and introducing new words frequently enough that we (actually, I) stay motivated. Nathaniel's speech therapist and I are considering reducing the twelve word monthly list to fewer words and working on them longer than a week. I remind myself often that we are not teaching a curriculum, but a child. Flexibility is our friend. For this week, we attempted to work these four words into our lessons and daily activities. In descriptions below and examples of what I modeled, this week's words are in capitals to draw attention to them. Other words for August (together, day, sorry, job, hot, bring, other, give) are in italics.

Week's Theme: Trees
I mentioned when we studied leaves that we would be revisiting the theme. This week we talked about trees in general. We identified additional parts of the tree. The words were already open on Nathaniel's communication device, and he knows where to find them. We talked about summer trees being green.  Building on an occupational therapy activity of placing beads on pipe cleaners, we spent a little time each day creating a summer tree sculpture. We modeled the following core words and phrases while working on it:

• It goes together.
• ANY branch will do.
• Give me the other please.
• I put it on other branch.
• You can put on ANY branch.
• I give it (to) you.
• It FALLS down.
• I KNOW it is summer tree.
• Put it together.
• Can you put on other branch?
• They go together.
• Bring that here.
• Will you give it (to) me?
• Good job.

Literature:
I chose these book on trees to read daily:
A Tree is a Plant by Clyde Robert Bulla.
A Tree is Nice by Janice May Udry
A Year Around the Great Oak by Gerda Muller (If you don't recognize this author, her books and their illustrations are beautiful.)
The Busy Tree by Jennifer Ward. This was the best title for a shared reading using AAC core words. The phrase, "come and see" are on the first and last page. It can be added to multiple pages. Also core words "my, look, and hear" can be modeled while reading.

Science and Culture:
Continuing our work on Nathaniel's All About Me book, Rich read him the story, Me on the Map, and they made a map of Nathaniel's bedroom. Nathaniel's communication app, Speak for Yourself, allows him to open all the words on the device with the touch of the button - babble.  Words that are not yet open in his word set are shaded purple. He loves to study all the symbols and experiment with words using this operational tool. 

Rich incorporated AAC into this mapping activity by reviewing the category organization of the app, finding the screen with household furniture, and then with babble open letting Nathaniel help identify what is in his room. Rich prompted Nathaniel for words like dresser and bookshelf. Nathaniel studied the page and then offered humidifier. We have never modeled this word. We didn't even know it was programed into the device or on this page. But every night, Nathaniel sleeps with a heated humidifier connected to his trach tube. The picture symbol shares similarities to the machine he has heard us call a humidifier for five years.

The fact that Nathaniel not only uses but searches for very specific words (mostly nouns) tells me a few things. His receptive language skills are very good. His knowledge of vocabulary is huge. He prefers to be very exact and concrete. He feels one very concise word can carry a lot of meaning. Rather than using core words, "It is there" and pointing to the humidifier, he prefers to label the humidifier and let us fill in the "it is in my room" part of the communication. I am not sure what to make of this, but humidifier isn't an isolated example. Komodo Dragon. Wrench. Motorcycle video game. Root. All things Nathaniel spontaneously said this week instead of "I see it," when watching Wild Kratts, "I want it," when helping me put together a cart or watching a boy play a video game in the waiting room, and "Look that," while on a walk. I have bought hook, line, and sinker into the paradigm that core words are THE way to increase an AAC user's communication. It seems Nathaniel still needs convinced.

Language Lessons:
Our phoneme of the week was Nn. Nathaniel continues to do well offering the phonemes' gross motor sign when he sees the letter symbol or hears the sound. One of our worksheets had three pictures who's name had the initial sound /n/ and one that did not. The later was a pig. Before I had a chance to say pig or ask Nathaniel which picture didn't belong, he pointed to the pig card, shook his head no, and did the gross motor sign for Pp. Strong independent work.

For the first time, we "sounded out" short vowel words doing three gross motor signs in a row. I don't know what he is thinking when we do these activities, but I am thankful he has a quick way to let me know he can identify the letter symbol he sees and the phoneme sounds he hears. We worked a few times on identifying the six letters we've learned on a keyboard. I said a phoneme sound and he would touch the letter.

We worked on consonant vowel consonant sound blending using symbol cards from his device. I said  /r/ /a/ /t/ slowly separating the sounds, and asked him to hand me the card showing the symbol. He rarely misses one of these drills. I hope offering consistency using symbols from his device for these activities helps language learning in general, though he may not need that layering.

Math
One of the ways I've simplified our schedule was to build our OT homework into our academic subjects. We worked on the pipe cleaner and bead tree while discussing science. Similarity he used tongs for hand strengthening while working on one to one correspondence and number recognition. Core Words I modeled during this activity included:

• Get ANY color.
• It FALLS. (When he would drop one.)
• You put other on.
• You(r) job is that.

ACC Instruction:
Each Monday we open the words for the week and work on the motor plan to find them. Nathaniel has reverted to referring to himself in third person, so modeled sentences using each new word and the pronoun, I.

• I FALL down.
• I feel SICK.
• I KNOW you.
• I want ANY candy.

We played with Pop the Pig. I placed the little hamburgers on a plate across the room. We pretended the Pig and I were eating dinner, and Nathaniel was our waiter. Core words I modeled during this play included:

• Bring (color) please!
• I KNOW what I want.
• I need you (to) bring more.
• Give more (to) me!
• You can give me more.
• You bring it slow.
• I KNOW you can go fast.
• Bring ANY please!
• I eat (to) much.
• I feel SICK.
• Bring other food.
• Sorry, not want ANY.

We played Ring-Around-the-Rosie. After we fell down, I modeled:

• I (You, we) FALL down.
• Did you FALL down?
• I feel SICK (from) turning.
• I KNOW you feel SICK.
• Sorry, I FALL on you!

Other Books We Enjoyed This Week:
Mighty, Mighty Construction Site and Goodnight, Goodnight Construction Site by Sherri Duskey Rinker and Tom Lichtenheld. Favorites here. Nathaniel offers the "Goodnight (truck name) Goodnight," on his device when we read. Both books are good for over stressing and modeling present participle verb endings.
Curious George Goes to the Bookstore by Margret and H.A. Rey. This one was just for fun.
D is for Dress Up, The ABC's of What We Wear by Maria Carluccio. I both liked and disliked this book. Disliked because the word chosen often didn't match the phoneme sound. Like KNIT for K. Some of the words for vowels were the short sound, some the long sound. I prefer consistency within one book. However, the illustrations are delightful and show diversity, which is often hard to find in children's picture books. The text is sparse (just the article of clothing name for each letter), which allowed us to create little stories about the children using Nathaniel's device. All considered, it was worth our time and multiple readings.

Nathaniel and I enjoyed peach picking on this morning. I posted one photo on my  My Instagram feed but here are few more, and what I shared on Nathaniel's public page, Hold My Words, this week.

Thanks for sharing our week!