 And Cynthia, welcome to the Complex Communication Needs webinar series from Alberta. My name's Kathy Howry and I'm really happy to see that we have lots of people on this afternoon, which I'm sure will be a very informative and practical session for everyone. So Dr. Cynthia Press, as she's put out here is from the University of Nebraska in Lincoln. I've been a bit of a follower of her work for a while. We met in person a couple of Isaacs ago, and I have been really, really happy that she agreed to be with us here this afternoon to talk about some of her work and really focusing on some of our youngest and earliest communicators. So, Cynthia, with that in mind, I'm gonna let you take over. I'm gonna mute myself, but I will be following along and making sure that if other people come in that they're muted. And also, if people do have questions, if you could put them in the chat, I will try and keep track of the chat. Cynthia, you won't need to worry about that at all. Okay? All right, sounds good. Thank you. The next thing that Kathy is going to put this handout up on the website as soon as the transcript is there. So you will have a copy of this. So I'm just looking to provide you some useful strategies at this point. I just put up a disclosure. I do have some assessments and some interventions that I've developed. None of these are particularly proprietary for me, so I have no particular conflict of interest in this information. Let's start with who is an early communicator because that's not entirely a young person. This could be children or adults who are not yet intentional communicators. And I've worked with many adults who are still working on strategies to use their gestures of deliberately conveying information. These could be adults or children who rely on gestures or partners for most of their messages. So these could include our children with autism who are relying on us to ask the right question for their messages to be interpretable. Here comes the time. These could be children or adults who are symbolic sometimes, but only under certain circumstances. And again, these could include our children with autism. And then these also can include children and adults who can speak sometimes, but may need reminders, may need some structure, may need some input, and that also children or adults who are missing the point of some of the more complex forms of communication. And again, these can include our children with autism. Just wanted to make a note that these can include children and adults who are across the disability span, as well as these can include adults who have a quiet disorder who have returns to being a communicator. It sounds like we still need at least one person to be a communicator on their own, and the lower left one, we've got some turbulence going here. So that will help us all up. On the, you all talked about this being a complex communication needs network. I wanted to then further define what formal AAC is, and I used the word form for an hour, because too many of us presume that AAC involves the voice output device, the sign. Those are what I'm considering formal AAC, meaning it is symbolic uses of a symbolic device or system. That's only one subset of what AAC is. That when you look at the Isaac definition, AAC includes all the ways of communicating, including gestures, including partner behaviors, including natural behavior of individuals, and that includes more multimodal strategies. Even people who rely on formal AAC will still use some of those multimodal techniques as part of their own relationships. My definition of AAC is anything that holds communication when traditional methods are not sufficient for AAC. So that means AAC can start at birth, and it doesn't require being symbolic or developing any prerequisites for AAC regardless of what age you are, so that there's no limitations to who can rely on AAC. It's just different uses of AAC at different ages or different skill levels may make a difference. So we can always start with partner recognition of behaviors at any point, and this tool that I'm gonna talk about today are particularly relevant for that partner recognition of those skills. Just a reminder, we've said that gesture and behaviors are part of multimodal AAC for anybody at any skill range, regardless of how symbolic you are. This can include postures, voice, body shift, partner responses, all of these kinds of behaviors, and everybody has a continuum of how and when they use these natural behaviors as a principle of symbolic AAC. So it still counts as AAC intervention if we come into an assessment or if we do intervention activities and we're addressing these partner-based or gestural strategies. It's still AAC if that individual would not be effective at using their communication strategies if these were not incorporated in their interventions. If you consider yourself an AAC specialist, you don't have to bring a thing to be doing AAC. Let's walk through some of the early, the breakdowns of different forms of early communication and again, all of us produce these behaviors sometimes, however symbolic we are as communicators. So one of the earliest forms of communication is spontaneous communication. So Logan, the grandchild that we just saw recently, he had some forms of spontaneous communication from birth. He would cry, he would fuss, he would squirm. That's what we traditionally consider some spontaneous communication. However, everybody produces these. My students, when it's about time to finish up class, they are squirming in their seats. If I ask a question, they all look down all of a sudden, that's spontaneous communication as well that they are communicating, even not deliberately, that they don't wanna get called on for that question. So all of us produce spontaneous communication for some reason. We've got object directed communication, which means I'm gonna reach for something that I want or I'm going to reach towards you as an object. This could include a device. So we put a picture symbol or a voice output device in front of the child and I didn't bring the devices with me so we're gonna have virtual devices. So we've got the Big Mac switch, let's say here. I can reach towards this switch and hit it just because I want to hear the click or because I want to hear the noise that it makes. It doesn't necessarily mean that I know that this is a communication device. It just means that I am using it as an object, just any other object. We can, and again, all of us produce some object directed behaviors at some times. There's a difference, however, this is what we consider intentional behaviors. I do this because I want it. I reach for my drink because I want the drink. Just because I reach for the drink doesn't necessarily mean, however, that I know that you are going to give me this drink. Being partner directed is adding additional complexity to those object directed behaviors. So I'm going to reach towards you because I want you to give me this drink. Now I am person directed or intentional in my communication. And just because I'm intentional in some aspects of my communication doesn't mean that I'm intentional in all of my aspects of communication. That still can vary a lot. This could include formal AAC directed towards a person. So I can take a picture symbol and give it to you. I don't know what it does. I just know that I'm supposed to do something towards you and it's supposed to make you do something. So it still could be a form of just intentional communication and we need to be cautious in how we interpret our children and adults' uses of our formal AAC. This also could be a natural gesture towards a person where I reach towards you and I want you to tickle me or I want you to give me something. As we look at symbolic communication, we don't just have a magical understanding that all of a sudden we become a symbolic communicator and now all symbols around us make sense. Any given symbol may have a process in which I learn what it means and how to use it. For instance, every speaker child has an initial way of using symbolic communication that's just referential. I know it means something, but I don't know what it means. For instance, you ask a child, where's your nose? They go, da, what's this? Da, where's mama? Da, what's your name? Da, I know that da means something, but I don't know what it means. So similarly, our kids who rely on AAC may give you this picture symbol and regardless of what the picture symbol looks like, I just know that good things are supposed to happen when I give you this thing. I have no idea what it means. I just have the expectation it's supposed to be meaningful or if I hit my voice output device and I'm gonna watch you expectantly that something's supposed to happen, but I don't know what it means. This is a referential use of symbols and it's important, first of all, to know that this is a natural process in becoming more symbolic at using this form of communication. Secondly, that it's situation dependent. Some situations I may know that this means Thomas the Tank Engine and in some situations I just know it means something good. So just because I can use this form of communication or this form of communication systematically in some circumstances, doesn't mean I can use it in other circumstances. Also, just because you can understand this message symbolically, doesn't mean that I understand this message symbolically. This can include speech. So I might say, ball, cupcake, cookie, more, in, that, with, and I don't know what any of these phrases mean. I just know they're supposed to be meaningful or kids with autism might walk up to the refrigerator and go and say all kinds of signs and not know what any of them mean and I just know they're supposed to be meaningful. It's very important not to overinterpret those behaviors that says this child representationally understands what they mean in the same way that we do. So they might just be referential and essentially another form of partner directed communication. As kids start to get an idea of partner directed communication or excuse me, more symbolic communication, I might have a differential use of symbols, which means this picture symbol might mean something that I like and these yellow ones are things that I don't like. I'm not exactly sure, but I know I wanna pick the white ones and not the yellow ones. Or maybe I know that this gets me a thing and this gets me an action. So I might choose between two different symbols, but I might not be very systematic. Ashley, we do need you to mute if you can. Thank you. So we don't know which of those two things that we're gonna pick actually has an impact on what we're doing. So that still is differential. When we're giving children a choice between objects and actions or things that I like and things that I don't like, we're trying to build that sense of differential understanding of symbols on the way to being representational, which means I touch this picture symbol and it gets me Diet Coke. It doesn't get me regular Coke. It doesn't get me seven up and it sure doesn't get me tickle. I know exactly what it gets me. So none of these are stages that children are at. Everybody who is a communicator uses all of these. And as we're collecting an inventory of all the different ways the children communicate, we need to reflect all of these types of communication that they're using. So if we have a child who's mostly using representational symbolic communication for most of their message, let's say they're a speaking product, they still may have some message but they can't access what it is that they want to communicate. So there might be ways of saying I'm confused that I convey with my spontaneous behaviors. I don't have the words that I can find to say I'm confused but I have other ways of conveying that information. So we need to reflect which messages I'm relying on a simpler form of communication for even if I'm both symbolic and a verbal communicator. So this tool is important for anybody at any level of communication but particularly important for our earliest communicators. So as we're thinking about those early forms of communication, as soon as we introduce formal AAC, we are making this process of communicating with spontaneous communication or symbolic communication or intentional communication harder using any number of these possible elements that make that communication harder. For instance, as soon as we introduce a formal tool of communication, let's say a picture symbol, we are automatically asking the child to look for an external thing to make it communication. So if I want you to tickle me, I'm just going to reach for you and I'm going to say tickle. That's going to be a form of intentional communication. Now you present to me this picture device, picture symbol and now I have to turn from you and this interaction down to this picture symbol and find it and think that this picture symbol means you. This is counterintuitive. The more we make our children look for the tool that is going to be their communication, the harder we are making that interaction. So already just finding the device that I need to communicate with is already a hard thing that we're adding to the representational symbolicness of the AAC in general. When we change from I want you to tickle me to pushing the picture symbol with a voice output device under it, we are automatically adding about four hard things to that communication interaction. Even if I know how to say tickle, well, yes, that's the language that's added to the intentional communication but we're also adding the visual representation of tickle here. We're adding the voice output and I now have to decide if the voice output matches the picture symbol, matches my language, which matches my intent and I have to find this and use it. So as soon as we work from tickle to push your switch, I want you to do tickle. We've automatically added four hard things to that child's communication and that starts to explain why when we introduce AAC it makes it sometimes we can hit a wall where a child can use some symbols or they can use their voice output but as soon as we add this device or symbol onto their early interaction, we're having them not be successful. So what we need to do in our interventions is to add only one of these hard things at a time. So sometimes we need to simply experience giving picture symbols just for the heck of it. Just when these external symbols are worth paying attention to. We're going to put those voice output devices right at the face of the person who we want to have tickle us so that when I reach and go tickle, you can help me hit that picture symbol and then I can learn, wow, this switch does something meaningful for me. It's just worth paying attention to it or listen to the voice output just to enjoy listening to the voice output and later on start to cumulatively add these hard things into that communication interaction. So when you hit the wall in terms of introducing AAC, see if you can only introduce one of these hard things at a time and then scaffold the rest of them for the child. And again, this is tool that I'm talking about today, maybe a way to help you break apart exactly how many hard things are we adding to the natural behavior that the child has already produced. Just food for thought. So ways that you can introduce formal AAC in a simpler way for children. It can simply be an advice, something worth looking. So if I wanted to introduce voice output just for the sake of knowing that hitting switches is interesting. Maybe I'm going to put your mother's voice recorded on here, your father's voice and I'm going to learn that just hitting that switch as a simple intentional communication behavior is interesting just in and of itself. So it's worth hunting for this external device just to hear the voice output. And that's already exploring AAC as a meaningful thing over and above, right at my level of complexity that I'm interacting with objects. It also AAC, formal AAC can be a means to get input from us about language. So if I'm trying to figure out which of two switches that I hit, well, maybe I can push them and I can hear the voice output or hear the language and start to help myself figure out which of these two differential symbols I wanna use. Can be a way to practice words. So if you have a child who is symbolic, verbal communicator in many circumstances but I don't know what word to say to get help maybe I can have a switch that I can hit that says help and maybe I can practice the words of saying help so that now I can find those words more easily myself or use my voice output device to get them. They also can be reminders of what to say even if I'm a verbal communicator I still might need those visual reference of all those different picture symbols that I can communicate. So that's background information around the context for which we're going to be talking about this communication signal in the joy. Now there are people that call these gesture dictionaries. It can be a synonymous term. I tend to not like the gesture dictionary first of all because dictionary presumes that we're being comprehensive and sometimes we're not we just don't know what all the signals we have that we can't recognize. Also gesture tends to mean only hand-armed signals to us whereas communication signals are anything that we recognize from that child or adult that's meaningful to us whether or not that child intended to produce that behavior whether or not it was a hand-armed behavior. So for any early communicator we simply have to have this inventory together so that all of us that are interacting with that child have a common way for understanding the behaviors that they're producing. We have an inventory of the possible ways that we have for that child that we can recognize that child conveying an intent so that if we're looking for a way for the child to expand their commenting, let's say we can look at their inventory and say well what's the closest behavior that they have to a comment even if it's not a comment it maybe it's a eyebrow raise when they see something that they're interested in maybe that's their comment and that's as close as they get to a comment. These are great times. So these don't have to be intentional behaviors they don't have to be intentional communication they may be very subtle they may be the absence of a behavior maybe the way that I show I'm interested in the behavior is that I don't or an activity is I don't get up and walk away that's the absence of behavior and that's still a signal. So we need all of these ways to capture what it is our children and adults are doing. In order to get a communication signal inventory it's also important to notice when a child produces that behavior. For instance, let's take our formal AAC maybe the child only pushes their switch when we hold the switch out to them and now they know they're supposed to hit it but if that switch is down on their table or they have to go hunt for it on another surface maybe now that's not a when when I can use that system. So it's important to know that I pushed my pictures my voice output switch when someone holds it out to me and that's the only when in which I see that behavior that tells us a lot about why they're not using their AAC device in some other context because they're relying on the when of us presenting that or presenting their picture symbol or giving them two choices or labeling those. So the when of when someone produces a behavior is important to specify really for every single one of the behaviors on our signal inventory. We need to know when they produce it if it's prompted or if it's spontaneous if there are certain partner behaviors or environmental circumstances that trigger that behavior then we know we want to elicit those behaviors using those same triggering events when we're doing intervention. So we're gonna build our intervention out of this communication signal inventory for most of our early communicators. So we're gonna plan when we see this kind of behavior that's an opportunity to move forward in becoming more intentional or more symbolic. When we see this behavior we want to encourage this behavior to occur more often and we're gonna plan different responses to those early communication behaviors so that we can see it more often. When we see this behavior we wanna do less so that the child can focus on what it is they're considering doing. If we find we've done a communication signal inventory and we've only got three behaviors on our inventory there are two main possible reasons for that. One is we haven't broken apart the when of that behavior very well. So we may have looks and reaches and makes a sound. Well looks when, looks when someone holds something out looks when someone comes in the door looks when a noise happens in our environment the looks plus the when become 10 possibly different signals from an individual. So we need to add the when. The other reason why we may not be getting many behaviors on our inventory is that we may really not have very interesting activities. Maybe we've got the child who simply sits in the back of the classroom and smiles because no real opportunities for communication have happened. So maybe we need to spend a lot more time trying out different activities to see what contempt that child to want to convey a message so that we then can see the child showing a wider breadth of interactions. So that's something to consider all of my students regardless of which class they're in produce a communication signal inventory a CSI for all the individuals they're working with. And I say there's a minimum of 25 signals you must have in my classes for regardless of how skilled your communicator is. So that's for me a bare minimum that everybody has at least 25 different combinations of behaviors that we recognize even from very, very early communicators who have very limited motor control or other range of behaviors. So here's an example of a signal inventory. I've shortened these a lot. You should be shrinking them and having more words. I've skipped some important words like a person and his object. And you should be adding more in here but I shrank the language and shrank the number of items just to fit them on the PowerPoint. So we have here a real child that I'd work with where the child watches somebody intently when that person acts on an object. Almost every behavior that anybody produces has more than one possible meaning. Don't have a one to one relationship between exactly what they said and exactly what it means. Even when I say a word, it doesn't mean only one thing. I could go ball and maybe saying that word means I want it, I'm interested in it, I'm confused about it or I just like saying that word to hear myself talk. There could be multiple meanings. So this one when she watches a person might mean she's interested, might mean she wants something, might mean she wants picked up, probably four or five other possible meanings. And so here is when we plan our response. This is not the response that currently happens in their world so much as what we want to do to plan an intervention therapeutically for that child or adult. Here's a very idiosyncratic one for this child. She goes, oh, oh, oh. And that's how her mother knew to come in when she was awake and this is something she did on her own. So part of the signal would say in the morning and on her own. So this signals that she's awake and maybe also signals that she's getting her voice ready to use it. There would be other possible meanings. So here is a planned response and we'll talk through those planned responses in just a minute. Now we've got another behavior that the child produces on their own combining two different kinds of movements. So she sucks and sticks out her tongue. Mom had interpreted that as I want a drink. Or maybe I'm just producing this because I see you and I know every time I do this, you come over and you interact with me. So maybe it's now become a more generalized behavior to get attention. I know you're near, I want attention, I want you to come over here, I want you to give me some choices. Maybe it means a lot of different things. So maybe give her a drink but also give her an opportunity to do something else to get your attention. And this child said ah and maybe spits things out. If she's interacting with them, maybe a pacifier. It could mean she's hungry, but again, maybe she's learned this as a social routine and there are various reasons she produces this behavior. So that's an example of a CSI. We're gonna walk through really for the rest of the session here. How do we create these types of inventories for our children? And we'll spend most of the time on how do you plan that third column? Because most of us can identify these behaviors. It's planning what we're gonna do about it that challenges us in intervention. So we'll walk through that. So when you were gathering these signals and meanings, and those are the first two columns on your CSI, what is the signal? The signal always includes the when and then what it means, it almost always includes multiple meanings for any given signal. We do this together with familiar people. So we don't just ask the parent, how does the child tell you they want more? The parent very often might say, well, they don't because I'm looking for a gesture or I'm looking for a word. If we're just in people, maybe they can't tell us anything about how this child communicates. What we really wanna do is interact with the parent and child. Watch for things that we observe and say, oh, was that face a happy face or not a happy face? Or the parent says, I don't think they like this toy. I'll be like, oh, how did you know? And they said, well, they kind of made this in their throat and say, is it just that sound? Or is it a sound plus their face? Or was there some other way that you knew this, meant they weren't happy, but is there a different way they'd use that sound when they are happy? And how would you know the difference? So in the context, the parent can interpret what's happening, but just out of context, the parents, the teachers, the aides really have trouble interpreting this information. So just as I said about the signals, don't stop at hand on behaviors, facial expressions, voice. That's what we're waiting for, those conventional signals, but things like leaning forward and brightening, pausing, little bit of eyebrow, tensing your body. All of these are possible signals or just not answering the question when it's been asked. The absence of a behavior can be the way that we interpret some kinds of messages. Every signal has a when in it. So the when is the context or the prompt or the opportunity. Did I initiate this behavior? I call those behaviors on your own. Very, very different from the behavior that only happens when you've been asked a question or presented an opportunity or when something around me happens. When we see children that are early communicators only do things when they're prompted, that says we've got a big opportunity for working on things to happen more spontaneously than they do now. We've got a big range of stimulability, but we haven't seen that transferring to initiation, particularly for our kids with autism, and that is a hugely important question and an issue to address. Remember that we have multiple meanings associated with the same behaviors, and we may have several behaviors that can be the same function. So maybe I reach for something when I want it, but maybe I also lean towards it when I want it or I vocalize towards a partner when I want it or I push away something when I don't want it or I throw it on the floor or I just simply turn away from it or I don't reach for it. All of those would be separate signals, all of which mean I don't want it. Some of them are more active, some of them are less active. We may want to then start to shape the child's behavior to be using more active or more meaningful behaviors for similar functions. If we find we don't have many signals from the child or if we're working with a symbolic communicator, we've got to remember to look for ways in which they're not able to use their intentional communication or their symbolic communication for some functions. And some of those functions may mean bored, I need help, I'm confused, I'm interested, I'm curious, I'm noticing something, I am kind of commenting on it, but I'm not initiating a comment. I need you to stop talking so that I can think about what I want to answer. Those are things to watch for that are almost always non-verbally conveyed for most of our communicators, including our symbolic communicators. So here's an example of signals and we're gonna walk through these particular four signals as we develop this CSI. So we've got a child who bangs a noisy object on the table on their own. So this is an object-based intentional communication, I'm just banging this on a table by myself and I'm not really involving anybody at any point. I'm just doing it. I've got another behavior where I look up and raise my eyebrows when someone comes in. So the when for the banging the object is on my own, I just do this, but when someone comes in, I raise my eyebrows and look up at them. We've got throws objects on the floor after I've used it for a while. This is also an on my own behavior. This is a way that I have for showing a negative reaction to an event. And then we have reaching for a full or an empty cup on my own. So I reach for it because of some presumed intent about that cup. So as we look at the meanings, be sure to consider multiple possible meanings for these. We thought that banging an object on your own means I like the sound and maybe that's one possible reason. But maybe I'm exploring. Maybe this is a play strategy. Maybe I don't know what to do with it. So I'm trying to figure out. Maybe I want help and I'm banging it hoping that the magic out there comes over and helps me. But cause I don't have very good intentional strategies to ask you for help with this. Those are all possible meanings that I didn't have space for to add to this signal. I look up and raise my eyebrows. Maybe it's a greeting behavior for me. Sure, maybe I'm saying hi, but maybe I also just want attention and I don't really know that I'm greeting you. I'll do this anytime you're in the room to get your attention. Maybe I'm curious. Maybe it's kind of like a comment. Woo, what is that? What do they have? Maybe I'm waiting for my turn to interact with you. Maybe I'm watching to see what you're going to do towards me. Maybe I'm a little unsure. Maybe I'm not sure what you're gonna do and I'm apprehensive. All of those are possible meanings for the same child. I may throw objects on the floor because I'm done with them. It's a frequent strategy. Maybe also on board. I'm frustrated. Maybe I also don't know how to use them. Maybe I need help and I've gotten frustrated because help didn't happen fast enough. And then the last one I might reach for an empty cup because I'm thirsty. Maybe I'm also just curious. Is there anything in there? I'm not thirsty yet, but I want to know if there's anything in there. Maybe I want more. Maybe I want to play with the cup. Maybe I'm reaching for it because I want to bang with it. Our individuals have complex reasons for doing what they're doing and we don't want to be limiting those forms of communication. So that's the signal. There's what it means. We'll spend the rest of the time on planning that intervention column. And I have seven basic different types of ways of responding to those communication messages. In general, there are three big picture ways that we respond to any behavior that the child produces. Maybe I want to maintain that behavior because right now that is a good behavior for you and I want to see you continue to do that. I want you to be more aware of you doing that. This is a good thing. And I just, I don't want to add any additional complexity to what you're doing. Maybe we want to increase some aspect of this signal, not just increasing complexity, but maybe increasing breadth. Maybe increasing the communicative function, the range of communicative functions you have. Maybe making this behavior more social even at the same level of complexity where you're at. There are lots of ways to increase the conventionality or the breadth or the use or the initiation of that behavior. And then there are at least some behaviors that we want to decrease input to. We want to do less because the child is telling us already you're doing too much and I need you to back off. I need you to do less. I need some space here. So if you are doing any of those behaviors that involve an increase in something in your response, we've got to know how are we going to know that the child is in fact doing something new? So sometimes we may think we're increasing their behavior, but if all that's in that third column, the response is us talking. Maybe the child isn't doing anything new and it's just really a maintenance behavior. So if a child does and we say, oh, you said you want more, you want more, more, more, that's just our behavior. The child doesn't necessarily learn anything new to do unless the child did it. My mantra for kids with autism but really all of our children is if I didn't do it, I didn't learn it. So in that third column, if you really want me to be developing a new strategy, you've got to show how you're going to help me produce that new behavior in some way other than just talking at me or showing me. Because if showing me was good enough, I'd already be doing it. There's a reason why I'm not doing the behaviors you've been showing me. Also remember in our response column as we walk through these strategies, only add one new hard thing at a time. So if you've never used a voice output device, yeah, maybe then it's gonna be just our behavior at first to show you that these devices are meaningful or I'm going to help you push the voice output device because I don't want you thinking about picking what the device is right now. I just want you to notice that, wow, this thing is really cool and you might want to pay attention to it. So only add one new hard thing at a time and watch jumping too many steps either from a spontaneous behavior to a symbolic behavior that's a big jump or working from an intentional or symbolic behavior to an augmented symbolic or intentional behavior. Watch how big of a step you're making. So let's walk through these seven ways and these are just categories of ways to respond. The most natural thing that we as adults want to do and that we find easiest to do so that's why we want to do it a lot is to simply respond to reinforce the child's behavior. The child reached and we go, yes, you told me more. That's pure responsibility. Responsibility is a powerful strategy. There's nothing dismissive about responsibility but we're gonna do this mostly for behaviors that aren't yet stable in the child's repertoire. So for instance, the child doesn't very often sign so they're gonna say, my turn, wow, that's great for this child, we're just gonna reinforce the heck out of, yes, you told me my turn, we're not wanting to increase this behavior and keep upping the ante or they're gonna stop producing this behavior. We just wanna reinforce it or you turned your head, you told me more, yes, that's great. If this already challenges their system, we don't wanna keep pushing that ahead. If we want them to be aware of your head turn mattered, your voice mattered, then it might be an A type response, this reinforcing behavior. We might wanna elicit the signal more often, maybe they're stimulable for it but only every now and then. So we're gonna keep doing that when that's on their signal inventory more often so that we then can get them producing this behavior and reinforcing it, reinforcing it, reinforcing it. We wanna emphasize a new concept like more or done or come here. Maybe we're just going to reinforce their natural behavior first so that they have that idea in mind, we can work with that. The more we're working with people who do not have reliable strategies for intentional communication, the larger percentage of our responses are going to be this kind of response because we want them aware of all the different behaviors that they're producing so that they then can be aware that they are making a difference in their environment. So some examples would be the child squirms in their chair. It's a spontaneous behavior. Most parents would just take the child out and it's worth having a discussion with the family to say maybe the child doesn't know she's telling us she wants out and they may need to have us tell them you told me out and then we take them out. So now it helps the child be aware that your behavior mattered enough that I may now do it more deliberately to get you to take me out. Or I have an object and the child reaches for the object so I want another one. Maybe I'm just gonna reach for it again and see if they do it more often and get this behavior more firmly established in their repertoire. Or if I have a facial expression that says I'm mad, maybe I'm gonna give you some feedback that this face that you're making is why I'm taking everything else away from. I don't get the concept mad yet but when you make that face it is accomplishing something in your world. Those are a responses just maintaining or helping the child recognize that skill. Then we have the responses and when most of us think about moving ahead or increasing their child's use or complexity of a skill or sophistication at using a skill when we think of increasing anything about our responses we're usually thinking of moving up in complexity and that's what a B signal might be but it also might be working sideways at using the same level of complexity for a new communicative purpose. So don't always think of symbolic to intentional behavior intentional behavior to intentional communication, symbolic and keep moving up the chain you've got to get breadth at any given level of communication skill or any given function as well as breadth, as well as depth. So this one we're looking at some other way to expand on their communication and again if you see yourself doing this too often then again we may be pushing every limit of the child and we may wanna look at some of these other letters of ways to respond that would meet their appropriate intervention goals. So some examples of these behavior are reaches for an object but I don't communicate about it. So this would mean I have the soda here and the child reaches for the soda as an intentional behavior but I'm not looking at you to tell you I want you to give me the soda I am reaching for the object, right? So that's an intentional behavior and it's very important that we don't confuse this with I am telling you I want more. So maybe I'm gonna hold the object closer to my face so that when you reach for the object you then reach for me. Many of our children with autism are going as soon as you hold it away towards your face I'm gonna look everywhere but at your face because I don't want to look at your face it's actually disturbing or even painful. So maybe I'll hold my hand in front of the object so that when you reach for the object you accidentally touch my hand and now I've helped you be communicative towards me in ways that are meaningful without you having to be don't touch my hand, touch my hand, touch my hand. You didn't learn anything if all I did was talk but if I helped you touch my hand now you're starting to get the sense that ooh, people matter, hands are useful. This is good. Now here's an example of working sideways on a behavior. Maybe I point at this soda can. Well, nine times out of 10, if not more, the partner's gonna assume you want that thing that's why you're pointing at it. And then we wonder why kids get to school and all they can communicate about are wants and needs communication. That's because that's all we've ever interpreted their behavior is meaningful. We've never really interpreted that as wow, cool. That's interesting. And so maybe the first time they point to this object they go, oh, yummy. Or wow, or shiny, or something else about it. So maybe a B response when they point is to first experience that event. In the child's signal inventory, in the skills that we're working on for a child, we should be working on something that conveys the idea of wow and look and uh-oh as some of the very early commenting behaviors that kids do. They may not be saying that symbolically, but maybe this is an uh-oh behavior and maybe this is a wow behavior and we're still gonna work on that commenting from the very earliest points we're working with the child or they're going to be hampered as we get further in their communication development and intervention. So if we have a child who likes to hit things just because I like the way that it happens. Maybe I'm going to hit the thing and we're gonna say wow. So I hit it, we go wow. I hit it, wow. Hit it, wow. We're just going to hit it and experience this for a different purpose to share social communication about this thing that I like to hit. Maybe I vocalize to you. And so I say ah, ah, and it's in a form of intentional communication. Can we learn an additional behavior that's still not even maybe symbolic? Maybe this is my ways. Maybe I don't have the symbolic wave yet, but I'm gonna add something that's a little bit more communicative towards somebody. Maybe I, you don't know. Ah, ah, I vocalize at you. You don't know if it means want or don't want. So maybe I'm gonna hold up the object and see if you lean towards it. Maybe that ah meant I want it. Whereas this ah, I give you a don't want. And so now I now can respond to that new signal in a different way. So if I don't know why you've added me, I'm gonna hold something up and look for an additional specific signal that I can interpret. Another possible response is creating a social routine around things. We know that our children with autism communicate more effectively if I can predict what's happening. Many times I can act on my world in any way I want to all by myself. I don't need you. So one of the more effective ways that we can engage that child with autism in our interaction is going to be around a social routine where I am the toy. Well, how do we create a social routine if the child doesn't already produce them? Well, we take a natural behavior that's happening in their world and we just add a social element to it just for the fun so that getting tickle isn't magic. I know that my behaviors have a role in the tickle game. It's not just a passive recipient of good things that I don't know how to control. And if I know how to expect things in peek-a-boo or tickle or the dad growling at me game, whatever it is, then I'm going to anticipate that things should happen and I'm going to show you new behaviors that should be on my CSI to indicate how I anticipate what's going to happen. So examples of this frequently when parents will tickle a child. So this isn't tickle, this is swinging. So you swing your arms while you're walking and the child giggles. So now that might mean they enjoy it. So now I'm going to swing, swing, swing, pause and see if the child will swing or make a sound or look at me or do something to take a turn. Same thing with tickle. The parent goes, I'm going to get you. And then they just pause before you start tickling the child and see if the child will go, or something to take a turn. We're not looking for any particular behavior yet. We just want to create the opportunity for the child to have a role in a social routine that becomes predictable. So if a child rolls something as my preferred behavior with any object, I roll things on my own. Well, that doesn't involve people. But maybe I'm going to pick an object and roll it to you and roll back. We're going to create some games that involve things. Maybe I'm going to roll something down an incline and we're going to take turns rolling things down an incline. And now there's a game that's predictable that involves people. And it's useful because I need to get the thing that I want to roll from you or I'm going to pause and be reciprocal. You take a turn, I take a turn, you take a turn. Those are options of C responses. A D response is something where it's like an A, we're not going to ask the child to do anything new. But there's another element to this that says, I want you to start to think about what this behavior that you've produced means. I want you to start to build maybe not a symbolic meaning of it yet, but something that helps you represent that idea in a more systematic way. This happens a lot with feeling words. For instance, a child shows you mad or sad. Maybe we want to touch it and just give you a notion that this face that you're producing means something and gets a result. We just want to have you associate this particular face with a particular kind of result so that you can start to build an understanding of the message. Does that's what makes it beyond just an A response? This also happens a lot academically where we want them to understand in versus out. Maybe every time they put something in a box, we say in because our target is to understand in, not just to reinforce yes, you put it in, which would be an A response. So for instance, looking at something, I look at this noisy thing. I didn't bring any toys in here. Whoa, that's interesting. I'm looking at this. So baby, I might want to give you a label for that. We're not gonna label stapler for a child, but car, for instance. So I look at, I happen to have a noisy car on my desk. So I look at this and then we're just gonna say car. Maybe we're wanting to introduce that vocabulary. Or they bump their arm and they get this owie face on. Well, baby, we're gonna say ow or help them touch their face and that's gonna mean ow in some way that just helps them recognize that this face goes along with ow so that next time I have an owie and you don't know why I have an owie, maybe I can start to at least have a concept of what ow means so that I can be moving towards being more systematic about conveying that idea. Or I bang objects on the table and it just means I like to bang it, right? But now I'm going to, as a partner, add the word we because that's something you enjoy. So we is a word that goes along with fun things and ow is a word that goes along with not fun things. And that's gonna help me with differential uses of symbols or words, even if I need some help at being more systematic. Three more types of responses and then we'll have time for questions. So now, maybe what I wanna do with my response is to expand the behavior into new context, new activities or in the terms of AAC, new modalities. So at the same level of complexity, maybe do it with a new person because I not generalize this behavior well. Maybe I need to know it gets results in a new situation. Maybe I need to do this with new partners. Maybe I need to know that I can request with my hand or with picture symbols. And those are all E type responses. It's no harder necessarily, but it's expanding it sideways in some situation. And this again is particularly important for our children and adults on the autism spectrum where I don't generalize easily and I really may need help in expanding this. So if I pointing to a picture symbol only an answer to a question, maybe now I need to learn that this picture symbol can also be a way to ask a question or request something for a new purpose, the same behavior. Or if I turn my face away, that means I don't understand it, maybe what needs to happen isn't my behavior changes. Maybe my partner, when you're showing me that you don't understand the behavior, maybe I need to give you object choices because you didn't understand my verbal question. So maybe we need to change the partner behaviors, not the child's behaviors in order to get things moving ahead. Maybe if I push something away in a noisy place, that means I'm frustrated. Maybe everybody in my environment needs to respond to this behavior right now because that's what's gonna help me more than moving off a level of complexity in my world to make this behavior more systematic for me. Another possibility, I've got a gentleman that I work with who every time he's confused about what's happening and he's stressed about routines, he'll raise his hand and go da da da da da da da da. And that just means what's next. So again, maybe what I need isn't a new behavior from me. Maybe I need my partner to offer me choices on my now and then board so that I can tell what's happening next. Those are all changes that involve situation context partners or functions that at the same level of complexity but are giving me more generalization and more opportunities. Then we have challenging behaviors that are not acceptable or not meaningful in some way and we need to have a way to respond to those as a team in a systematic way. Very important when we see challenging behaviors from an individual is to also watch for the warning behavior. So if I throw things off of my desk when I'm frustrated, we wanna watch for that facial expression that says I'm about to throw things or if I'm gonna pinch you, the leaning forward with my handout is your warning behavior and we wanna intervene before the challenging behavior happens because if I haven't yet produced my challenging behavior, now you can give me a more appropriate behavior to produce but if I've already pinched you, by George, we don't wanna be giving you a better way to get something to happen right at that moment because we're gonna reinforce the pinching. Maybe we wanna pause for five seconds and now give you a more appropriate way to do it because we don't wanna reinforce that pinching behavior. So an example here, we had a little girl who would pfft pfft pfft pfft pfft pfft pfft every time I'm frustrated. So maybe we want to have, I hear your voice, you must want all done. Remember that anytime we've got a replacement behavior, we wanna make sure it's just as easy to produce as the behavior I already produced. We don't wanna say push your picture, push your switch to get to be all done, because that's harder. And if I'm already stressed, I don't wanna produce that new behavior. Last one, sometimes our individuals are giving us signals that I need you to do less. I need you to shut up, I need you to go away, I need to just stop. When I'm already having a tantrum, that is not the time to teach me anything. I just need to calm down first before we learn anything. And this can happen sometimes for challenging behaviors. If I already pinched, maybe we just need to pause and then next time give an opportunity for a new thing. If we have seizures, we need to recognize what a seizure behavior looks like. That's what the first signal is here and then plan a way to respond to that. Or the next one is, I do this when you've asked me a question and I don't know what you mean. We need to shut up. We need to not keep asking the question again and again when you're already working on understanding the first question or I don't understand. Or if the first one is stairs into space, do you want juice or cookie? And the person still looking at juice and cookie, maybe I still need longer processing time and you need to wait. So the last thing here, then now maps onto each of those previous behaviors that we had and picks a different type of response. I've given you examples. So the banging the noisy item on the table, well, that's an opportunity to create a turn. I could do any one of the six responses, potentially seven responses to any behavior. But I think that's an opportunity to get some turn taking going, banging back and forth. The raising the eyebrows? I think this person means a greeting. So I'm gonna help you do something that involves voice output because I really would like that person to come over here and now voice output's gonna buy me something where it isn't gonna buy me something if I can just reach for it myself. The throws objects on the floor? Maybe I'm gonna have a done box that you can put things in so that you don't have to throw them on the floor when they're done and we're going to have an alternative behavior that's just as easy. And then the empty cup? Maybe it's gonna be a partner behavior where we're gonna start to use some object symbols that means something working towards being more symbolic but not yet introducing anything in terms of picture symbols that are moving up several layers of complexity. So I'm done there. We have a time for a few questions, I believe, Kathy. Hi, wonderful. That was, wow. A great jam-packed and really informative. I wanna say systematic. There's a bunch of words that are coming to my brain, Cynthia. I know that people are going to maybe have questions, maybe have to process a little bit before they have some questions. I know one of the things, I certainly learned a lot, thank you. One of the things that I've suggested to people when I talk about communication inventories is to think intentionally about modeling, symbolic communication other than giving them the oral word. And I think this has helped me to think that through a lot more, but also given me some questions. Do you wanna comment a little bit about modeling or aided language stimulation? It's huge right now in the discussion in the field. You wanna say anything about that? You bet. Sometimes we would do aided language stimulation for a D-type response. So when I'm reaching for Play-Doh, you're just gonna say, yes, you told me Play-Doh. That's just gonna be starting to say that these picture symbols mean something and that's just pure input to the child. You're not expected to do anything. Maybe if I'm reaching for a soda can, I'm going to now put the picture symbol on top of the soda can so that you can now reach towards it and then I can help you either touch it and say, do you want more soda? And we've got soda here. And then I give you the aided language stimulation of soda as a choice. And now you reach for it. I'm not gonna expect you yet to touch it, but by George, you might just accidentally touch it and then you're again using it. Or if I'm going to model choices, I'm going to say, do you want, we've got two picture symbols. Do you want juice or milk? Juice or milk. I'm going to show you those inputs and I may be, so you reach for your juice and now I'm going to give you the picture symbol input to disambiguate whatever it was you told me so that you can see that this picture symbol has a meaning for what you're doing. So we can give input for anybody using the picture symbols. I would focus when we give the symbolic input to a child for when they're showing us the intent related to that. Otherwise, we're presenting picture symbols as ways to communicate in any way, shape, or form, even for people who have intentional behaviors and are just reaching for the soda. We can still introduce those picture symbols. We don't have to wait to introduce picture symbols, but we're not going to expect you to engage with them at a symbolic level. We just want you to notice these are good things to pay attention to. So there are different reasons we would use aided language stimulation for any given signal for a child depending on how complex the signal they already gave us was. Perfect. Thank you. That was just lovely. I'm going to just see if there's, I'm going to go to the chat. I see there's a few things in the chat. So people are saying great way to think about early communication. Sometimes we ask two questions in one statement. Do you want to cook your juice? We need to ask one question at a time for some students. Yes, some nice comments here. Does anyone have any questions? It would probably be the simplest if you put them in the chat so that we don't have multiple mics on at the same time. We'll give you a couple of minutes. I know typing takes longer than talking. Alternatively, I've been so very clear that you all understand it, but having done this with all my students, I realize it's harder to implement than it is to explain on my end. Well, isn't that always the case? The devil comes in actually putting into practice but I'm hoping that people will be really intrigued by this and we'll definitely work at doing some of that implementation. And Cynthia, I would not be at all surprised if we get requests to have you come back and maybe do a review or a part two or maybe we could have people talk a little bit about how they've done it. So maybe I'll hope that that happens and I'm gonna see, people are just saying thank you that they enjoyed it very much. So yeah, it was, and as I said, I certainly did as well. So thank you very much. And as a challenge to everybody, let's hope that, oh, here, I'm gonna just say one more thing from Jennifer. She needs to try it out and we'd love a review later. So maybe Cynthia, you and I can talk offline about that at another time to see whether we can come back and see what people in Alberta have done with this CSI. I keep thinking about the TV show and maybe it's not unlike that. The CSI is a detective show and maybe this is a little bit like being a communication detective but doing it systematically and intentionally. So I'm filling some gaps. Okay, so people are saying thank you. So I will say thank you very much. Again, it was a wonderful webinar and for people online, I will definitely post this as well as the slides. A few people asked me for the slides in the chat. Can send them to you that way if you send me an email. And with that, I'm going to say good night for now. And again, thank you. People just keep coming in the chat saying I found this so very helpful and I certainly would agree with that. So thank you, Cynthia. You bet. Okay, good night all. Good night. That was great. No, I, yeah. Oh yeah, you need to be back on, okay. That's what, no, no. I was just, I'm going to stop. I'm going to stop the recording.