Communication Through Spelling

How does spelling to communicate fit under the umbrella of augmentative and alternative communication (AAC)?

Oct 21, 2022

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The Weeklyish

Spelling to Communicate

Listen now (22 min) | For this edition of The Weeklyish, I share my early experiences with using the Picture Exchange Communication system with my nonspeaking students and my discussion with occupational therapist, Dr. Dana Johnson, about how Spelling to Communicate fits under the umbrella of Augmentative and Alternative Communication (AAC…

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2 years ago · 1 like · Tim Villegas

Hi Friends.

My name is Tim Villegas, and you are reading or listening to my newsletter, The Weeklyish, where every couple of weeks, I break down what is happening in the world of inclusive education or what’s been on my mind about what inclusion looks like in the real world. I like to say The Weeklyish is for inclusionists, because if you are a subscriber, then it probably means you know that our educational system is broken, but you want to build something better.

For this edition of The Weeklyish, I want to take you (way) back to when I was first learning how to work with autistic learners. I was in my first job as a special education teacher, and I remember going to a multiple-day training on using PECS or the Picture Exchange Communication System. The learners in my special education classroom, were either nonspeakers or had some verbal speech (including echolalia) but didn’t communicate reliably.

In case you don’t know what PECS is, it is a training program that uses applied behavior analysis strategies to teach learners nonverbal symbolic communication. Essentially, rather than a learner using verbal speech to communicate what they want or need, they could point to or give picture icons to their communication partner. The communication partner would then respond to the learner’s request. And theoretically, you could build to more and more complex sentences or phrases. During my training, I learned about creating low-tech communication systems for my students, and as the learner moved along, they could graduate to higher-tech systems like speech-generating devices. It was an exciting time, and I spent many hours putting these PECS books together for my students.

But there was a problem. It didn’t work for everyone. And despite spending much of our day trying to get the students in my classroom to communicate using picture icons, many of them just didn’t seem interested in communicating that way. And for the rest of my time as a classroom teacher, I’ve seen PECS and other communication systems work nominally well but never as well as we all hoped they would. It is not that the learners didn’t make progress, but rarely was it successful the majority of the time.

The especially hard situations were where a learner had verbal speech but what they were saying didn’t match up to their behavior. In fact, I remember one learner who would say all the words we had practiced for a particular situation using a social script, but even as they were saying the correct words, they said while sobbing. Which told me they were very uncomfortable, sad, or angry. So, I always thought they might be a better way, but even with all the support from Speech Language Pathologists, I often felt ill-equipped to teach communication skills to my students, though I was told we were doing the best we could.

It wasn’t till I saw the documentary Wretches & Jabberers that I started to think differently about communication for nonspeakers. The documentary featured autistic adults who historically were nonspeaking that now typed to communicate. I was riveted. And that same year, I went to the TASH conference in Atlanta where Larry & Tracy, the people featured in the film, came to share their insights with the audience.

Now, I know there are some concerns about typing/spelling to communicate, but for the instances that I’ve observed, it looks pretty real to me.

In fact, most recently, a good friend of mine started working with a young man with autism on spelling to communicate. She had spent many years with him working on various educational and independent living skills, including communication. And it wasn’t until the last few months that he’s been able to answer open-ended questions using the letter board. But it has taken a lot of work. When I heard about this turnaround, I asked if I could come and observe. It just so happened that the consultant, Dr. Dana Johnson, that was training my friend was going to be in the area and I was invited to come and meet her while she did a session. Dana is the owner of Interplay Therapy Center and Founder of Invictus Academy Tampa Bay, a non-profit private school for students with sensory-motor differences.

I observed a lesson for about 45 minutes. It was in a small bedroom that was converted into a classroom, where three other adults and I were hanging back watching the interaction between Dana and let’s call him Todd. Todd is an unreliable speaker, so while he has some verbal speech, often what he says does not match what his behavior tells you. Dana read a nonfiction passage to him and then asked him a question. Then Todd would point to letters to spell words using a pencil on a letterboard Dana held out in front of him. She calls them “pokes.” So, Todd poked his answer. And by the way, this answer wasn’t rehearsed, but in all the questions that I observed, he answered them correctly. And the last question was an open-ended question that took Todd nearly 20 minutes to answer, but he did it nonetheless.

I was so impressed, that I asked Dana if she would sit down with me to explain what Spelling to Communicate really is. And how it fits in under the Augmentative and Alternative Communication (AAC) umbrella.

Here’s Dana:

Well, AAC is essentially augmenting communication. So, all of my clients have some difficulty with communication. So, when most people think about AAC, they think about iPads, they think about computers, they think about high technology which I mean, we live in this day and age, and everything is high-tech, so that makes sense. And when you think about low tech, it's like, what, why aren't you choosing to use keyboards? Why aren't you using an iPad where, you know, there's these options for, um, individuals who can't communicate to use?
And I mean, my whole stance on everything really is. Whatever the individual chooses to use as their reliable, and that's the key there. Reliable form of communication. Awesome. So. Any use of letter board, you can call it spelling, you can call it typing, you can, um, call it spelling to communicate is really just another form of augmentative communication. It just happens to be a low-tech form.

As she was talking, I was reminded of my early days using PECS with my students. And I thought hmmm, this is really fascinating because to start this process with a learner, you have to assume a few things. Number one, the learner wants to communicate or is motivated; number two, they know that the letters have meaning. If you are a special educator, how many times have you heard about moving from the non-symbolic stage to the symbolic stage of language development? So why should spelling to communicate produce a different result for learners who aren’t successful with PECS or some other communication system? Here’s Dana again.

One of the things that I look at with any form of communication, anything that we do every single day requires intentional movement. So, it requires us to have an idea. To plan, sequence and organize that idea. Then we initiate the movement, we complete the task, we adjust if we need to based on our sensory feedback, and then we complete it. And that process is called praxis. So, when you think about communication, you also have to think about motor skills, and that's not always the case when we think about communication.
When we say communication, most people think about talking or speaking, especially within the, autism world. One of the hallmarks of autism is delayed speech and, we don't think about speech though as a purely motor task. And speech is 100% motor. There isn't any cognitive in our ability to speak.
So, when you say that, I'm presuming that the individual has the ability to learn or has learned that a letter is a symbol and when you put these together, it forms words. I do, depending on the age, of course, but all of my clients who are working on spelling, as their form of reliable communication, I presume every single one of them knows that.
So, I think that where the breakdown happens is the understanding that every form of communication requires intentional motor skills. The cognitive piece is the language part.
So, it's, it's a complex process, but what research is now showing in individuals with autism is that the breakdown is in their connections between their brain and their body, which is apraxia, or dyspraxia is the term that you would hear. When somebody isn't getting, so to speak, a form of communication, whether it be PECS, or even, an AAC device like an iPad with an app.
It's not because they don't know, it's because they can't get their motor skills to do what their brain actually wants or knows. And so, with spelling and spelling to communicate, we actually teach the motor skills. To point to letters to then be able to spell. So, I do presume all of my kids can spell. I have seen hundreds of clients and not one of them has not been able to spell.
So, you know, up until this very day that's the case. I may come across. I'm not saying that everybody, but up until today I have not had one that cannot spell. And so, we teach the motor skills and it's like riding a bike. Uh, you know, when somebody wants to learn to ride a bike, I don't just say, Okay, go ride a bike, right?
Like, we have to coach them. We don't just do it. And so, I think that that's something where when we're talking about different forms of communication, we have to keep that in mind because, Communication is very complex.
And even though we break it down into AAC buttons or a PEC, just because the child can't reach out and grab the PEC or bring it over to the teacher to request something does not mean that they don't know what they wanna communicate.

Now I know I briefly shared my observations at the beginning of The Weeklyish, but I wanted Dana to explain what the teaching process for spelling to communicate looked like. The brain-body connection for autistic learners that Dana described really made sense to me. Early in my career as a special education teacher, I used the Edmark reading program to teach my students to read sight words. Part of the program paired sign language with pictures and sight words, and I experienced firsthand how using sign language as a gestural prompt increased expressive communication with my students. The more my students copied the motor movements I did with sign language, the more their verbal speech and their reading of the sight words increased. Here’s Dana talking about the teaching method.

Going back to the motor skills, cuz that's what we have to think about now from this point on, is looking at everything through a motor lens is we have to teach those motor skills. We have to teach how to point to a letter, because. I have clients that come in, and they can poke, but they can't bring their arm back.
It's just not a movement that they've ever done. So, I'm, again, not assessing their cognitive ability. It's okay, let's practice. Pointing or poking forward, moving your hand forward and pulling back forward and back. And we do it. I mean, doing something over and over again is going to make it permanent, so we have to make it where one, it’s interesting, because as a practitioner, I'm thinking about the motor demand because everything's motor, but I'm also thinking about the cognitive demand.
So, there's this seesaw where in the middle of the seesaw, so if it’s unbalanced, dysregulation is gonna happen. So, the middle of the seesaw is regulation. So, if the motor demand is too high, like let's start on a keyboard. That's why we don't start on a keyboard because it's about the motor skills, that's going to dysregulate.
That's why when teachers will say, Okay, well let's see if Johnny can spell this word, and they pull out a keyboard. Well, now that we know what we know about motor skills, that's why he can't because the motor skill output is just too high. But then I'm also what we call feeding the brain with information, because I presume competence, and so I work with what we call a lesson and I teach a concept. So, we could be learning about Benjamin Franklin, we could be learning about the history of pyramids, it's not about what you think they love, because most often that's a loop or something that isn't the case.
So, I'm teaching, I'm reading about this concept, and then we're gonna practice poking the board. So, we're gonna say, spell garden, spell tulip. And I'm helping them just like I am teaching somebody to ride a bike. I'm saying things like, Get your eyes. You know, move your eyes over next door. Jump down.
I'm giving directional prompts because I didn't tell my friend's child that I'm teaching to ride a bike to go ride a bike. I said, Put your hands on the handlebars. Push harder with your feet. That's what I'm doing when I'm going through, and so essentially. Once you get really good and you become accurate on the first set of boards, which is larger letters, um, more forgiving for your eyes as well, you move up too much finer, um, motor movements until the keyboard.
And then I have clients right now that are working on independent typing, so kind of going down the road of what are some, you know, uh, questions or concerns that people would have about spelling to communicate and spelling and typing would be that, why is somebody always holding a board? You know, that's like, why, why can't you just put the board on the, on the table or, and I mean, there's a number of reasons why.
But I have clients that absolutely I am not touching the board and it's on the table and they're typing so it can get there. But it's all about the motor skills. And that's the, that's the one thing that I think was left out early on when, you know, spelling on a board was first introduced is really the understanding of what I talked about with the motor piece. I think if that was part of the original conversation, I don't think we would be having these concerns. Because when I start talking about what we've talked about earlier, they're like, oh, okay, well that makes sense. Then, so that would, that's probably the biggest concern is, you know, well, is it the speller or is it the person holding the board? Now I am prompting right at the beginning, but it doesn't matter what form of AAC you're using, you're prompting to help teach them how to do this.

Dana and I talked for a good 20 minutes more about unreliable speakers, the brain and body connection for autistic people and communication, and I’d love for you to be able to hear the whole conversation. Go to patreon.com/thinkinclusivepodcast and become a patron to get the complete lightly edited version of my interview with Dana Johnson.

To wrap up, I asked Dana what she wanted our audience to leave our conversation with.

When I have families come to see me to start the process and to be introduced. And, it's interesting cuz they're like, I just wanna see if my child can do it. And in my head, I'm like, oh, they're gonna be fine. But it is just that they're like, oh, I just wanna see. Right? And then their child does an amazing job and they're just like, oh my goodness, I had no idea.
And they wanna go back because they come and they travel to see me and they're like thinking one thing, right? They leave thinking something totally different and they want everything to be changed right away. You know, they want their child to be taken out of, special ed or in a self-contained. They want them now that they know, that they understand infor, you know, all the stuff, which obviously can't be changed on, on Monday.
So, they're like, well, what can I do? Right? And, and. I'll say two things that I really feel that everybody needs to know, whether they're spelling or not. The first thing is, of course, presuming competence. So even though that child cannot demonstrate their knowledge right then with, you know, because they don't have a way to, a reliable way to. Presume because that's the least dangerous assumption that they do understand and they want to learn.
Their bodies are not going to look, we've, we've talked about what does listening look like? Does listening have a look? No, we've made that up. Which is eye contact and sitting straight in your chair, because that's what our teacher said to us, like, sit up, you're not listening. I've had clients under the table having, you know, difficult time and I'm reading the lesson and they can sit up in the chair and they're just like, boom.
So, these kids can, can do that even though their bodies don't have a look in terms of what it looks like to listen. So presuming competence is number one, speak to your child. My oldest client is 58 years old. Speak to them like they are their age. Then the second thing is really try and learn more about the motor and a breakdown and apraxia and the disconnect and that they're able to understand what you're asking them. And even though, like you said Tim, the body, it's a behavior, you know, that you're observing. Insides don't match outsides. It's not something that is indicative of what they're wanting to do or what they're feeling. It makes it harder as a parent or as an educator, um, to really, cuz then you're like, Okay, well is it that you're happy or you're sad, or you're like, what’s going on?
Um, once they're on their way to having a form of reliable communication, you see behaviors decrease because these kids are like, oh, mom and dad, teacher, they, they get it. They get me now. So that reduces anxiety and behavior. Um, so those are the, the two things. If you cannot, you know, you don't have access to spelling or typing with the child or the student doesn't do that. Those are two things that you can do instantly. Presuming confidence is the easiest and the hardest thing because we have, it's a mindset change, which is way harder. And the motor and understanding what does it mean to be able to control your body and to not, because that's the big question mark.

Thanks to Dana Johnson for spending some time with us on The Weeklyish.

For more information about spelling to communicate, go to the International Association of Spelling for Communication. Dana’s company website is interplaytherapycenter.com.

Have a great week!

Dr. Dana Johnson, Ph.D., MS, OTR/L is the owner of Interplay Therapy Center and Founder of Invictus Academy Tampa Bay, a non-profit private school for students with sensory-motor differences. Dr. Johnson has a Master’s Degree in Occupational Therapy and a Ph.D. in Child and Adolescent Mental Health and Development and has worked with individuals with motor and sensory differences for over 15 years. She started her career as an occupational therapist supporting children in the public school system. From there she moved to the clinical environment in Raleigh, NC working in a private pediatric clinic supporting children with varying diagnoses. In 2009, Dr. Johnson moved to Tampa, FL where she gained experience working with children on the autism spectrum and was introduced to Spelling to Communicate (S2C). Her private practice opened in 2010 and has grown to serve children, adolescents and adults with motor and sensory differences, including autism, apraxia, sensory integration disorders, and other developmental disabilities. Dr. Johnson is a spelling to communicate trained practitioner and works with families and professionals internationally.