Teaching auditory scanning can be so so tough! Karen Natoci - I loved your explanation of using the student's own body to anchor an array of three choices. A great building block towards auditory scanning, and impressive that he can do it! I wonder if focusing on an acceptance strategy (a sign or gesture and/or button saying "that's the one I want" or "yes" or "that one.") would be helpful? Then he just has to wait for the option he wants. Also, I would highly recommend having a structured list of options that are presented in the same order each time the student practices this skill. As I'm sure you know, predictability and anticipation are so important for auditory scanning. Tactile symbols/real objects could be used to support his learning of the concept of scanning before transitioning to just auditory scanning. Sounds like a fascinating and challenging situation. Please keep us updated as you try strategies!

Hi Jamie I hope I may chime in! I know this child... his history is complex & he is diagnosed with a severe TBI as a baby with significant head trauma due to abuse. He "sees" enough to get around quite well and responds very well to intense light. He is very very strong and readily uses a high-strength (possibly unintentionally hurtful) push/pull. He will also throw objects quickly and at missile speed which threatens the safety of those in the room. He scratches, bites and is particularly exhausting for the staff. He has a dear, sweet side, too- and likes to hold a "comfort doll" to self-soothe. Overall, he is very very strong & super active. He does have "speech" but it is mainly repetitive at the single word to short sentence level. His speech can also sound neologistic (nonsense but with imitative contour) as a way to stay engaged with a staff person. It is difficult to tell how he uses his echolalia. He will use it with a question intonation to seek permission to do something (although the speech is unrelated, the intonation does match with his intent.) We know what he likes, doesn't like, and easily chooses given an array of 2-3 with tactile representations of what he might like (or from the real objects themselves). Yes/no is so hard a concept for him to 'express;' however, he can listen/feel/be exposed to yes & no receptively. (He is very well exposed to "no!" or "stop" from staff because of his behaviors.) Not sure if I mentioned that he has perfect sense of rhythm!! He will even use syncopated rhythms with me when we each play the "wooden frog" together along with music. We are trying to make tangible symbols for "more" "stop" "break" on a talking device; however, we anticipate that these will break. I think the Texas School for the Blind has some nice ideas for potential symbols to use for CORE (more, stop, me). Again, this seems so abstract! With the yes/no a two talker with velcro (rough=no, soft=yes) was tried and the yes/no was used / modeled as a way to make a choice in a partner assisted scan routine. {But maybe, "next" and "that one" might be more meaningful!} Another technique tried was using his own body to 'anchor' an array of three choices. Let's see if I can explain this: If we know that he wants his doll, we can offer him 3 items: shoe, doll, paper. I touch one place on his arm (above elbow) and say "shoe?" (also give him a chance to touch shoe, briefly w/ his other hand.) Then I touch his elbow and offer "doll" (give him a brief sampling), then I touch his wrist and offer (paper, with a brief sampling. I take his left hand and touch/label the three spots on his arm: shoe, doll, paper (as a review) and ask what do you want? and in these instances, he used his left hand right away to touch his own elbow (where I offered doll.) This has worked nicely- it requires partner commitment to do. Basically, it's just a way to move beyond directly touching the actual item from which to make a choice and hopefully - eventually build toward auditory scanning. We do not have tangible symbols for everything for direct select but that would be an option, too. He is very very rough on all tangible symbols and none of them have lasted. He is strongly auditory (hence the echolalia and his strong rhythm abilities.) This type of child is so challenging! I can try to post an example of using his arm as a reference to make a choice because it is difficult to describe. What do you think? Amy, I know you have a particular interest in the use of echolalia in students with CCN. He is very different than the fellow that you met. Sadly, and possibly due to the TBI, this little boy can go from "0" to "100" with his reactions and cannot "grade" his limb use (i.e., tactile exploration). He seems to have a sort of "limbic fire" and has hurt the staff.

In my experience, "yes" and "no" can be challenging for individuals with visual impairments and multiple disabilities. It is abstract. Choosing between two concrete things that have meaning may be a first way to indicate "yes". A highly preferred tactile object that is already associated with a pleasurable activity becomes a way to learn what "yes" really means. YES! You touched this and pulled it to yourself.. yes you want X. Let's do X! Yes! you want that. Building on the meaning behind the echolalia. No can also be dramatic and fun... "No" you don't want this... you really want this. I think that really acknowledging someone's "no" and "yes" behaviorally is a way in.... You recognize that the person is already communicating and you honor the current communication behaviors. Then you scaffold again and again to the verbal paired with some real objects. Perhaps... Communication in familiar routines with highly preferred or low preferred objects is a way to build meaning, in my experiences. I'm fascinated and would love to help! Wishing you well!

Could you provide more information about where this student is in terms of ability to express other intents? Without any other knowledge about the student's communication skills, the first questions that naturally come to mind are: 1. Are you sure that the student understand the questions that s/he is being asked? Is his/her comprehension of speech certain? 2. Is the student's use of speech primarily echolalic, or does s/he have some meaningful and spontaneous speech? 3. Does it really matter to the student what the answer to these questions is? Is the difference between a yes or no answer a really important one? This is a really important skill that you are targeting, and a very high level skill (at least within the scope of the Matrix).