Tuesday, September 23, 2014

Learning Never Stops

I wish I knew when it came about that only children need services, or only children need specialists such as behavior analysts or only children need the developmental specialist doctors. When did the focus become only about the first ten years of a child with autism's life, or if you are lucky, into early adolescence. Then BAM, once 16 hits, 17 and then the dreaded 18...POOF, it's gone. The resources your child could access as a younger version of themselves was plentiful. Individuals wanting to help your child were everywhere (well, depending on where you live). Behavior therapists were in and out of your home for years during those coveted years. They are rarely found once the teens hit.

Typical teenagers are in high school and then to further their learning, they go into college or specialty schools or even job training - the list is endless. Adults are always trying to teach themselves new things- whether you want to learn to cook better, ride a motorcycle, learn a foreign language for the first time. The possibilities are endless.

So tell me why...why when our children with autism reach adulthood that most services cease. Most learning programs are either hard to come by or don't exist at all. The number of behavior analysts that see adults with autism are VERY few and typically only in residential, group homes or crisis situations. I want to know why. Our children are in adulthood far longer than they are in childhood. Their learning doesn't cease because they reach a magically age, just like your learning never stops throughout your lifetime Just because Kreed didn't learn to brush his teeth or shower or put on his shoes as a young child, doesn't mean he can't learning it now. He makes weekly gains as we work on it. Kreed had zero communication for most of his life until he was 14 years old. Then he used a device for the first time and was able to ask for a few things. By the time he was 16 even more technology came out and he began to have small conversations with those closest to him. Who knows what he will be saying when he's in his 20's...30's or beyond. His learning doesn't stop.
The view nowadays seems to be to just hold and survive when our kids hit 18 years old. That we are stuck with whatever level our child is at right at that moment. I'm here to tell you it's not true and it's time for us to fight a new fight- that our children are lifelong learners and services shouldn't end just because they are becoming adults. We shouldn't have to hold and survive. We shouldn't have to scour the internet for service providers or doctors and only be told nope sorry, only for children. Why? Someone tell me why?

Why aren't there inclusive communities that don't cost thousands of dollars to attend? Why aren't there behavior analysts willing to work daily with our kids to continue their learning. I don't care if a child didn't learn to read during their childhood, keep trying. Their brains haven't stopped processing information. These children don't become brain dead overnight on their 18th birthday. Learning is lifelong. Period.
As Kreed nears his 18th birthday my only view is this: I can't wait to teach him even more things. While Kreed is incredibly affected by autism and his various medical disorders and will most likely live with us for the rest of his life, that doesn't mean its a life sentence for him or for us. It just means we will be the ones to continue to teach him and expect more for him and give him a life filled with love and happiness.

While some may say "but Kreed is an easy child, look at what he's learning, my child can't do that," I will promptly direct you to the rage videos we have posted on youtube. Kreed was never an easy child. Ever. He was hard. He caused chaos and destruction and everyone who encountered him labeled him as unteachable and that he would never communicate or learn anything of substance. We chose to reject that view and worked countless hours and stayed incredibly consistent with him and gave him a communication device where we then spent many more thousands of hours teaching it to him. He was HARD. He still can be if he's in the mood. But I always knew when he was about 12/13 that if we didn't work our butt's off to get some of those behaviors under control and give him communication, then we would be the family holding on and surviving. So we pushed and we gave up a lot to get him where he is today and continue to. Because it's OUR future. It's not just HIS future, but it's ours as caregivers as well. We are fully aware of the lack of services and that the responsibility for his care falls squarely on our shoulders. So we took it and we teach him. Some days more than others. Some days are complete failures. Others are complete successes. But on our failure days we always know there are new days to come and get back on our feet.
So as Kreed approaches adulthood and I look around and wonder where are the resources are...I realize there is a new fight and a new kind of awareness that needs to happen. Our adult children with autism are lifelong learners, just as you and I are. We need the resources that they had as a child- they can still learn communication, they can still learn self help skills, they can still learn to read, write, do math. They have probably MORE behavioral issues than the younger children, so we need the behavior services so it's not on us already exhausted parents. 
I have always told Kreed: I will never stop fighting for you. 
That includes into adulthood.
 


Sunday, September 7, 2014

I am not a perfect parent

I am not a perfect parent. 

Sometimes I'm tired. Sometimes I'm hurt. Sometimes I'm so mentally exhausted I can't think straight. Sometimes I'm stressed beyond belief. Sometimes I do not do things right for Kreed or I yell too much or don't take the time to understand. 
I am not a perfect parent. 

The trick is knowing that no one else is either. We try and we do our best for Kreed at each point in time- but sometimes our best is not super awesome- sometimes our best is sheer exhaustion. 

Kreed sometimes has days where he rages all day. Or pees in every part of the house. Or spills food everywhere. Or yells at me all day. Or hits me. He is not a perfect kid either. But we love him unconditionally and to the moon and back. Turns out Kreed also loves us unconditionally and forgives us when we have just as shitty days. These dimples sure help. 
We would like to think we can be there 100% for our kids every second of every day and be perfect therapists also. Sometimes we are just tired parents. Who wouldn't be after waking up every two hours at night to put them back to bed or clean up whatever mess they left us while we shut our eyes for JUST A SECOND. 

When those eyes are open some days are filled with that pee, or poop, or hitting or yelling. That's they way it goes. Like I said, our kids aren't perfect either. Some days the world is too much and it's so much easier to hit and yell and not use a toilet. I get it, I do. Some days Kreed just wants Five Guys for every meal and doesn't understand that's not okay. He's hungry and he wants their fries damn it. So we fight and yell and have it out. Then he apologies, I apologize and life goes on. 

Sometimes life feels like a repeat every single day- sometimes nothing changes and it's a struggle to get through. Other days are amazing. Some days are both. I'm not a perfect parent and he's not a perfect kid. So that how that goes. 
But as long as we keep in mind progress not perfection, I think we will be alright. Last year we were at the end of eight months of pure hell- he raged like crazy and hurt himself and me badly day after day to the point he could no longer ride in a car or be out in public. He was restrained constantly to keep him from destroying his body or the house or me. It was utter hell. I think I went to a part of myself and my brain that kept the full weight of those eight months far far from my consciousness. Now I can barely recall it and I guess don't want to. Now it's a year later and there is much to celebrate! Including knowing none of us is perfect and we do what we can with what we have!


This
To this...
This is not always an easy life. Some days will be better than others. Sometimes the bad days stack up and you don't even hardly remember what a good day looks like. But it will come- it will be a smile, a nod, a moment of wonderful...something...and the world will be okay for that time- 5 8seconds....5 minutes.....5 hours. That is what we hold on to. 

And remember it's ok. We are not perfect. We try our hardest at whatever point we are at and we love, love, love...and often that is what saves us all.



Tuesday, August 26, 2014

10 Simple Rules for Working with my Child


Dear Therapist, Teacher, Aid, etc,
You are starting treatment or teaching my child. There are just a few small things you need to know before you begin working together. 

1. My child has no limits. There is nothing he can't do or nothing we can't adapt for him to do. If he is not doing something, it is a result of your teaching methods, ability to motivate or lack of creativity. Teach to him, do not have him learn to you. If you take this approach, I guarantee you will be successful in some way. 
2. If I tell you he can do something, and even film it for you, but you say he can't or he cannot generalize to you- again- see #1. If I can get him to do it, then you either have a failure of motivation or he just doesn't like you. In the event of the latter, I wish you luck. 
3. Find what motivates my child. And listen to me if I tell you what he likes and what motivates him to do things at home. I am with my child 24/7, you are not. If what works for me doesn't work for you, then find something. Do this before you ever begin to work. It will go better for the both of you. 
4. Repeat after me: tell me and I forget, teach me and I remember, involve me and I learn. Pay attention to the last part. That is how my child will learn- involve him, show him why it matters. Otherwise, good luck to you.
5. My child will say no to you and that's okay. Then there is room to negotiate. And if you are negotiating that means he is using language! As his parent, the fact that he can argue with you is a wonderful thing. Keep working it. 
6. We believe on cooperation not compliance. If you decide to use compliance as your word choice- again, good luck to you and we won't miss you. My child knows how to cooperate with others and find common ground and learn from you. He is not taught to blindly do what you tell him without the ability to say no, or question why he has to learn it. 
7. My child has a voice and he uses it. Deal with it. We have worked our whole life for him to have a voice. You will not ever decide his opinion on something. Ask him. If you decide to talk for my child, I will invite (or force, whichever must be done) you to duct tape your mouth shut for an entire 24 hours and let other people speak for you and make all your decisions. Then let me know how that feels.
8. Do not talk about him in front of him. He may not always choose to speak, but he certainly has ears to hear and a brain to understand. If you decide to do this, I will have a conversation about you, in front of you and let you feel how it feels.
9. Respect my child and he will respect you. You do not need to talk to him like he is hard of hearing or far below his age. He's a human being and deserves to be treated with respect and dignity. If I hear you talk down to him, again, good luck to you (and by now I hope you've figured out what that means). 
10. You are with my child for an hour, maybe a couple hours or half a day. I am with my child 24 hours, 7 days a week. Do not talk down to me either or good luck to you. I have to hold strong even at 3am and he decides it's time to get up after 3 hours of sleep for me- while you sleep comfortable in your bed at him for your 6-8 hours of sleep a night. When we discuss goals- make them functional for his life at home with me- not just your hour or two hour session. I need to know what works even when we are all bone dead tired or stressed to the max or when we have some down time to cuddle. Until you know what it like to be with my child 24/7, don't ever assume your way is best or think I "should" have done something. Cooperation is the key word here. Or good luck to you. 
This is just a note to let you know the rules for working with my child, but with us as a family. I will never tolerate anyone treating him like he is less than or that he can't do something. If you do not have the #nolimits philosophy, then we won't be able to work well together. Challenge yourself to find what works for him. Teach to him instead of learning to you. Learning never stops. 

In the end I think you will find he is smart, funny, kind and a riot to be with. It's not hard to teach my child if you hear his voice, treat him with respect and involve him in learning. There can be so much fun in therapy when the focus is on cooperation and learning for life. I hope you enjoy working with him as much as we enjoy raising him. If you have any questions- ask him or ask us- we've been doing this a long time with him and we will continue to be doing this for a long time with him. 
 
 
 
 
 


Friday, August 1, 2014

#NOLIMITS

This project started with Kreed breaking through so many limitations others set for him and our philosophy that he has #nolimits Then I invited individuals and families to send in their photos of their children or adults defying the odds and showing the world that though they may face more obstacles and challenges than most, ultimately they have #nolimits Please share and raise awareness for special needs and prove to everyone how special these individuals and families are for defying the odds. Thank you to everyone who sent in photos I hope this has touched you just as it has touched me. And special thanks to The Script for recording such an amazing song.

"Superheroes"
All the life she has seen
All the meaner side of me
They took away the prophet's dream for a profit on the street

Now she’s stronger than you know
A heart of steel starts to grow
All his life he's been told
He’ll be nothing when he’s old
All the kicks and all the blows
He won't ever let it show
'Cause he's stronger than you know
A heart of steel starts to grow
When you've been fighting for it all your life
You've been struggling to make things right
That’s how a superhero learns to fly

Every day, every hour
Turn the pain into power
When you've fighting for it all your life
You've been working every day and night
That’s how a superhero learns to fly

Every day, every hour
Turn the pain into power

All the hurt, all the lies
All the tears that they cry
When the moment is just right
You see fire in their eyes
'Cause he’s stronger than you know
A heart of steel starts to grow

When you've been fighting for it all your life
You've been struggling to make things right
That’s how a superhero learns to fly
Every day, every hour
Turn the pain into power
When you've fighting for it all your life

You've been working every day and night
That’s how a superhero learns to fly
Every day, every hour
Turn the pain into power
Every day, every hour
Turn the pain into power
Every day, every hour
Turn the pain into power

She's got lions in her heart
A fire in her soul
He's a got a beast in his belly
That's so hard to control
'Cause they've taken too much hits
Taking blow by blow
Now light a match, stand back, watch them explode

She's got lions in her heart
A fire in her soul
He's a got a beast in his belly
That's so hard to control
'Cause they've taken too much hits
Taking blow by blow
Now light a match, stand back, watch them explode

When you've been fighting for it all your life
You've been struggling to make things right
That’s a how a superhero learns to fly
Every day, every hour
Turn the pain into power
When you've fighting for it all your life
You've been working every day and night
That’s a how a superhero learns to fly

Every day, every hour
Turn the pain into power

Oh, yeah...
Every day, every hour
Turn the pain into power

Ooh, yeah
Whoa

Every day, every hour
Turn the pain into power
When you've been fighting for it all your life
You've been struggling to make things right
That’s how a superhero learns to fly

Thursday, July 17, 2014

Disconnected

Sometimes, every once in a while, I feel disconnected from Kreed. I can't even really explain it in words. There are some times he has conversations quite frequently on his device, then other times, it's only requesting again. These times make me more sad than frustrated. When you look at Kreed, you know there is so much he wants to say. I'm always searching how to give him more language, better language.

Most of the time, these times come when his medical issues are at their worst. It often seems he has to conserve so much energy just to feel well, that it doesn't leave a lot left for anything else. I wish I knew how to make him better. I wish I knew how to ease his pain. Instead we just wait- wait for doctors, wait for tests, wait for health. Meanwhile I watch him continue to lose function in his hands- the peripheral neuropathy is getting worse. He now rarely wants to use his left hand- it's constantly doing the pill rolling motion like it's alseep and he's trying to wake it up. Since his hands ARE his VOICE...it makes him harder to use his voice. That fact alone makes me want to cry at night after he's gone to bed. We worked so hard to give him a voice, only to have various medical issues try and take that voice away.

I hate feeling disconnected from Kreed. It's an odd feeling. Almost like part of me is gone too. I spend so much time with him and working with him and talking to him and anticipating what he needs and figuring out when something is wrong- that when he moves away from me and goes into himself, there are some empty spaces within myself.

Normally times like these prompt me to give him new language on his device. Which is exactly what I'm going to do- try to find new language or more language to make help pull him out of his shell and talk to me more. Every since he found his voice, I don't like the silence. He will also tend to perseverance on certain things like food. Whenever we feel stuck- I always go back to one fact: the more language we give him, the more connected he becomes to us.

I would do anything for Kreed and give anything to him...right now I need to find even more language for him and hope he can find his way back to his voice and communicating more. I feel heartbroken when I don't hear his arguments or his thoughts and how he feels. We live in Kreed's World, but I don't like it when he begins to shut everyone out from joining him. I'm sure more videos will come as we go through this next process of finding more language and more ways for him to say what he thinks, model it for him and watch him enjoy communicating again!


Tuesday, July 8, 2014

ABA and AAC

From my professional blog Something To Say AAC www.somethingtosayaac.com

This is not about DTT. This is not about PRT. This is not about NET etc etc etc. Or any other three letters that are a "subtype" of Applied Behavior Analysis (ABA). This is about using the principles of ABA all day, every day to help a teenager with autism learn to communicate with his Alternative and Augmentative Communication (AAC) device. Over the years so many "types" of ABA have cropped up- each proclaiming to be new and improved version. Or a mix of DTT with naturalist teaching instructions. Or whatever someone wants to say it is. I have a news flash for all of those people- it's ALL ABA. Period. If you knew ABA inside and out, you would realize that the point of ABA is so that children learn naturally. If you are good at ABA- that should be your goal in the first place! When anyone decides one one "type" of ABA, you are then possibly only using "part" of ABA, and thus you can't just assume you can only use part of ABA with every child you meet and expect it to work for every child. Meaning some children might need some version of discrete trial, but in other situations more natural examples. It’s different for all kids and across skills. Rarely does a child need one and only one approach while they learn.
Augmentative and alternative communication (AAC) is all forms of communication (other than your own natural voice) that are used to communicate everything (needs, wants, thoughts, comments, responses, questions etc). In people with severe language delays or a lack of functional speech or any kind of speech, AAC devices are used to become their voice. These can include Sign Language (so those peeps who think they are not using AAC by teaching sign language- this is AAC too), picture exchange systems, switches, eye gaze or computer devices that use symbols or words. The thing to understand about AAC devices is that it enhances speech AND impacts behavior. If an individual is able to communicate, they won’t have to rely on maladaptive behaviors to get their point across- hence why ABA practitioners should be all over this! I’ve learned over the years the lack of use of AAC devices through the years has more to do with experience, or lack thereof, and limited knowledge of how to implement devices to impact people’s behaviors. This is why we film Kreed, this is why I write about it and why I try to advocate far and wide for the use of communication devices by families- not just speech therapists in a session- but for children, teens and adults to have a voice at all times, even if it is not their natural one. One more added fact about AAC devices. For those who believe that using an AAC device will cause a child to NOT speak, check out the research first. Research has shown that in fact, using AAC device ONLY helps develop even more oral communication (Blischak, Lombardino, & Dyson, 2003, Miler et al., 2006). ABA is a science and we only use scientifically researched approaches- the proof on how AAC devices can be implemented and help behavior and speech is right there in the research literature. For any ABA practitioner that says using AAC will halt any kind of oral speech or impede progress in using their natural speech- you are giving false information and perhaps limiting an individual’s progress by not knowing the research. Shame on ABA practitioners who do this because you are also not disseminating correct research and telling families the exact opposite of what sound scientific research has shown.
At home with Kreed you will see us use ABA all the time, all day, in every situation. Just like his use of his AAC device. The reason we are successful with his AAC device is because we use the principles of Applied Behavior Analysis to teach him the language of the device. We MODEL language for him, we PROMPT him to use the correct language, and we REINFORCE his correct use of his device. We reinforce this mainly by either respecting the words he says, by delivering the item he chose with his communication, by or engaging in conversation.

With every behavior Kreed exhibits, we try to determine the function (which is just a fancy way to say we figure out why he’s behaving the way he is- is it a want/need, sensory, attention, escape/avoidance or automatic?). Once we know that, we generally replace it with language to help him navigate the situation. For instance- his current obsessive issues. While most would think it's x, y or z, for Kreed it's actually a medical reason causing his obsessiveness. In reaction to not getting his obsession he tends to bite himself. So we block his biting attempts and then give him new language. We are response blocking and replacing the behavior with language. ABA at its core.

We are also consistent. Once we give Kreed an answer- that's it. Even when he argues to death on his device. But that's the wonderful thing- we replace his behavior with words on his device. We constantly redirect him to using his device. Because guess what? If he's pressing buttons on his device and arguing, that behavior is incompatible with biting or hitting his head on something. And we praise him highly for using his device. So in ABA speak we are doing a DRI- differential reinforcement of incompatible behavior. We are reinforcing the use of his device which he uses his hands for- and he does not use his hands to bite, since they are busy talking to us.
We also have clear goals for Kreed. We don’t work on everything at once or everyone would be crazy with it. We normally target a few activities for Kreed to be successful with at a time, work on them until he masters them, and then move on. For instance, right now we are working increasing his attention to tasks with playing games. Kreed’s skills have grown by leaps and bounds and he is finally at the point where he is ready to learn new games rather than just movies. So we are using a token economy system (the tokens are actual cash haha- can’t get more natural of a reinforcer than that) and as he completes and activity or a chore at home, he earns a dollar. When he gets to five dollars, he gets to go to Five Guys or choose to save it for something else. Currently he needs many verbal and physical prompts to complete activities. It’s mastered for us when he can complete the activities without assistance to completion. Again ABA at its finest. His secondary goal to the activities is using activity based language on his device. We don’t just play games with Kreed and expect him to silently interact and just complete them and be done with it. Our actual point is to increase his language on his AAC device.  So we always add vocabulary specific to his games or chores when the time come and then first we MODEL the language we expect him to say depending on the situation, then we PROMPT him to use the language. This is how it works for most situations, we model and then we prompt and then over time we gradually reduce the prompt until he is commenting on his own. ABA and AAC working together hand in hand, just as it should be.

This is also why I don’t understand why more behavior analysts don’t embrace AAC technology, why more speech therapists and behavior analysts don’t work together. Our job is to impact the children’s behavior, to turn the maladaptive to appropriate behavior and to either develop new skills or improve current skills. All of this can be done with AAC. We have the technology NOW. Yet not everyone uses it for these kids who are nonverbal- particularly older kids with autism or adults where the technology was not available at the time of early intervention. Why should I ever expect a child to just “comply” with whatever it is I want to do, without the individual having a choice in the matter? Just because they are nonverbal, does not mean they don’t want to be heard. It does not mean they don’t have feelings and thoughts going on in their head. As a result of being unable to speak with their natural voice, they are the unheard voices in our communities. They are the students and clients just expected to do as they are told and when they refuse, they are labeled as non-compliant. I have a newsflash to people who label individuals who are nonverbal non-compliant: refusing to do activities is the ONLY voice they have. It is the ONLY way they are able to assert choice. Without language, they are left in this chaotic world with the choice to follow what everyone tells them to do, or refuse to do it and face the consequences.

Kreed was labeled non-compliant for years and years. He never had a voice or a choice. Now when you hear him “talk,” it’s amazing to watch the wheels turn in his head and the things he thinks of, just to have a voice, just to have a choice. Choice in life is a fundamental human right, it’s not an action only for those that use their natural voice to speak. We should be working much harder to give children, teens and adults a voice. Much harder. Kreed’s case alone has taught me this and countless others. I welcome my arguments with Kreed because it means he has a voice and he is using it. It means he does not have to do exactly what we say (well, if I say no, it's still no ha, but he can at least try to negotiate a better position), but he has room to negotiate and to try to improve his life on his own and not rely on others 100% of the time.

And speaking of non-compliance: Practitioners need to get rid of the archaic language based on the word compliance. It should be COOPERATION not COMPLIANCE. I refuse to have individuals comply, I want them to cooperate. Cooperate denotes that we are working together to goals. Compliance denotes a power struggle and a power hierarchy that says I have more say than you and you have not right to any other choice. It is this kind of language that leads individuals who are nonverbal to continue to not have a voice.
There is such a vast language difference between the two words. 
In Compliance it even mentions the words "conformity" and "coercion." That's awfully powerful language to be using on kids and once again highlights the magnitude of the word. 

But this word:
Denotes a more positive word and more descriptive to what we are actually trying to accomplish with these kids! If we were to use cooperation over compliance, it would improve our teaching abilities because we will be attempting to learn to teach better so that the children we are working with will cooperate with the task at hand. It also allows for dialogue rather than strict obedience. Aren't we trying to get the children to have joint attention and joint actions! Our goal should be COOPERATION not COMPLIANCE. Period.

This is also where the marriage of ABA and AAC falls apart.  To be successful in implementing an AAC device, the foundation has to be cooperation not compliance. The device is THEIR voice. I don’t have a right to tell them exactly how to use it or refuse to accept their words. Just as I would never silence an individual who uses their natural voice, I would never silence and individual who needs a device to communicate. That means for every meltdown, tantrum, every learning opportunity or any other time- that device needs to be present. ABA could be the basis for teaching so many to have a voice using AAC and from a young age. I would rather have a child learn to talk back to me during a session with a device, then just sitting there waiting for what is next, but not being able to help decide or have a say in anything.
We impacted Kreed’s behavior by using AAC. When we used to tell him he couldn’t go to five guys (if he brought us the picture card, or anything that looked like checkers because that’s what the walls there look like), it would be the end of the world. Biting, hitting, yelling, and throwing himself on the ground. He couldn’t cooperate with us. He couldn’t negotiate. Now with his device, we might say no, and he might then ask us a thousand more ways (Five guys is my favorite restaurant. Are we going to five guys? I love it.. I love French fries. Can we go? Among others ha), and the answer may still be no so then we give him more choices, “We can’t go to five guys right now, do you want to do…” and then he can make more of a choice or decide to talk to us more etc. The fact of the matter is, he is TALKING to us, rather than getting angry. Or he is talking to us while he is angry but he’s not hurting himself. As a result of being able to talk through his frustrations, his behaviors have lessened significantly. And we didn’t have to come up with fancy charts, or various reinforcement systems or timers or any other more complicated procedures than just teaching him to communicate to us on an AAC device. 
Prior to becoming conversational on his device, where he could only say wants and needs but still lacked back and forth language, this was also his behavior if he just brought us a picture of what he wanted:

With the RIGHT device and implementing his device in all situations: 
This blog is both about how ABA can be used successfully with individuals who use AAC, but it’s also about a call to arms for individuals who are nonverbal. Realizing it should be about cooperation and not blind obedience. Ensuring that they should be allowed a voice and a choice in life, just as those who have their natural voice are afforded that ability anytime they want to voice it. 
- Erin Polk

For videos to see ABA and AAC in action please visit Kreed's FB, Blog or youtube. 
www.facebook.com/kreedsworld
www.kreedsworld.blogspot.com
www.youtube.com/kreedsvideos

More posts on ABA and AAC will follow including Assessment and using verbal behavior principles to help AAC language!

For more research on AAC and the impact it has on communication and language, check out this list from PRAACTICAL AAC:

Ganz, J.B., Earles-Vollrath, T.L., Heath, A.K., Parker, R.I., Rispoli, M.J., & Duran, J.B. (2012). A meta-analysis of single case research studies on aided augmentative andResearch Reviews Supporting the Use of AAC alternative communication systems with individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42,1, 60-74.

McCarthy, J., & Light, J. (2005). Attitudes toward individuals who use AAC: Research review. Augmentative and Alternative Communication, 21(1), 41-55.

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of AAC intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research , 49(2), 248-264.

Schlosser, R. W., & Blischak, D. M. (2001). Is there a role for speech output in interventions for persons with autism? A review. Focus on Autism and Other Developmental Disabilities, 16(3), 170-178.

Schlosser, R. W., & Sigafoos, J. (2006). Augmentative and alternative communication interventions for persons with developmental disabilities: Narrative review of comparative single-subject experimental studies. Research in Developmental Disabilities, 27(1), 1-29.

Schlosser, R. W., & Wendt, O. (2008). Effects of Augmentative and Alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17(3), 212-230.

Tien, K.C. (2008). Effectiveness of the Picture Exchange Communication System as a functional communication intervention for individuals with autism spectrum disorders: A practice-based research synthesis. Education and Training in Developmental Disabilities, 43(1), 61-76.