The Proloquo Stimmer

Towards the beginning of this year, I wrote several posts on my Fumbling Thru Autism facebook page (https://www.facebook.com/pages/Fumbling-Thru-Autism/102482513246303) about hiring a Augmentative and Alternative Communication (AAC) consultant, purchasing a separate iPad, and programming the heck out of Proloquo2Go (https://itunes.apple.com/us/app/proloquo2go/id308368164). For those who are unfamiliar, the iPad app Proloquo2Go is basically an electronic way to generate expressive (spoken) language with a series of customizable visual choice boards via icons that speak when touched. As of August, we have put AAC and Proloquo2Go on hold and the purpose of this post is to explain why we came to that decision. There are many blog posts by others who tout that AAC does not interfere with spoken language development (http://aac.unl.edu/yaack/b2.html) and proponents will hint or outright say that deciding not to use AAC is denying any child with expressive language delay a voice. But I have decided that things can be much more complicated than they seem, and the decision of appropriateness of AAC for a young child who has significant spoken language delay and autism depends on a many competing factors. I will start this post with Beth’s speech profile at the time we tried Proloquo2Go, detail some of our experiences while trying to use Proloquo2Go, and then give an update on Beth’s speech.

Beth’s Language Profile

Beth’s last detailed speech evaluation was a few months before we tried Proloquo2Go, in October 2012 at 4.5 years old. The results showed a 2-year-old receptive (ability to understand what others are saying) and 2-year-old expressive (ability to speak) language level. Beth’s articulation was assessed as appropriate for her expressive language level.

I was uncertain of the accuracy of the receptive language speech assessment, and I wondered if Beth receptively understood more than she could show during the test. In addition, I was inspired by all the stories of kids in news reports and blog posts who could not talk or could not say complex things with spoken words, but could use a device to reveal complex inner thoughts.  So in an expensive experiment, my husband and I decided to try Proloquo2Go on the iPad.

Proloquo2Go Setup

This is the main menu for Proloquo2Go (I tried many formats, this is how I left it when we stopped using the device). The icons that are outlined in thick black and look like folders have sub-menus. Some icons/folders were for requesting things that she could say verbally but sometimes had trouble saying (like food and drink), some were for things that I thought she might know receptively, but could not express (like expressing feelings, yes/no), and some were for teaching new expressive language  (like question words and school work).

Main Screen Proloquo2Go

Main Screen Proloquo2Go

Despite tons of modeling, encouragement, and sometimes even a quick hand over hand to expand her language, when Beth picked up the device she went to the “want” folder most of the time. So the main screen was primarily used by me for modeling new language and I made sure anything she requested like food, drink, and favorite items were in the “want” folder, even if there was a duplicate way to request the item from the main screen.

I Want...

I Want…

Confused just looking at the screens above?  You should be! Programming just enough language to let a child be independent and yet not hold her back form advancing her language was a monumental task, especially since she already had a significant amount of spoken language. I played around a lot with removing words, making icons bigger, and changing layouts so that Beth could visually scan and make the choices easier. I didn’t want it to cut into other things we were doing, so I was up late at night programming the thing all the time. I wanted to make sure I was giving the device the best chance possible. So if you take this route with a program like Proloquo, know that it will be a full-time effort at first and it will be very time consuming.  But there are other options out there, such as SpeakForYourself (http://www.speakforyourself.org/), which I understand is easier to use.

Test Cases

At the time we started using Proloquo, high on our communication frustration list were the following:

  • Requesting items, foods, and drinks (she requested things very inconsistently at the time).
  • Telling me which song she wanted in the car, because she just kept saying “Jack” over and over. Jack was in reference to a Jack Johnson album we played many times, so she was stuck saying “Jack” but it seemed she wanted other songs and would scream in frustration.
  • Saying people’s names during greetings.
  • Answering yes or no when we asked her questions.

I figured if we could make progress in the above areas, which we had been working on for a long time verbally, then I would be sold on Proloquo and AAC for Beth.

Test Case Results

  • Requesting Items: When she went to the “want” folder, she went to her favorite items. So, what Poloquo2Go taught me was that she was basically thinking about her mouthing items (floss, edible toothpaste, etc.) all the time! I sort of knew that, but I didn’t know the extent of it. After playing around with her favorites, she eventually settled of pressing certain buttons over and over. Beth is a huge sound stimmer and Proloquo2Go was no exception. I finally came to the conclusion that she was gravitating to her favorites, then stimming off the sound. If I would move her onto the food folder, she would do the same thing, first play around, then settle on a few favorites, then stim off the sound. Proloquo2Go has an option to have a wait time and disable the sound for a time period after pressing the icon, but she got confused and frustrated after I added the wait and she would walk away. I thought maybe the favorite things were just too powerful, so I moved her onto the other test cases.
  • Song Requests: The first challenge was to get images that represented songs on some mixed CDs that we had in the car. Fortunately there were many pictures available within the program so I didn’t have to pull stuff off of Google. Examples of song icons: the sun icon represented “Sally Go Around the Sun” and the elephants depicted “Elephants Have Wrinkles” (see screen shot below). I really thought the song request menu was working for a while. She did like to listen to the same song over and over. But then she started stimming on the sound again by pressing certain buttons over and over. When I put the wait time on the sound, she would explore the buttons more, but would always come back to her favorite stim buttons. Was she stimming? Was she requesting the same song over and over?  Now we have worked on this issues without the device with success, I can say looking back that it was both. The combination of Beth’s impulsive button pushing (she has impulse control issues with almost anything, and she will act before thinking) and stimming meant that spoken language, while harder for her, had a benefit in that it slowed her down and she had to stop to consider choices and what she wanted to say first.
Song Choices

Song Choices

  • Saying People’s Names During Greetings: The “people” folder I used for teaching the names of family and friends consisted of pictures of everyone we know. To make a long story short, what I learned from Proloquo2Go was that kiddo cannot put names to faces.  I noticed she really avoids looking at and studying people in real life, and she cannot name people unless she ties that person to a location or she knows them very, very well. I have even made a huge poster of friends that has been hanging on our kitchen wall for months and we discuss the names and faces and their features and she still cannot do it. I strongly suspect face blindness at this point. So, the problem was not that she couldn’t say people’s names, it was that she had a problem with processing faces and then putting names to faces.
  • Answering “Yes” and “No”: We had tried forever to get Beth to answer yes or no to questions consistently by various methods. I thought this was a slam dunk for Proloquo2Go and that she most likely understood how to answer receptively, but was just having trouble speaking the answers. To make another long story short, even yes and no resulted in impulsive button pushing and stimming, and it turns out she really didn’t understand the interaction and what it meant to answer yes or no to a question. We (me, her dad, and speech therapist) did an intense verbal effort and what seemed to worked best was shaking our heads back and forth to prompt her to say “no” when we were fairly sure she did not want something and nodding our heads up and down to prompt her to say “yes” when we were fairly sure she wanted something. I can say now that she fully understands “yes” and “no” answers and I have Proloquo2Go to thank for making me realize it was a true understanding issue and not just an expressive language issue.

Reflecting on Proloquo2Go

Proloquo2Go did not reveal a huge gap between expressive and receptive language like I had hoped. But then again the sound stimming and the impulsivity with pressing buttons impeded our efforts to use the device effectively. Also, she was recently diagnosed with impaired visual scanning, which feeds into her tendency to not look and examine items before she presses buttons. The upshot is that since Beth has a significant amount of expressive language and her articulation is not bad, the motivation for continuing to try to figure out ways around the stimming and impulsivity is just not there for me. Even though it did not work out for us right now, I can see a point in the future where her receptive language outweighs her expressive language ability and typing out thoughts may be easier for her. So, we are working on spelling, writing, and organizing spelling letter tiles right now, with an eye on typing in the future.

Progress is a Slow Slog

Beth has made a lot of progress in the last 4 months after we discontinued Proloquo2Go. A new speech evaluation is pending, but I would say Beth, who  is 5 years and 9 months old, is somewhere between a 3 and 4-year-old expressive level. I would say her receptive language understanding is definitely at a higher level than her expressive language now. Now that I understand Beth better, I would say that she has problems getting stuck on phrases and linking certain words to others, and impulsively answers without considering the question or her options carefully. Giving her lists of choices and mixing up the choices, and telling her to slow down and think through the options, is helping her stop and consider choices before speaking the answer. Also, being extremely concrete about what words mean, what I am asking, why she should say certain things during social situations is effective for her now that she has more receptive language. At this point, Beth totally gets answering yes and no (and even says no (insert non-preferred item here)), her requests for food, drink, and favorite items are rapid fire, she can request many different songs in the car, and she is able to string words together a little easier. We are making progress. It is just a slow, slow slog.

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Review of Language Category iPad Apps

See here for an updated post on what worked for us: https://fumblingthruautism.wordpress.com/2015/05/18/the-answer-to-the-category-problem/

In my last post, I compiled and shared a list of language categories (http://wp.me/p2OomI-Ia). By keeping the list of categories in mind, I can quickly highlight categories with Beth in natural settings, such as while reading, playing with toys, and on outings. But Beth’s understanding of categories has been emerging for a very long time, and I was unsure if she was progressing with incidental teaching.  So, I do what I usually do when we have a tough problem. I turned to the iPad as a teaching aid. I downloaded and road tested (i.e. Beth, my 5 year old who has autism, played with them) as many language category apps as I could find.  The good news is there are many to choose from. The bad news is, in my opinion, no single category app has a wide range of categories, necessary customization capabilities, and adequate rewards to motivate Beth.  So, I used parts of several apps for teaching Beth categories on the iPad and it seems to be helping.

Below is my review (actually Beth’s review) of the language category apps we tried. My hope is this post will help you filter through all the options faster than I did, because it took me a month to locate and try all of these apps.  If there is a key category apps missing from this post and you would like Beth to review it, please contact me at tl_calvert@yahoo.com.

Rating system:

  • Worth Trying
  • It’s Okay, But…
  • Didn’t Work For My Kiddo

Sing it!

Tuneville (https://itunes.apple.com/us/app/tuneville/id405968611?mt)

tuneville

Idea: This app uses the time-honored tradition of teaching kids through song

Price: The section  “How Many…” is free, each additional section (like categories) is $0.99.

Rating: Worth Trying

Pros:

  • Good graphics and design (pause button, several levels to progress from listening to a song to full participation, catchy songs)
  • For kids who love songs, this app capitalizes on that natural motivator
  • If your child likes the song, you can easily create a new song to the same tune (or just try singing the last question of the song “What are these?”)  to extend to categories outside of the app.

Cons:

  • The categories they include are great core categories (food, clothing, letters, numbers, shapes, animals, instruments, and toys), but I wish they had more.  
  • I wish they varied the questions “What are these?” to teach the different ways of asking about categories (I just pause after the first “What are these?” and sing things like “What do you see?” and “These things I see are…?” to vary the question).

Read and Play!

Buddy Bear (Lite: https://itunes.apple.com/us/app/autism-pdd-categories-lite/id527931314?mt=8 ; Full version: https://itunes.apple.com/us/app/autism-and-pdd-categories/id519101618?mt=8) budy bear categories Idea: The app is like a book, with an easy matching component and short animation.

Price: Lite version free, full version $14.99

Rating: Worth Trying

Pros:

  • It was a hit with Beth because of the cute bear, easy matching that kept her engaged, and rewarding short animation clips.
  • Fairly wide range of categories put in context.

Cons:

  • The categories range from easy to complex and the categories cannot be limited in settings (but it is pretty easy to skip ahead).

Create a Scene Together!

Make a Scene (http://www.makeasceneapp.com/)
make a scene Idea: The app is like putting stickers on a background scene, where you drag and place critters from the bottom bar to the background. There are several “Make a Scene” apps (like farm, ocean, jungle).

Price: Each category (with many items to place on a few different backgrounds) is $0.99

Rating: Worth Trying

Pros:

  • Good graphics with fun sounds and short animation after the items are dragged and dropped into a background scene
  • Good beginner category activity

Cons:

  • My only wish is for more scenes, but you can’t have everything!

Talking Picture Board (https://itunes.apple.com/us/app/talking-picture-board/id452550955?mt=8)

talking picture board Idea: The app has many features (large choice board organized into categories, ability to create quizzes and flashcards), but I like it because you can create scenes by putting items onto a background

Price: $1.99

Rating: Worth Trying

Pros:

  • Huge board with many categories and real pictures of items
  • Large number of background scenes (save items in the “banks” and then use the play mode to create scenes)
  • This app packs it in.  You can quickly make a memory game, flashcards, a receptive identification game, and create sentences.  Save a subset of category items in a bank and make custom games (a memory game, flashcards and receptive identification games, yes/no game, and a spelling game) and create picture sentences.
  • The ability to take your own photos using the iPad camera for category items and backgrounds and save them within the app

Cons:

  • The design is a bit cumbersome, due to process of saving category items into “banks” to create the customized games and activities.  Also, it would be better if photos of my category items could be saved within each category rather than being located in one separate location.
  • Cannot add a spoken label to the category photo items I add through my iPad camera
  • Beth was not as interested in creating scenes in this app as she was with the Make a Scene app discussed above.  Probably because the items did not animate when they were placed on the background.

Sort It!

Categories Learning Center (by Smarty Ears) (https://itunes.apple.com/us/app/categories-learning-center/id496646536?mt=8) category app smarty ears

Idea: Sorting items into two bottles and much more (other sections for category naming, Where Does It Go? game for sorting into three bottles)

Price: $9.99

Rating: Worth Trying

Pros:

  • Huge list of categories, with options to turn each category on and off (organized by level 1 and 2 categories)
  • Easy concept … sorting things into bottles
  • High level category challenges (sorting and flashcard/question games) to try after your child masters simple sorting into two bottles

Cons:

  • Uses cartoon-like pictures instead of real pictures and the pictures are a bit small
  • There is no reward.  A satisfying “clink” as the items go into the bottle would be so much better (like the Candy Count app for sorting colors, https://itunes.apple.com/us/app/candy-count-learn-colors-numbers/id454950461?mt=8) and fireworks/verbal praise when all items are sorted correctly is needed.
  • For the level with two bottles, it would help to separate the bottles apart more to reduce the fine motor challenge.

Sort It Out 1 & 2 (Lite:https://itunes.apple.com/us/app/sort-it-out-1/id501939025?mt=8 and https://itunes.apple.com/us/app/sort-it-out-2/id501952788?mt=8 , Full versions through in-app purchases)

sort it out

Idea: Sorting of items onto a few scenes, but mostly into shelves/long boxes

Price: Lite version free, full version through in-app purchase $1.99

Rating: Worth Trying

Pros:

  • Cute cartoon-like graphics
  • Good starter app with easy categories
  • Reward is a smiley face and verbal praise

Cons:

  • I see this as a starter app only, since there are no spoken words when the items are pressed and the category list is limited (no higher level categories)
  • Beth needed a lot of modeling by me and verbal hints (put with the cars, put with the balls, etc) with these apps. I think the large field of items at the bottom of the screen and the sorting into horizontal bars above was a bit visually overwhelming to her.
  • It could use a better reward (fireworks, spinning, or confetti)

Tiny Hands Sorting 1 & 2 (Lite: https://itunes.apple.com/us/app/tinyhands-sorting-1-educational/id599965478?mt=8 and https://itunes.apple.com/us/app/tinyhands-sorting-2-educational/id588415329?mt=8 , Full versions through in-app purchases)

tiny hands

Idea: Simple sorting games into containers or backgrounds.

Price: Lite version free, full version through in-app purchase $2.99

Rating: Worth Trying

Pros:

  • Very nice cartoon-like graphics
  • Good starter app with easy categories
  • Nice hint feature (a hand showing where to drag item)
  • Very intiuitive…Beth had no problem knowing what to do
  • Reward is a silly character flying across the screen with balloons, verbal praise, and applause

Cons:

  • I see this as a starter app only, since there are no spoken words when the items are pressed and the category list is limited (no higher level categories)

Autism iHelp – Sorting (Lite: https://itunes.apple.com/us/app/autism-ihelp-sorting/id609622929?mt=8 , Full version through in-app purchase -9 category sets)

iHelp Sorting App Idea: Sorting items from the bottom of the screen into two category boxes on the top of the screen.

Price: Lite version free, full version through in-app purchase $1.99

Rating: It’s Okay, But…

Pros:

  • Uses real high-quality pictures
  • Encouraging verbal praise for each correctly sorted item
  • Settings allow for audio on/off, male/female voice, varied sorting of number of items in each box

Cons:

  • A limited, and random, set of categories (toys/clothes, farm animals/zoo animals, bathroom/kitchen, letters/numbers, circles/rectangles, green things/red things, air vehicles/land vehicles, happy/sad, he/she)
  • Could use some fireworks and extra reward after all items are sorted correctly

Where Do I Go? (Lite: https://itunes.apple.com/us/app/where-do-i-go-group-match-words/id499190609?mt=8, Full version through in-app purchase) Where do I go Idea: Sort items by dragging them from the bottom of the screen and dropping them into one of three category scenes.

Price: Lite version free, full version through in-app purchase $1.99

Rating: It’s Okay, But…

Pros:

  • Cute cartoon-like graphics for the sorting items and sorting box background
  • I love the combination of sorting and making a scene to put the category items in context
  • Confetti, a big happy face star, verbal praise, and a spinning category item as the reward
  • Nice hint option (a hand showing where to drag item) that can be turned on/off in settings

Cons:

  • Small set of categories (home [kitchen, bathroom, living room], climate [polar, tropical, desert], geography[sea, land, sky], food [fruit, vegetables, grain], animals [mammals, birds, reptiles])
  • The categories were too advanced for Beth.  I guess it can be used for higher level sorting for older kids (?)
  • No customization options.
  • One of the verbal praises is “I’m home!”  Can you imagine that becoming a verbal stim for an autism spectrum kid?  I can, so I hesitate to use this app!

Category Carousel (https://itunes.apple.com/us/app/category-carousel/id516878389?mt=8) category carousel

Idea: Sort items by dragging them from the bottom of the screen and dropping them into two small category icons on the top of the screen.

Price: $3.99

Rating: Didn’t Work For My Kiddo

Pros:

  • Uses real high-quality pictures
  • Encouraging verbal praise for each correctly sorted item
  • A visual reward with carnival music and carnival picture after a selected number of items are sorted correctly
  • Settings allow you to choose the categories to be sorted and adjust the number of items to be sorted (6, 9, 12), adjust the number of correct items sorted until the reward music/image appears, and change the frequency and select on/off for verbal praise.

Cons:

  • The program uses a drag and drop method, where the pictures must be placed over the appropriate category icon (which has a single image that is supposed to represent a category) in the upper bar and then the pictures you drag to the icon disappear.  This design confused and frustrated Beth, so we couldn’t use the app.
  • A limited, and random, set of categories (animals, transportation, clothing, food, household, instruments, occupations, summer, winter) with easy and hard pictures mixed together within the categories.
  • There is no way to select and hide some pictures within each category
  • It would be so much better if a short video of a spinning carousel or other carnival ride was used as the reward!

Sort It Out Pack (https://itunes.apple.com/us/app/sort-this-out-pack/id595179812?mt=8) sort it out

Idea: Sorting items into two train cars

Price: $29.99

Rating: Didn’t Work For My Kiddo

Pros:

  • Cute concept with the train traveling to different places and getting loaded with cargo
  • A large number of pre-loaded categories (flowers, toys, bedroom, music, body parts, weather, drinks, sports, school, ocean, cleaning, shapes, house, insects, animals, clothes, tools, bathroom, kitchen, transportation, vegetables, fruit)
  • Easy concept … sorting things into two train cars
  • Verbal praise and slight fireworks when the items are all sorted
  • You can take pictures with the iPad and add them to the pre-loaded categories or make new category sets

Cons:

  • For the price of the app, it fell way short of my expectations
  • The app contains drawings instead of real pictures
  • Many of the pictures within a category were not beginner pictures or not familiar to Beth, and there was no easy way to hide the pictures for later use without deleting it
  • Instead of accepting the item if it is placed anywhere within the appropriate category train car, the app requires that each picture be placed within a box and the tolerance is tight.  This really frustrated Beth.
  • The ability to take pictures is great, but it was very difficult to get a good picture and the size of the picture ended up to be too small for Beth to recognize the item (there is letter box above and below the pictures that makes the pictures even smaller than the pre-loaded drawings)
  • This is picky, but it just bugged me that the places the train stopped sometimes had absolutely nothing to do with the categories my child was sorting. They could have just had very general stops like home, city, nature, etc. and that would have been more appropriate for sorting various categories in context.

Flashcards (Ho, Hum, Yawn…)

This section is brief because Beth doesn’t like the flashcard apps on the iPad, and these were no exception.

ABA Receptive By Class (https://itunes.apple.com/us/app/aba-receptive-by-class/id346469566?mt=8)

aba

Idea:  Receptive identification

Price: $1.99

Rating: Worth Trying

Note: This app is by Kindergarten.com.  If you like them, check out their other flashcards…nouns, feature/function/class, etc.  http://kindergarten.com/

Biggest Pro: Large category set with real pictures and customization options.

Biggest Con: None.  This is a good deal.

Categories Learning Center (by Smarty Ears) (https://itunes.apple.com/us/app/categories-learning-center/id496646536?mt=8)

See review above under the Sort It! section.

Rating: Worth Trying

See.Touch.Learn (https://itunes.apple.com/us/app/see.touch.learn./id406826506?mt=8)

see touch learn

Idea: This is an excellent flashcard program if you will be using a lot of flashcards and want to make custom sets.

Price: Free, with in-app purchases of card sets (range from $0.99 to $1.99 a set) and a charge for community membership where you can download sets (such as category quizzes) put together by other people to save time ($1.99 for one week, $19.99 for a year).

Rating: Worth Trying

Biggest Pro: You can do anything flashcard related with this app.  I own it and we used it for Beth’s old ABA program, and may use it again to gauge progress.

Biggest Con: It is time-consuming to make custom sets.  Expect to join the community and buy all the sets, because you will end up doing that!

Talking Picture Board (https://itunes.apple.com/us/app/talking-picture-board/id452550955?mt=8)

See review above under the Create a Scene Together section.

Rating: Worth Trying

Name That Category (Fun Deck) (https://itunes.apple.com/us/app/name-that-category-fun-deck/id453817829?mt=8)

name that category

Idea:  Flashcards

Price: $1.99

Rating: It’s Okay, But…

Biggest Pro: Cute cartoon-like pictures

Biggest Con: This is simply a flash card set.  Beth found the pictures slightly amusing.

Category Therappy (Lite: https://itunes.apple.com/us/app/category-therappy-lite/id571553130?mt=8, Full: https://itunes.apple.com/us/app/category-therappy/id571551926?mt=8)

therappy

Idea:  Receptive identification of category items in four different games

Price: Lite version free, full version (with more categories and ability to limit categories) through in-app purchase $14.99

Rating: Didn’t Work For My Kiddo

Biggest Pro: Large range of categories with real pictures

Biggest Con: When Beth tried the Classify game, the design frustrated her and was the complete opposite of every other category app on the market.  She wanted to drag and drop the category item on the category, which made intuitive sense, but the app wanted her to poke the overall category.

I Can Do Categories (https://itunes.apple.com/us/app/categories-from-i-can-do-apps/id561715173?mt=8)

i can do

Idea:  Receptive identification of category items in five levels of games

Price: $2.99

Rating: Didn’t Work For My Kiddo

Biggest Pro: Large range of categories with real pictures

Biggest Con: When Beth hit the wrong answer in the Level 1 game, then tried to hit the right answer, nothing happened and she was confused.  Usually apps reward choosing the correct answer even if the child picks the wrong one at first, but not this app.

From the iPad to the Real World: Feed the Animals

This is the third iPad to the Real World post (other posts can be found at http://wp.me/p2OomI-sq and http://wp.me/p2OomI-ry) where I take iPad apps that appeal to my daughter Beth and turn them into “real world” activities.  The iPad does the priming by knocking out the expectation and process hurdles, so that Beth can work on fine motor skills and I can work with her to expand her language or teach her educational concepts. I cannot stress how much of a miracle it is to see Beth walk up to the task I have made based on the iPad app and just do it.  There is no complaining and no running away, she just gets to work.  Amazing.

So, this third iPad to “real world” activity is based on the Feed the Animals app (by Anshu Dhanuka, https://itunes.apple.com/us/app/feed-animals-kids-educational/id500097320?mt=8).  Beth just loves this app, and here she is using the app on the iPad:

I made a “real world” feed the animals activity made from screen shots of the Feed the Animals app and a milk carton.  Here are the instructions for making the activity:

1.  Take screen shots of 4 animals (which includes the side bar with the food choices) from the Feed the Animals app.  Here is how you can take a screen shot of anything on the iPad, and save it in your camera roll: http://thehowto.wikidot.com/print-ipad-screen

2.  Print out the images.  Either e-mail the pictures to your computer for printing if you don’t have a wireless printer or download an app, such as iCan-Print (https://itunes.apple.com/us/app/ican-print/id448566661?mt=8), to print the pictures from the iPad to your wireless printer.  I had to increase the size of the pictures to 200% and use landscape mode on iCan-Print.

3. Cut the top off a clean half-gallon cardboard milk carton and turn it upside down.  Trim and attach the print outs onto each side of the milk carton with double sided tape.

Attach Pictures to Milk Carton

Attach Pictures to Milk Carton – This Picture Shows 1 Side Completed

4.  After putting pictures on all sides, cover the outside of the milk carton with clear contact paper (http://www.discountschoolsupply.com/Product/ProductDetail.aspx?product=16955&keyword=contact%20paper&scategoryid=0&Ca).  Also, cut out and cover food choices with contact paper.

Cover with Clear Contact Paper

Milk Carton with Pictures on All Sides, Covered with Clear Contact Paper

"Food" Covered with Clear Contact Paper

“Food” Covered with Clear Contact Paper

5.  Cut out the mouths with an X-Acto knife (http://www.amazon.com/X-ACTO-Series-Knife-Cap-XZ3601/dp/B005KRSWM6/ref=pd_sbs_op_1).

Cut Out Mouths with an X-Acto Knife

Cut Out Mouths with an X-Acto Knife

6.  Finished product….these hungry animals need to be fed!

Finished Product, Sides 1 & 2

Finished Product, Sides 1 & 2

Finished Product, Sides 3 & 4

Finished Product, Sides 3 & 4

There are many more pictures on the app, so I will be making more of these milk carton feed the animal activities.  So far we have worked on the following concepts while feeding the animals:

  • What does the animal eat?
  • If we know an animal in real life, I say that animal also likes to eat that food too
  • If she puts in the wrong food, I put my hand inside and have him spit out the food and say “yuck” or “he didn’t like that!”
  • We work on color of the animals and foods
  • What does the animal say?
  • We talk about the monkey sitting in the tree, the mouse has big teeth, etc.

From the iPad to the Real World: Fine Motor Work with Sight Words

The iPad has helped my daughter Beth progress on her fine motor control, but she still resists using her hands in the “real world.” With her fine motor, motor planning, and sensory challenges, fine motor activities in the “real world” are one of her biggest hurdles.

Since Beth is absolutely obsessed with the spelling app First Words (by Learning Touch, https://itunes.apple.com/us/app/first-words-deluxe/id337462979?mt=8), I turned the app into a “real world” fine motor activity.  Because Beth loves the app and is already familiar with the pictures and spelling process, she willingly works on using the letters tiles to cover the letters on the print out.  I cannot tell you what a miracle it is to see her doing a fine motor activity without resistance!  Here she is doing the activity (with a really bad sinus infection, so these are actually the worst of circumstances!):

Instructions for Making the First Words Fine Motor Activity from the First Words App

1.  Take a screen shot of the picture with the word below it from the  First Words app (make sure the settings have auto advance set to “off “).  Here is how you can take a screen shot of anything on the iPad, and save it in your camera roll: http://thehowto.wikidot.com/print-ipad-screen

2.  Print out the image.  Either e-mail the picture to your computer for printing if you don’t have a wireless printer or download an app, such as iCan-Print (https://itunes.apple.com/us/app/ican-print/id448566661?mt=8), to print from the iPad to your wireless printer.

3.  Using letter tiles (http://www.amazon.com/Eureka-Tub-Letter-Tiles-176/dp/B000FA6DXS/ref=sr_1_1?ie=UTF8&qid=1359138618&sr=8-1&keywords=letter+tiles), arrange the tiles to spell the word on the First Word print out, put the tiles upside down on a copy machine to copy the word on white paper, then cut out the copied word and paste it over the word on your First Words print out.  This makes an exact size match for your letter tiles.

4.  Cover the First Words screen shot (with the pasted word made from letter tiles) with clear contact paper (http://www.discountschoolsupply.com/Product/ProductDetail.aspx?product=16955&keyword=contact%20paper&scategoryid=0&Ca).

5. If your child has trouble finding the right tiles in a pile and/or picking them up, try organizing them in an egg carton like this:

First Words Activity

First Words Activity

First Words Spelling Print Outs

First Words Spelling Print Outs

From the iPad to the Real World: Puzzles

When it comes to getting Beth to do puzzles, we have tried it all. Small puzzles, big floor puzzles, wood puzzles, jigsaws, puzzles that make noise, puzzles with favorite characters, cube puzzles, foam puzzles, progressive puzzles (starting at 3-4 pieces), and on and on. We bribed her with all her favorite edibles, we tried working very slowly from baby puzzles to  multi-piece puzzles, and we tried using sound puzzles since she liked them the best. We saw some progress, but in the end Beth still hated puzzles.

Since Beth had a distaste for puzzles in the “real world,” we were shocked that she LOVED the Disney puzzle books on the iPad.  Disney Puzzle Books were the perfect puzzles for Beth, because they had a small number of jigsaw pieces, had characters she liked, and there was a faint background image so that she could match the pieces.  The iPad puzzles are much easier for Beth to navigate compared to the 3-dimensional world, because the pieces are already oriented correctly and all Beth has to do is drag them into place and get close to the right spot.  Look at Beth go doing a Minnie Mouse puzzle on the iPad (1):

Converting a Puzzle on the iPad into a Real World Puzzle

Beth loved the iPad Disney puzzles so much, I decided to convert one of the puzzles into a 3-dimensional version.  She immediately liked it!  I still have to take out only 3-4 pieces at a time and orient the puzzle pieces correctly so that she doesn’t get frustrated.  But at least Beth was happy to do the puzzle and did not protest or flee the scene, as she does with other puzzles!

Here are step-by-step instructions for turning an iPad puzzle into a foam puzzle:

1.  Take a screen shot of the puzzle (I actually had to take two pictures and put them together, because when the puzzle is completed, the outline of the puzzle pieces disappears and the iPad app immediately goes to video).  Here is how you can take a screen shot of anything on the iPad, and save it in your camera roll: http://thehowto.wikidot.com/print-ipad-screen

2. Print out the puzzle image.  Either e-mail the picture to your computer for printing if you don’t have a wireless printer.  Otherwise, you can download an app, such as iCan-Print (https://itunes.apple.com/us/app/ican-print/id448566661?mt=8) to print from the iPad to your wireless printer.

3. Put the image on adhesive foam (http://www.elmers.com/product/detail/950049?filterPath=white%2Fcraft) and cover with contact paper (http://www.discountschoolsupply.com/Product/ProductDetail.aspx?product=16955&keyword=contact%20paper&scategoryid=0&Ca).

5.  Cut out the puzzle with an X-Acto knife (http://www.amazon.com/X-ACTO-Series-Knife-Cap-XZ3601/dp/B005KRSWM6/ref=pd_sbs_op_1).  Make sure to press straight down when you are cutting and trim any rough edges.

Minnie Mouse Puzzle on Self-Adhesive Foam Board

Minnie Mouse Puzzle on Self-Adhesive Foam Board

An unexpected bonus is that the foam puzzle pieces make a very satisfying “pop” sound when they go in, which seems to motivate Beth even more.  Here is Beth popping two puzzle pieces into the foam puzzle:

We still have some work to do, but I hope this is the beginning of the end of Beth’s puzzling puzzle problem!

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(1) https://itunes.apple.com/us/app/disney-junior-minnie-mouseke/id569670649?mt=8

Preschool with the iPad: Listen…Think…Poke!

In a previous post, l shared how our daughter Beth learned to work the iPad (See http://wp.me/p2OomI-bo).  Finally, she was able to poke and drag, and could, in theory, use a variety of preschool apps. There are some great preschool apps out there, and Preschool EduKitty (1) is notable for its custom settings (where the number of items and types of activities can be chosen by the parent) and the very motivating reward of a kitty sliding down the slide saying “weeeeee.”

After watching Beth use Preschool EduKitty and other preschool apps, it became obvious that we had one more major hurdle to clear before fully utilizing the iPad as a teaching tool: impulse control.  Left on her own, this is what Beth does with a preschool app (Preschool EduKitty, 1):

As shown in the video above, Beth doesn’t listen to the directions (e.g, touch the number 3, pick the circle, etc.), and she immediately pokes at all the choices on the iPad screen. She loves to hear the sounds the icons makes, so the sounds compete with the intended motivator in the program (the little kitty sliding down the slide).  Also, it doesn’t take long to poke at all the icons to find the right one, so she just ignores the directions and starts poking.

I would guess this is a common problem, not just for kids like Beth who have autism or other special needs, but for all young children using education apps on the iPad.  But I have not found a preschool app that includes settings and features that help Beth listen to the directions before poking.  So, as a work-around, I tried the following blocking methods to help my daughter with her impulse control.

Methods of Blocking the iPad

Using my hands.  First I tried telling Beth to wait and blocked access to the screen by putting my hands in front of hers.  This forced her to wait and listen to the directions, and many times she got the answers right on the first poke. But this method was not ideal, because she got very frustrated when I blocked her and she reached around my hands to poke at the screen.

Sliding the iPad.  Then I tried sliding the iPad away from Beth’s reach to make her pause before poking.  That worked fairly well, but she could not study the screen easily because it was so far away.

Acrylic Block.  Finally, I tried using a clear acrylic sign holder (available on Amazon in various sizes, mine is a 11 by 8 1/2 landscape sign holder) to cover the screen. I slid the acrylic sign over the iPad to prevent Beth from poking the screen until the directions were stated. Before I moved the acrylic block, I watched Beth’s eyes to make sure she studied the screen and I re-stated the directions if I felt she did not hear them.  Then I slid it the acrylic block off the screen so that Beth could poke and choose an answer.  After Beth poked the correct answer, I slid the acrylic sign back into place before Beth had a chance to continue poking at the screen.

Here is a demonstration of the iPad sliding technique, followed by the acrylic sign technique:

The acrylic sign block works very well as a work around.  But I wish the  preschool apps included features and settings that would discourage random poking and encourage listening to directions and studying the screen before poking.

The Ideal Preschool App

To manage the impulse control problem, an ideal preschool app would contain the following:

1.  To discourage random poking, the choice icons would motivate children to get the right answer, and downplay the incorrect answers.

  • The icon for the correct answer would have fireworks coming out of it and applause as soon as it is poked.
  • The icons for the incorrect answers would disappear immediately upon selection of the icon with the correct answer (my daughter continues to try to press the icons for the incorrect answers after getting the answer right).
  • An option would be provided to turn off the sound for the incorrect answers (sometimes my daughter enjoys pressing icons for the incorrect answers just to hear the sound they make).

2.When the instructions are given, the screen would pause and have a wait indicator (e.g, the screen changes its look, the icons are inactive, and a wait icon appears in the corner of the screen).  This feature would help a child understand the concepts of waiting for directions and taking time to study the screen.

3. In case number 2 above does not work, the app would have an option for the parent to pause and unpause the screen manually.

4. To minimize frustration due to pausing the screen, activities that don’t require pausing the screen should be included.  For example, the app could include puzzles, matching, and counting sections that allow unhindered poking/dragging.

Do you want the features and settings above within your favorite app?  Then please share this post with the developer and spread the word. Do you have other ideas to manage impulse control via app design? Please comment on this post here or on my Facebook page (http://www.facebook.com/pages/Fumbling-Thru-Autism/102482513246303).  

  1. Cubic Frog Apps (2011).  Preschool EduKitty (Version 1.0) [iPad application software], https://itunes.apple.com/us/app/preschool-edukitty-fun-educational/id456520113?mt=8

Applying Floortime to Technology: How My Child with Autism Learned to Use the iPad

In this post, I will share how our daughter Beth learned to work the iPad (i.e. learned to poke and drag, the key to using all apps).  I will narrate our process during videos of my daughter demonstrating the apps, and then generalize the lessons I learned at the end of this post. Since we are using Floortime (1) for play therapy, I took a play-based child-centered approach to helping Beth use the iPad.  I realize that all kids are different and this approach may not work for all children, but I am hoping that by describing the process we used to help Beth succeed, our experiences will help another family.

Fumbling with the iPad

We got the iPad almost 2 years ago, when my daughter Beth was about 3 years old. My husband and I downloaded several fun apps that we thought would motivate Beth. But because of Beth’s fine motor, motor planning, and communication delays, she became easily frustrated.  I tried hand over hand (using my hand to guide hers) to help her progress on the iPad, but she resisted this method of teaching.  She managed to poke at a few things within apps, but helping Beth progress on the iPad fell to the bottom of a long priority list and we let it go for awhile.

When Beth was about 4.5 years old, I decided to put more time into teaching her how to use the iPad, because I hoped the device could help her with her fine motor development and, eventually, preschool learning.  To teach Beth, I primarily used a Floortime approach (following her lead and interests, sitting beside her and demonstrating the apps with my own hand, highlighting items on the iPad with simple and excited language, using no additional rewards other than the app itself). With a lot of patience, careful thought, and trial and error with many apps, Beth has made astounding progress over the last 3 months.

But Beth’s road to progress started with a lot of poking, so that is where I will begin…

Beginning Poking

We had tried to get Beth to use her pointer finger for years (popping soap bubbles, putting holes in play-doh, popping cookies dough out of cutters, pointing to things she likes, etc), so it was hard to imagine her working the iPad touch screen with her finger.  But for Beth, using her pointer finger on the iPad was easier than using it in the real world, because her movements were confined to a two-dimensional screen. In fact, beyond finding motivating apps, I did not have to help Beth with this step.

We started with a simple free Balloon Pops (2) app and she quickly got the hang of it:

A bubble pop app (Beautiful Bubbles, 3) is also available from the same seller.  There are many other similar apps available if these do not work for your child.  Try these key words in iTunes and browse under the entertainment category: pop, bubble, balloon.

Advanced Poking

Next we used a few apps to help Beth refine her targeting (i.e. the targets she had to poke were more spaced out).  Refined targeting required more motivation, so I looked for apps that emphasized her natural love of real-looking bubbles (Bugs and Bubbles, 4) and her favorite song (Itsy Bitsy Spider, 5).  To encourage Beth to expand her exploration of the Itsy Bitsy Spider app, I sat beside her and poked non-preferred items and excitedly labeled the items and their actions.

To find apps that work for your child, try entering keywords of your child’s favorite toys, songs, or objects into iTunes, and, if necessary, limit by the entertainment or education categories.  Find apps (or parts of apps) that are controlled by poking only.  The best targeting apps have objects that are significantly separated and/or moving, and require poking over entire iPad screen.

From Poking to Dragging

Controlled dragging of objects with her index finger was a big challenge for Beth.  There was a single vertical dragging item on the Itsy Bitsy Spider (5) app mentioned above, so we started there.  Then we used the app called Wheels on the Bus (6), which is made by the same company as Itsy Bitsy Spider, and has both horizontal and vertical dragging.  Wheels on the Bus was a perfect next step for Beth, because she loves the song and the app used the same singer and some of the same graphics as Itsy Bitsy Spider.  To encourage her to try dragging, I sat beside her and dragged my finger across non-preferred items and excitedly labeled the items and their actions.

If your child has trouble learning to drag, I suggest finding apps (or parts of apps) that are very motivating to your child and have a lot of poking and very minimal dragging.  After mastering the minimal dragging apps, slowly increase to apps with more dragging.  This may take a lot of key word searches and some trial and error (i.e. purchasing several apps that don’t work out), but it is worth it.

Advanced Dragging

Next I had to find an app with lots of dragging.  Because Beth loves letters, I looked for a spelling app, and I found one that had spinning items as a reward (First Words, 7).  I think I demonstrated the app 1 time and she immediately started using it.

There is a free version of First Words (7) if you would like to try it out. If your child is good with sorting, you can try the sorting section of Bugs and Bubbles (4) or the Candy Count (8) sorting app.  Many preschool apps contain a sorting section, drag and drop puzzles, and drag to match sections.  Again it may take some creative keyword searching,  browsing in iTunes, and purchasing some apps that do not work out, but it is well worth it.

General Lessons Learned

  • I use my child’s interest (favorite toys, objects, songs, etc.) when selecting apps.
  • I find apps that have the right amount of challenge for my child.  If she is having trouble, I try to break the goal into smaller parts (i.e. find easier apps, use easy parts of preschool apps, or look for easy options within apps).
  • If I the app itself is not very motivating (i.e. spelling), I find apps with rewards my child likes (spinning, firework visuals, applause, etc.).
  • If I see my child stimming (hand flapping, jumping up and down, etc.) while using an app, I take it as a good sign that I have found the right app!  It means that she is excited.
  • If my child becomes fixated on a part of an app, I try to slowly expand her use of new parts by sitting beside her, demonstrating the new parts on the iPad with my own hand, and highlighting the new parts with simple expressive language she understands.
  • I try free apps first, but I do not hesitate to spend money to find the most motivating apps for my child.
  • It pays to take time to browse iTunes to find the most motivating apps for my child.
  • I use creative keyword searching in iTunes to find apps, then filter by category (entertainment, education, etc) if the hits are too large.
  1. http://www.icdl.com/dirFloortime/overview/index.shtml
  2. Joe Scrivens (2012). Balloon Pops (Version 1.1) [iPad application software], https://itunes.apple.com/us/app/balloon-pops/id436692552?mt=8
  3. Joe Scrivens (2011).  Beautiful Bubbles (Version 1.0)  [iPad application software], https://itunes.apple.com/us/app/beautiful-bubbles/id447038145?mt=8
  4. Little Bit Studio, LLC. (2012). Bugs and Bubbles (Version 1.1)  [iPad application software], https://itunes.apple.com/us/app/bugs-and-bubbles/id500195730?mt=8
  5. Duck, Duck, Moose, Inc. (2012).  Itsy Bitsy Spider (Version 1.1) [iPad application software], https://itunes.apple.com/us/app/itsy-bitsy-spider-by-duck/id331863487?mt=8
  6. Duck, Duck, Moose, Inc. (2012).  Wheels on the Bus (Version 1.1) [iPad application software], https://itunes.apple.com/us/app/wheels-on-the-bus/id303076295?mt=8
  7. Clozure Associates (2012). First Words Sampler (Version 4.4) [iPad application software] https://itunes.apple.com/us/app/first-words-sampler/id312571156?mt=8
  8. Camigo Media LLC (2012). Candy Count (Version 1.3) [iPad application software], https://itunes.apple.com/us/app/candy-count-learn-colors-numbers/id454950461?mt=8