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September 11, 2012
Technology and Autism: What’s available and What Works

Tags: News and Advice; Resource Guide

By:
Jennifer Leighton, M.A., CCC-SLP
Bernadette Murphy Bentley, MPA
 

There is so much buzz today about technology helping kids with autism. Although this talk is exciting, it can also be very confusing to parents. As a Speech Language Pathologist and Autism Resource Specialist who specialize in finding the most appropriate tools to develop children's language and communication skills, social skills, cognitive skills, organizational skills, and so forth, we are going to describe what you need to do to determine the type of technology that is a best fit for your child's needs, discuss the types of technology that exist and how specific types of technology can help your child, and how you might get technology paid for.
 

Assessment First!
 

Before you consider getting any type of technology for your child, you must first have your child evaluated by an expert who can assess your child’s specific needs, make individualized recommendations, and then guide you on how to use the technology.

One of the key components to determining whether or not a device, system, hardware, or software program is right for a child is to conduct a feature-matching analysis.  Feature Matching looks at a child’s skills, how a child can access a device, and the child’s communication abilities; and matches the child’s strengths and weaknesses with the appropriate software or hardware. It matches technology features to the needs of the child.

There are several approaches to getting an assistive technology evaluation. One way is to pursue it privately through specialized centers such as:

Another way to get an assistive technology assessment is to ask your child’s school to conduct it, not just at the three-year evaluation but at any time you think your child’s disability could be helped with technology. Because schools generally do not have assistive technology experts on staff, they usually contact out the evaluations to one of the organizations above or an independent evaluator.

IDEA the federal special education law, states that “each public agency [school] must ensure that assistive technology devices or assistive technology services, or both … are made available to a child with a disability … if the child's IEP Team determines that the child needs access to those devices in order to receive FAPE [free appropriate public education].”

To learn more about your rights to an assistive technology evaluation for your child, your child’s right to school-purchased technology, and your right to technology training by the school, visit the Wright’s Law assistive technology page
 

Types of Technology
 

There are two purposes for technology supports: 1.) For Alternative and Augmentative Communication (AAC) and 2.) As a motivating teaching tool or strategy for increased independence. For this second purpose, technology can serve as a support for academics and literacy, social skills, vocational training, for leisure time pursuits, and daily living.

Whatever type of technology you choose for your child, it is important that you don’t introduce the technology as a toy and then expect that the child will be able to use it later only as a tool or learning device. In many cases, if a child has become acclimated to using the iPad for fun, it is often extremely difficult to have it function as a dedicated communication device as well. What is very effective, however, is having your child use whatever games/apps are fun for them and then having them use their dedicated communication device  (even if it is another iPad used exclusively for communication) to tell you about it.

A great way to become familiar with different types of technology is to attend Easter Seals monthly technology Open House on the first Wednesday of every month at the Assistive Technology Regional Center one block from South Station in Boston. The Center is open all day for walk-in appointments and is staffed by experienced technology experts who can demonstrate various types of equipment. If the Open House time is not convenient, call (617) 226-2634 or email atrc@eastersealsma.org to schedule an appointment anytime Monday through Friday from 8:30am to 4:30pm.
 

1. Augmentative and Alternative Communication (AAC):
 

It is important for families to know that introducing any type of AAC support will only enhance and increase verbal output! The research supports this fact. Making language visible through the use of technology for children with language delays and impairments assists in continued speech and language growth and development. In fact, in cases of children we have worked with, when children began to speak and their families took away their communication books, their progress immediately slowed down.  Using an AAC system to work on language will help facilitate language progress, and in this way a child can work on language skills without having to wait for speech production skills that might not be meeting his or her language or communication needs.

There are three levels of technology that are helpful for you to understand as you read further.

Low or Lite tech: Any communication system that does not require a power source.

Mid tech: Any communication system that requires a source of power and is very easy to program.  Might require some level of training to adequately program and maintain the device.

High tech: Any communication system that requires a power source and extensive training to competently program and maintain the device. High tech devices incorporate sophisticated electronics or computers.

Low tech options:
For AAC, low tech options include: communication books, Picture Exchange Communication Systems, topic boards, picture communication symbols, Pragmatic Organization Dynamic Display (PODD) communication books.

Mid tech options:

High tech options:
High tech options include, but are not limited to:

Apps for Communication/AAC
Apps that are going to be used for AAC on the iPad need to be adapted and customized for each child. Therefore, as stated above, it is essential that a skilled professional determine whether an iPad app will meet a child’s communication needs and then provide ongoing programming and training. Here are just a few of the apps available for AAC/Communication needs:

2. Teaching Tools and Support Strategies:

Technology provides a visual support to children, which is key in aiding not only language development and communication skills but also in facilitating learning. There are many strategies that enable a child to pay attention to interaction, to expand the range of communicative function, to clarify the meaning of spoken language, and to increase independence and lead to less reliance on verbal supports.

Visual supports can also help improve behaviors, facilitate participation in activities, improve predictability of daily events, improve transitions, improve memory, and attract and focus attention. Because visual symbols are stable over time, they help make concepts more concrete for children with disabilities. They can also help reduce anxiety.

Here are a number of low tech and high tech options (Some of these are described in more detail below):

Low Tech Options:

  • Activity  Picture Schedules
  • Rules of the Bathroom
  • Reminder Strip in Bathroom for Tooth brushing
  • Time Cards: (Quill, 2000) Helps individuals visualize how much longer an activity will last and will facilitate transition to the next activity. A time card contains a linear sequence of symbols which are removed by staff members at set intervals.
  • Turn Cards (Bloomfield, 2000) Visual strategy to help individuals understand the concept of reciprocal action. Aids comprehension of basic patterns of alternating responses between two people.
  • Break Card
  • Visual Negotiation Tool “First you do this, then you can do that”
  • Visual Reward- Airplane Puzzle
  • Positive Visual Behavioral Support Strategies (Token Boards; Star Charts)
  • First-Then boards
  • Visual Timers/Time Timer
  • Social Stories
  • Video Modeling using video equipment
     

Apps as Teaching Tools:
 

Scheduling
For Students who need more support:

For Students who need less support:

First-Then Boards

Visual Timers

Positive Visual Behavior Support Systems
For students who require more support:

For Students who require less support:

Social Stories and Video Modeling
For students who require more support:

For students who require less support:

Social Media Communication

Compilation of Apps by Jennifer Leighton, M.A., CCC-SLP and Karen Waddill, M.A., CCC-SLP/ATP; Cotting Consulting at the Cotting School, Lexington, MA.
 

Paying for Technology

As stated earlier, if you go through your child’s school for the assistive technology evaluation and the IEP Team determines that your child needs assistive technology, the school is responsible for providing that technology.

If you choose to fund the technology yourself, one approach is to take advantage of Easter Seals Assistive Technology Loan Program which offers Massachusetts residents with disabilities and their families low-interest cash loans they can use to buy assistive technology, devices and services that will increase their independence.  The program also loans low-cost assistive devices through its Long-Term Device Loan Program. For more information about either program, call Ferol Smith at 508-751-6431 or Leonidas Tonevski at 508-751-6428, or email them at MassATLoan@eastersealsma.org.

Here is a list of organizations that have funded iPads in the past for children with ASDs:

Insurance Coverage for Technology

For an insurance company to consider paying for technology there must be a trial with the device. Typically three devices need to be included in the evaluation process. When a possible device or system is determined, the trial typically takes place over a period of four weeks during which time the school and family can see how the system works for a child across a variety of environments.

Each insurance company is different and will cover different amounts for AAC devices and necessary equipment. In most cases, insurance will not cover the cost of an iPad or iPad apps, however one parent chronicled how she secured an iPad for her child with ASD covered under her insurance plan.

As you approach your own insurance company for coverage, here are some terms to be familiar with:

DME (Durable Medical Equipment): This refers to devices that last longer then 3-5 years and may be purchased by your insurance company.  In the case of augmentative / alternative communication, this term generally refers to equipment that your child will use to communicate and is deemed medically necessary by your child’s doctor or speech language pathologist.

HCPCS Codes: These are codes that your insurance uses to identify what kind of DME you are looking into renting/ purchasing. When you give this code to your insurance company, they should be able to tell you if this device is covered under your specific plan.  Codes that might be relevant as a result of your AAC evaluation include:

E2510 = speech generating device (such as PRC, Dynavox, Saltillo, and TOBII devices)

E2511 = speech generating software program (such as Boardmaker and Boardmaker with Speaking
Dynamically Pro)

Yearly Cap: This is the maximum amount of money the insurance is willing to pay toward any DME per calendar
year.

Lifetime Max: This is the maximum amount of money that a plan will pay toward a person’s benefits over a lifetime. Once this max has been reached, the insurance will no longer pay for any other benefit charges.

Co-pay: This is the amount of money you must contribute to the total cost of the DME.

Deductible: This is determined by your insurance plan to help control your costs. You may be responsible for this deductible amount before your insurance company will pay anything toward the device.  

What to do if you have private insurance or Mass Health:
 

Ask the service representative about your DME coverage.  Important questions to ask include:

  • Will the recommended equipment be covered?
  • Is there a yearly cap, co-pay, deductible or lifetime max benefit?
     

Remember, when speaking with the service representative, it will be important to give them the HCPCS code to determine the exact amount that will be covered.
 

If you have Mass Health (CommonHealth) as back-up insurance:
 

After obtaining the above information from your primary insurance, contact CommonHealth to see if they will cover the remainder of the costs.

Explain to them what expenses your private insurance will not cover, and inquire if this will be covered under CommonHealth. The representative will ask for the HCPCS codes.
 

What are my options if my insurance does not cover the recommended equipment, or only covers a small portion of the expense?
 

If your insurance is through your employer, you may change your insurance plan during your employer’s open enrollment period. A different plan might have a larger DME cap, or no cap at all, providing you with better coverage for purchasing the recommended equipment.

You may also inquire with your employer to see if they would be willing to negotiate a different DME benefit with the contracted insurance plan.

Consider opening a Flex Spending Account, or ask about the restrictions on a Flex Spending Account that you already have.  Some will allow you to make a withdrawal toward a DME.

Applying for CommonHealth (a kind of MassHealth for children with disabilities) as a secondary insurance might be an option. CommonHealth may be able to help pick up the extra cost that a primary insurance is not willing to pay.

You may also try fundraising by submitting a letter to local organizations such as the Knights of Columbus, Lions Club, Rotary Club, Free Masons, etc.

Fundraising on your own is another option. Some families have had success with fundraisers like spaghetti dinners, a car wash, sponsors for a race or walk, etc.

Your school district might be responsible to pay for an AAC device for your child. (See early information in this article about this subject.) Keep in mind that there might be restrictions in terms of when the child is able to bring the device home. Also, when your child turns 22 years old, the school district will own the device.

Funding information compiled by Elizabeth Benson, AAC Assistant, Communication and Technology Lab at Spaulding Outpatient Center for Children, Lexington, MA.
 

Conclusion
 

Navigating this technology market becomes more and more confusing as new technologies are being developed and becoming available every day. Technology has a place in our lives and can help youth with autism spectrum disorders increase their level of independence across settings and can allow for opportunities that might not have been available in the past. It is essential for parents and guardians to be wise consumers of technology, and consult with professionals who can help you help your child achieve their full potential.

Research assistance for this article was provided by Meg Ruddy, intern at the Center for Children with Special Needs at Tufts Medical Center.

FYI: The Roger A. Bauman Parent Lecture Series will be featuring author Jennifer Leighton, CCC-SLP, speaking on “iPad Apps for Learning and Communicating for Individuals with ASDs” on Thursday, September 27th from 6:30-8:30pm at the Charles River Center, 59 East Militia Heights Road, Needham, Mass. There is no cost but registration is required. To register or if you have questions, please contact Julie O’Brien at 781-860-1726 or email jobrien20@partners.org

Jennifer Leighton, M.A., CCC-SLP
Speech-Language Pathologist
Senior Consulting Therapist
Cotting Consulting at the Cotting School
Lexington, MA
 

Bernadette Murphy Bentley, MPA
Autism Resource Specialist
Center for Children with Special Needs
Tufts Medical Center
Boston

1 Comments

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Comments

Kathy O'Donnell on September 26, 2014

Am wondering about success using PODD system with deaf multicap 5 year old