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Assistive technology is any kind of technology and/or tool that can be used to enhance the functional independence of a person with a disability. Often, for people with disabilities, accomplishing daily tasks such as communicating with others, going to school or work, or participating in activities can be a challenge. Assistive Technology (AT) devices are tools to help overcome those challenges and enable people living with disabilities to enhance and have access to a quality of life, that may otherwise not be known, and lead more independent lives.

The mission of this blog is to serve as a voice of a constant researcher in the field of educational and assistive technologies so that the best products, strategies and services may be located easily, in hopes that they will then be delivered, taught and used to better the lives of people with disabilities.


Teaching Yes/No Responses

Strategies for Teaching Yes and No in Speech Therapy - See more at: http://www.speechbuddy.com/blog/speech-therapy-techniques/strategies-for-teaching-yes-and-no-in-speech-therapy/#sthash.EcfizRxc.dpuf

Teaching a student to communicate yes and no, easy yes? Important, no? 

We all want our children to be able to answer yes and no questions. It just makes life so much easier when we feel we know what they want and do not want. It is a common speech goal with our students with severe speech challenges. By being able to respond with a yes or no a child can describe preferences, answer questions, and clearly express their wants and needs. Right?

It is common to think of "communication" as spoken words, written words, and also sign language but really, we use many different behaviors to communicate. Many of our students communicate but don't use clear forms of communication instead will express themselves with non-traditional forms of communication such as sounds, facial expressions, body movements, eye gaze, and other behaviors. 

ASHA shares, "Intervention should focus on providing the individual opportunities to influence family members, staff and peers by expressing wants, needs, and preferences and having others respond to their expressions." 

Kate Ahern, author of Teaching Learners with Multiple Special Needs blog, shares in her posting Best Yes" and Rewarding Successive Approximation: Shaping, simply put, is rewarding the small steps that lead to a large success.  Also known as "rewarding successive approximations" I call it, "Close enough is good enough, for now."  By which I mean that if we reward a first time step towards meeting a goal and then each tiny step closer we will eventually get there.  Shaping is baby steps.  In the case of yes/no this starts with something known as "best yes".

Below was shared by a colleague of mine, however the author is unknown. It is the best explanation of teaching yes/no to students with complex communication needs (CCN) that I have read. I hope it helps you to understand that yes/no is a cognitively demanding strategy. Not that we shouldn't try to teach it but that we must be aware of what and how we are trying to do so.

"Teaching a child to respond appropriately to yes/no questions is a higher level task than one might think. Young children learn to say "no" fairly early, but they often use it indiscriminately, more as a "declaration of independence" than as an actual response to a question. The child first learns "yes" and "no" in relation to his own wants and desires, such as, "Do you want a cookie?" Questions that involve absurdities or relating an event accurately require a great deal more cognitive processing and attention. For these reasons, it may be very difficult to teach a child to respond with "yes" and "no" until he has become proficient at other more motivating and concrete communicative tasks (for example: requesting choices and directing action as discussed previously.)

The need for teaching a clear yes/no response to a severely disabled child is obvious. For a child who is not able to adequately express himself, the listener will frequently resort to a "20 Questions" routine. If the child can maintain their original thought and intent as well as appropriately respond with yes and no, then he may be able to get his point across. This is often difficult for the young child. If the questioner asks something that wasn't the child's original intention, but sounds like a good idea to the child, he will naturally respond, "yes". This can break down communication because the original idea is lost. Yes/No responses have a place in communication, but they shouldn't be relied upon as the main means.

I often begin with the activity of acceptance versus rejection as described above. "I want that" and "I don't want that" are early forms of yes and no. They are also concrete and directly related to the child. Yes and no can be introduced to the child with the same activity that deals with personal wants and desires.

By using questions that are related to wants, the child easily sees the consequences of his responses because he will or won't get the item being offered. Once the questions start becoming a little more abstract, the teacher must give short explanation and help the child to understand the question. She should also give him a second chance to correct his response once the explanation has been given. As the child's skill improves, give him a third choice, such as "I don't know" or "I don't care" or "I want something else".

Using an augmented method (such as pointing to a symbol) for responding yes and no is much more abstract than a head nod or a verbal response would be for a non-disabled three-year-old. Ask the non-disabled three-year-old to respond to a yes/no question by pointing to a symbol and you will see that he finds the task difficult at first. They must increase attention to task and coordinate their physical movements at the same time they are thinking about the question. It is the combination of all these factors that makes it even more difficult for the disabled child. Therefore the child will need practice with this task on a level at which he can be successful and it will need to be done in the most motivating way possible. Integrating the yes/no questions throughout the day in actual situations helps to make it a more relevant activity.

Note: A head nod or head shake for yes and no, as well as verbal approximations, should always be encouraged. It is only when these responses are unreliable that the use of symbols should be added for clarification and confirmation. Sometimes symbols may be used as a temporary step for the child who responds too quickly. The symbols may help him pause and process the thought if they are presented in a way that forces a delay in responding. Once the child has incorporated this delay, the symbols may be faded in favor of verbal or gestural responses."

Other thoughts to consider:

  • Yes, all children can and do communicate from the moment of birth. It is important to remember that communication is not just speech. There are a variety of ways to communicate, such as crying when hungry, tugging on mother's skirt to get juice, and speaking in sentences. 
  • Life is more than yes and no. Sometimes we need a maybe, I don’t know, I don’t care, etc. Offering a third response should be considered. To communicate these, it could be a shoulder shrug, looking up or....
  • Because yes and no really can mean accept and reject, affirm or deny, and often just rhetorical questions- we must be sure what types of questions we are asking. When we are trying to develop a yes and no with our students, be sure to ask accept and deny questions only until we are sure that they understand, then we can move on.
  • It is best to have a physical method for communicating yes, no and your third choice. Head nods are preferred and should always be modeled (exaggerating your own head nod with the verbal with every yes/no response that you give). If your child cannot produce a head nod, look to see what they are using and make sure everyone knows their method.
  • As with teaching all forms of communication: model, model, model. All day, every day. Exaggerate your modeling. “You like this toy? Yes!” “You want to go outside? Yes!” “You are upset, aren’t you? Yes.”  "You want this? Yes." When you say yes, model that head nod!!
  • Answering yes/no questions are deceptive in their apparent simplicity. Questions serve many different functions:
    Examples –
    • Do you want your juice? Acceptance/rejection; in the here and now
    • Did you go swimming today? Confirmation/denial; in the past
    As Kate Ahern shares, "There are so many ways we all say yes and no every day. None of us is limited to just one means and our students should be either. In teaching our students a yes/no response we aim for the most universal - verbal and/or head nod/shake (at least in the USA, in English) but if those are not possible any other system is better than none at all." For a list a list of some responses seen used by people with significant special needs over the years, see Kate's blog.
  • Typically developing children have difficulty reliably answering yes/no questions before the age of 30 months. By about 18 months, they recognize a yes/no question and respond, but usually in the affirmative because that is what is expected as a response.
  • The typically developing child is introduced to “no” in terms of prohibiting his action. Children with severe disabilities hear the word “no” much less. When asked a yes/no questions, typically developing children give some kind of feedback about whether or not they understood the question. 
  • Communication partners of children with CCNs frequently have to guess whether or not the question was understood.
In the article "Yes? No? Maybe So?..." by Phillip Harmoth, he shares an important component: "one could speculate that the reason caregivers do not wait for a response as often as they ask questions is because they are aware that children with severe multiple disabilities cannot respond, due to their physical or mental disabilities. Consequently caregivers take the child’s turn and then continue the dialogue." He continues to say, "Caregivers need to be taught that when asking questions of children with severe multiple disabilities, they need to wait for a response more often. In so doing, caregivers will be inadvertently signaling to the child it’s your turn … in addition to giving the disabled child an opportunity to respond and be an active participant in the dialogue. As a result, caregivers would give the message to the child that what they have to offer is valued and expected." Ah! How many of us do exactly this? Do we give sufficient wait time and do we understand their responses?

For teaching strategies, please visit Kate Ahern's blog. She provides teaching strategies that I know I embrace. Kate also provides some fun ways to teach yes and no along with some resources worth exploring. She also provides you with strategies for using books to teach yes and no.Linda Burkhart's process of teaching yes/no with the use of recordable switches is my favorite and Kate describes it well: The Yes/No Series and 10 Steps to Teach a Head Nod and Shake

But please consider: Life is more than yes and no. Encourage and accept many forms of communication. Do not always focus on these two simple words that are not so simple and remember - there is so much more to communicate than yes and no anyway! I encourage you to explore Multi-Modal Communication Strategies. And remember, As ASHA Shares: "In summary, "yes" and "no" are very important vocabulary that all of us use often. However, it may be difficult for children with severe disabilities to learn these responses at the beginning stages of communication. Alternative symbols and signals that indicate a desired or an undesired object or event may be easier to learn."

What is Multi-Modal Communiction? EVERYTHING an individual uses to communicate or enhance communication. Different strategies may be needed for different situations and communication partners. Strategies and tools may be combined to meet a wide variety of communication functions.In essence, all communication is Multi-Modal: we use language, gesture, posture, and other non-verbal modes often at the same time as we use objects in the world and the environment itself in order to communicate. 

Please visit the Bridge School Website and take a few minutes to watch their short and to the point videos in each section. Every teacher, educational assistant and parent of a student with severe communication challenges should take the time to explore life beyond yes and no. 

Updated 2/2015
Strategies for Teaching Yes and No in Speech Therapy - See more at: http://www.speechbuddy.com/blog/speech-therapy-techniques/strategies-for-teaching-yes-and-no-in-speech-therapy/#sthash.EcfizRxc.dpuf
Strategies for Teaching Yes and No in Speech Therapy - See more at: http://www.speechbuddy.com/blog/speech-therapy-techniques/strategies-for-teaching-yes-and-no-in-speech-therapy/#sthash.EcfizRxc.dpuf