Just four years ago, my son, Jake, who has autism, couldn't make his basic needs and wants known. His speech therapist thought an augmentative communication device — a touchscreen computer running specialized software that speaks in a computerized voice when icons are pressed — would help him communicate with parents, teachers and peers.
Jake is in good company — according to the American Speech-Language-Hearing Association, more than 2 million people in the United States have a severe communication disorder and may be candidates for augmentative communication.
But acquiring such a computer is not as easy as walking into a store and purchasing one. An extensive evaluation and trial must be conducted to assess the user's needs. Then, it can take many months to gain insurance approval, if coverage is available at all. A device sophisticated enough to produce full sentences usually costs upwards of $7,000.
Traditional AAC devices — the acronym refers to "augmentative and alternative communication" — have a few more knocks against them. They're much heavier than a laptop, can take a long time to boot up and have a short battery life. Accessories, like protective cases or extra batteries, must be purchased through the company, aren't covered by insurance and are pricey.
And for a young child (or even an adult), they can be stigmatizing — most of them lack any sort of "cool factor." They scream, "I'm different." What's more, insurance won't pay for a device that's "open" — one that connects to the Internet for browsing and e-mail or runs other applications, even a word processor. The user can run only the communication software on the device. With the online world as integrated into life as it is these days, this limitation has become positively absurd.
Samuel Sennott, a graduate student at Penn State University, began working with people with disabilities at age 19 when he volunteered at The Respite Center in Hopkinton, Mass. He became deeply aware, he says, that the needs of people with communication difficulties were not being adequately met by the available solutions. So he developed vocabulary for communication software that could run on a small, inexpensive portable touchscreen computer — the iPod touch and iPhone — and now, the iPad.*
"It came as a flash," he recalled, "realizing the potential when the iPhone first came out. Yet, it took much collaboration and teamwork to make the dream a reality." Through a partnership with AssistiveWare, a company based in the Netherlands that specializes in software solutions for people with disabilities, Sennott c0-developed a prototype of an AAC system on an iPhone. Two years later, the final version of the software, Proloquo2Go (the "2" in the name referred to it being a sequel to a program that had been developed for Mac computers) was released. His primary goal was to provide "an affordable, powerful and cool system that is easy to acquire."
In 2009, Sennott and Adam Bowker published a paper in Perspectives on Augmentative and Alternative Communication titled "Autism, AAC and Proloquo2Go." The article discussed the software in light of best practices in AAC for individuals with autism. This year, Sennott sold his interests in Proloquo2Go and says he is focusing on "helping more holistically" and working on his doctorate.
When asked whether Proloquo2Go would be expanded to other smart phones such as the Droid or other touchscreen tablets, AssistiveWare's CEO, David Niemeijer, said that the company thinks that Apple's iPod and iPad provide an excellent platform that allow them to focus on functionality. "We'd rather stick to one platform and do a good job there than do a mediocre job on multiple platforms," he said. Niemeijer feels that Apple is very supportive of assistive technologies in general and said they have offered support for technical issues and include assistive technology products on iPods and iPads that their education staff demonstrates for school districts.
With an iPod Touch, iPhone or iPad and Proloquo2Go, available to download for $189.99 from the iTunes store, someone who needs augmentative communication can have a functional voice for well under $1,000. That's cheap enough to avoid the labyrinthine process of dealing with insurance, plus the user can access e-mail, browse the Internet, visit social networking sites and do anything an application can do — manage a to-do list, use a daily schedule or text a friend.
There's an important caveat: they must be able to use the touchscreen. While traditional AAC devices support alternative methods of activating the icons, such as an eye gaze or switch, for people with severe physical limitations, this capability isn't yet available on the iPod, iPhone or iPad (although some determined and ingenious individuals have developed workarounds such as a mouth stick). And the iPod Touch is so small that fine-motor issues can make it hard to press the right icon. So while some people guffawed at another gimmicky Apple product when the iPad was announced, folks who use assistive technology applauded — the iPad opens up a world of new possibilities for them because of its larger screen.
Although so far Proloquo2Go is the most fully featured application that's available for AAC users on the iPod and iPad, several other companies have popped up with their own augmentative communication applications. AutoVerbal Talking Soundboard PRO, iPACS, HaloTalk, Look2Learn, Expressionist, iConverse, and Voice4U are all relatively inexpensive applications that have become available recently. TapToTalk began life as augmentative communication software that runs on the NintendoDS, but it's now available on the iPad as well. It requires an Internet connection and is subscription-based.
For people who can type, there are some alternative options to icon-based programs. Speak It! offers powerful text-to-speech capabilities for $1.99. Type a word or sentence, hit the "Speak it!" button, and your iPod or iPad will speak it for you. It will also read documents and articles out loud. There's also iMean, created by Michael Bergmann, whose son, Dan, has autism. iMean is a letter-board-based text-to-speech app; some people can more easily use an A-to-Z board (instead of a QWERTY arrangement) to type words.
The number of applications sprouting up is almost dizzyingly diverse, and it can be hard to know what will work best for an individual child — that's where a speech-language pathologist with experience in augmentative communication would be a major asset. They're an integral part of any insurance- or school-funded AAC device process. Typically, augmentative communication specialists conduct a comprehensive evaluation and then run a trial of at least one device, collecting data on the person's usage and making a recommendation. But many people don't have access to such a specialist or the funding to hire them. With applications prices so low and iPods, iPhones and iPads in many people's lives already, parents of kids with autism, as well as adults with special needs, are taking matters into their own hands.
The potential of using this new technology for communication isn't limited to autism spectrum disorder. People with aphasia, amyotrophic lateral sclerosis, traumatic brain injuries and cerebral palsy — anything that impairs the ability to speak — are also using iPods, iPhones and iPads successfully to communicate. The RJ Cooper & Associates even offers wheelchair mounts and stands for the iPad.
Besides low cost and easy availability, the familiarity and "cool factor" of an iPod, iPhone or iPad can't be underestimated — even for adults. Glenda Watson Hyatt, an author who has athetoid cerebral palsy and types with only one thumb, purchased an iPad to use with Proloquo2Go. In an initial review of the device on her blog, Do It Myself, she reported last month, "My friend, Hope, was having trouble figuring out what I was saying and she asked, 'Where's your iPad?' In that moment, I felt a sense of normalcy and acceptance. Using an iPad, which could become as commonplace as the BlackBerry and iPhone, is not yet another thing that makes me different. ... People were drawn to it because it was a 'recognized' or 'known' piece of technology rather than being standoffish with an unknown communication device."
And then, she writes, "I did something I had never done before: I went into one of the many Starbucks at O'Hare and ordered my first mocha frappuccino by myself. No misunderstanding or hand gesturing involved. It was so cool, like another door had just opened for me! ... I feel like technology is finally catching up with what I truly need."
Although it's incredibly powerful for someone with communication difficulties to use an iPad with Proloquo2Go, the potential uses for small, portable touchscreen devices in the lives of people with different abilities reach beyond AAC.
Researchers in the College of Education at Auburn University recently received a grant from the National Center for Technology Innovation to conduct research using iPads tailored to meet the needs of children with autism. The team will evaluate their effectiveness in increasing the children's social and communication skills. They'll use video storytelling and develop touch-activated voice recordings that children can share in interactions with each other. Scott Renner, coordinator of assistive technology in the Center for Disability Research and Service and one of the authors of the grant proposal, cites cost-effectiveness as a major factor that influenced the choice of iPads.
People with autism spectrum disorders tend to thrive on routine, and laminated paper picture-based schedules have been used for years as part of best practices in classrooms and therapy settings for children with autism. Apps are surfacing that do everything from making picture-based daily schedules (iPrompts, PictureScheduler, StepStones), to creating social stories (Stories2Learn) — photo-based "books" that help children with autism understand their own behavior and others' feelings. Social stories can help children learn social routines and expectations, review appropriate interactions, and prepare for new situations (such as a medical procedure).
Instead of printing photos and text from a computer, laminating and binding the books and storing them, parents and educators can search online for images or snap a photo with their iPhone and quickly and easily create a portable electronic story with text and voice recording.
Jamie Knight, a web developer from the U.K. with autism, wrote an article for ATMac, a site that covers assistive technology for Apple and Mac users, about the iPhone's impact on his life. He doesn't mince words. "I could not live (independently) without my iPhone," he begins. Knight loses the ability to speak when under a lot of stress, so he uses Proloquo2Go in such situations. But he also uses the iPhone to organize his life — iCal keeps his schedule and the apps Things and Task Paper manage his to-do lists.
The evolution of computing technology has opened up a new world to people who rely on assistive technology to communicate with others. And the opportunities to use this technology in new ways keep multiplying — as fast as app developers, educators, parents and adults with different abilities can imagine them.
* An earlier version of this story described Samuel Sennott as the developer of the software. He developed the vocabulary but not the software itself and can best be described as its co-developer.