The Communication Matrix

Friday, March 23, 2012

Karen Natoci Florka, M.S., CCC

Speech & Language Pathologist
Wing Lake Developmental Center
Bloomfield Hills Schools District
 ASHA Disclosures

I completed training through level IV with the

Design-to-Learn Project with Philip Schweigert
in 2005. This goal of this presentation is to review
the Communication Matrix Profile so that you may
feel comfortable administering it to your pre-symbolic
students. I have purchased the copies that you have
and received written (email) permission to copy
enough for this conference. I am not employed by
the Design-to-Learn Project and am not receiving any
compensation for this presentation.
 Assumptions:
 Little or no experience with students
with severe and multiple disabilities on
your caseload,
 This is a beginning, early intermediate
level course
 Goal is to help you get started with
these kids on your caseload
 Careful not to over or under-estimate
what these kids can do!
 Agenda:

Frame Communication Development

•  Focus on Pre-symbolic Communication
Complex Students
•  Profiles of complex students in the classroom
•  Co-morbidities seen
•  Current approaches and IEP goals
Communication Matrix on line-FREE!
Look at the Levels (emphasis on presymbolic)
•  Greater depth
•  Clinical direction
Characteristics of our
“Complex Students”
 Where do I start?
What do I do? Can this child learn?
What IEP objectives are appropriate?
Child not
interested? What evaluation tools are
available?
Overwhelmed

How do I deliver services to this child?

Can this child hear? Doesn’t follow directions

“hit the switch”
The Communication Matrix
Rowland, 2004
 Philosophy

Everyone Communicates!
 Everyone Communicates

 It is our job to figure out how & shape

communication so that our students can
interact with more people…..
 Philosophy:

 School is an important base for recognition

of developing communication throughout
the day, not just during speech time.
 Parents can assist us in figuring out how
their child communicates with familiar &
unfamiliar partners.
 Philosophy, continued:
  We need administrative & related services support
to establish a building-wide view of communication
importance,
  We’re going to think small, not too big, so as not to
get overwhelmed,
  Think of communication as being situation
specific,
  Think of incidental opportunities too, beyond the “I
want” activities!
  Communication Enhancement
 Analysis of Communication
 Involves:  Elements of
–  Social (people) Communication
–  Cognition, –  The SENDER
–  Vision, –  The RECEIVER
–  Hearing, –  The TOPIC
–  Central and –  The Means of
Peripheral Nervous EXPRESSION
System –  INTENT of the
–  Anatomy speaker
Triangle of Communication

Learner: speaker, conveyer

means

teacher: Topic
Listener/receiver
Development using this model

Child: sender
Learner: speaker, conveyer

means

Adult: Topic
Listener/receiver
How Expressive Communication Develops:

Progressive distancing between sender & receiver:

Pre-symbolic symbolic
Development using this model

Child: sender
Learner: speaker, conveyer

means

Adult: Topic
Listener/receiver
How Expressive Communication Develops:

Progressive distancing between child & the topic itself:

“Daddy at
“Self-topics” topics related to “doggie!” work”
or internal self
states
Development using this model

Child: sender
Learner: speaker, conveyer

means

Adult: Topic
Listener/receiver
 How Expressive Communication Develops:

Progressive distancing or increase in level of ABSTRACTION

between topic of expression and the means of which to
express it:

Direct physical Gestures, point Phonologic or

contact between or vocalize written
topic & child sound of plane representation
 Common Characteristics of Individuals who Struggle with
Speech

  Rarely initiate interactions,

  Primarily respond to others’ initiations, (responders rather than
initiators)
  Usually communicate via multiple unconventional modes– use fast,
efficient and unusual behaviors only recognizable by those who know
them,
  Communication attempts depend on a “knowledgeable other”
  Unintelligible vocalizations are common,
  Rarely interact with peers,
  Vocabulary not available when they really need to communicate.
 Partner Characteristics:
Communication Interaction Style or, WHAT DO WE DO?

  We tend to dominate the interactions,

  We preempt the augmented communicator’s turn,
  We don’t give the AAC user time to formulate messages,
  We often fail to respond to their initiations,
  We often anticipate their needs, making it unnecessary for them to
communicate!
  We use rhetorical speech for which answers are not being solicited,
  We use “fills” and “tags” which obscure the meaning of the message
(complicate it) and cancel the intended effect,
  We double state their messages and repeat them as if their speech didn’t
count,
  Here’s a big one: We say “good job” in response to any attempt to
communicate at all which is inappropriate.
  Overall unbalanced communication.
 What is The Communication Matrix?

Assessment Tool:

Pinpoint how a person is communicating,

Provide a framework for determining communication

goals.

First published in 1990 and then revised in 1996, 2004 by

Dr. Charity Rowland of Oregon Health and Science University.
Parent Version of the Communication Matrix
 Target Population
  Appropriate for individuals of all ages who are at the earliest
stages of communication.
  In a typically developing child: 0-24 months of age.
  Accommodates any type of communicative behavior including
augmentative and alternative forms and presymbolic
communication (gestures, facial expressions, eye gaze and
body movement.)
  Appropriate for individuals who experience any type or degree
of disability, including severe and multiple disabilities including
intellectual limitations and sensory and/or physical impairment.
  NOT suitable for individuals who already use some form of
language meaningfully and fluently.
 Communication Functions:
(The Communication Matrix)

–  4 REASONS FOR COMMUNICATING –

–  Horizontal -

 Refuse
 Obtain
 Social
 Share information
 THE COMMUNICATION MATRIX
PROFILE
Rowland, 2004

 Communication Skills Development

•  vertical
–  Level I: Pre-intentional communication
–  Level II & III: Intentional communication
•  Pre-symbolic behaviors
•  Nonconventional behaviors
•  Conventional behaviors
–  Level IV, V, VI, VII: Symbolic
communication
Four Reasons to
Communicate
 Nine categories of
Communicative Behavior
 Results
 Two major products:
–  A one page profile
–  Communication Skills List
 Review of Each Level I-VI

  Behaviors are:   Receptive:

  Behaviors are not:   Literacy
  Speech:   What should we foster
  Physiological and/or train:
  Motor:   Considerations:
  Technology/Access:   Not appropriate:
 Level I
Pre-intentional Behaviors
 Behaviors
–  and communication are one and the same
–  are reflexive or reactive
–  NOT purposeful
–  associated with states of being (discomfort,
comfort, closeness)
 WE do ALL of the interpreting!
 Level I

 Speech:
–  cry,
–  gurgle,
–  coo,
 Physiological:
–  Breathing rate
–  Drooling
–  Heart rate
 Level I

 Motor:
–  Head movements,
–  Postural movements or change,
–  Limb movements,
–  Trunk movements,
–  Leg movements,
–  Change in tone, rate,
 Level I

 Technology/Access
–  Place an access switch near the body part
that moves with the least amount of effort
by the student
–  Go for independence (do not touch the
student once set up)
–  Activation will be random at this point
–  The experience will do the teaching
 Level I

 Receptive:
–  VISUAL
•  Awareness of your face, objects used during an
interaction,
•  Localization to lights, high contrast objects,
pictures, toys,
–  AUDITORY
•  Localization to sounds
•  Response to rhythms (music, chants)
•  Seems to recognize familiar voice, people
 Level I

 Literacy? Yes. Focus on Shared

Enjoyment!
–  VISUAL
•  Awareness of books, pictures, video
•  Looks toward picture or book
–  AUDITORY
•  Attention to reader’s voice
•  Response to inflection or change in reader’s
voice
 Level I
 What should we do?
–  Find out what the child LIKES
–  and DOESN’T LIKE.
 How do we do that?
–  Preference Assessment
–  Survey how the child responds
–  Keep track with a chart
Preference Probe
Every Move Counts (Korsten,
Dunn, Foss & Franke)
  Sensory-Response Assessment
  Goal: Collect objective data on whether the child
shows some reaction or response to specific stimuli
organized by sensation.
–  Which material, people, interactions are highly
reinforcing (what do they LIKE?)
–  Which behaviors appear to be voluntary and
might serve as a means of intentional
communication.
 Level I

–  Remember that behaviors at this level are

probably not purposeful!
–  If you think that the child is demonstrating
behaviors ON PURPOSE, then the child is
NOT communicating at a level I!!
 Sample IEP goals
  Student will develop a repertoire of behaviors (i.e.,
look, vocalize, smile, movement) in response to
visual stimuli, 3/5 presentations given wait time
(minimum 10 seconds).
  Student will develop a repertoire of behaviors (i.e.,
turn toward, quiet, smile, movements) in response to
auditory stimuli, 3/5 presentations given wait time
(min 10 seconds).
Never underestimate a student’s ability to
use some mode of communication.

Consider: heart rate, respiration,

facial muscles, lower extremity
movement.
 Video
 Tre
 Level II
Intentional Behavior
  Behaviors
–  Appear to be more intentional
–  are not intentionally communicative
  Child does not
–  realize that they can control another person by
using their behaviors
–  typically use their eye contact to their advantage
(to engage you)
–  know to wait for a response from the adult
–  have dual orientation (joint attention) yet!
 Level II

Nevertheless, some of these behaviors

serve a communication function…why?

Because teachers and parents interpret

them as communicating something!
 Level II

  Children direct their behavior directly on

objects (want/reject)
  Children direct their behavior directly to you
(want/reject)
  But you do not know what or who!
  Behaviors should be a bit more differentiated
(vary according to the situation or need) and
not as difficult to interpret. But you are still
doing the guessing!
 Level II

 Speech
–  Cry,
–  Gurgle,
–  Coo,
–  Fuss,
–  vocalizes
 Level II

  Movement:
–  Head movement toward object
–  Head movement toward person
–  Lean toward or away
–  Approaches object or person
–  Pushes away, swipes at reaches toward
–  Facial expressions
–  Clearer and stronger preferences
–  Knows what child likes and doesn’t like!
 Level II

  Technology:
–  Contingency awareness (general cause & effect)
–  Learning to use an access switch or a big mac!
–  May repeatedly “hit the switch” without waiting for a
response
Single switch practice
 Level II

  Receptive:
–  Localizes, more aware of environment,
–  Showing more attention, concentration,
–  Seems to be listening and showing
“interest”
–  Showing interest: objects, pictures,
 Early, pre-symbolic communicators:
(behaviors to read and perceive)

  Approaches person or
  Change in position, object
posture   Gesture
  Limb movement
  Looks at object or
  Head movement person
  Facial expression
  Takes object
  Vocalization
  Reaches towards
  Move away from
object/person
object
  Push away object or   Touches object
person   Activates switch
 Level II
 Place VALUE on symbols!
 Use them!
 Augmented INPUT!
 Level II
 Receptive use of symbols:
–  Start pairing objects and situations with symbols
–  Pictures
–  Words
–  Sign language
–  Gestures
–  Use packaging
–  Use parts of objects
 Level II
 Literacy:
–  Access to books
–  Access to a “pencil”
–  ABCs
–  Focus is on enjoyment and interaction around
books (emergent)
 Level II

  What should we do?

–  We should be responding to potentially
communicative behaviors so that the child
becomes aware of its communicative purpose and
through our reactions, can begin to direct
behaviors TO US!
–  Show the child symbols, narrate events, talk to
child, use objects as symbols!
 Level II

  What should we do?

–  Scripting, use of a VOCA turn-taking
–  Assign MEANING to objects/symbols!
–  Give our students a PENCIL
–  Read (repetition, interactive) books!
–  Use TRANSITION OBJECTS !!
–  Objects and Symbols can tell the learner what
comes next!
What comes next?
 Where am I going next?

bathroom Go home
bus

thirst

lunch
Tactile symbol systems:
Scripting

sequencer

Little step by
step

Big step by step

Kaylan

Bryson

Brandon
 Level II

Communication Priority:
  What should we do?
–  Be responsive to the child.
–  Establish Intentional Communicative Behavior.
  How do we do that?
  Use DATA from Preference Assessment
–  Readability-is the behavior easy to interpret consistently by
others?
–  Do-ability-can the child easily do this behavior or is it difficult
motorically for the child to initiate and do?
–  Applicability-is the behavior useable across partners &
places?
 Level II

  Start with: Preference Assessment / Probe

–  Work on: Reinstatement (repeat
something pleasurable)
–  Add: gaining attention
 Preference Assessment
  Present an object/toy/action one at a time
–  Easy to read behavior
–  Difficult to read behavior
  Highly structured sensory preference probe
  Go slow, provide ~15 seconds stimuli, stop, then
wait.
  Be perceptive to all behaviors.
–  Note behaviors exhibited during the activity,
–  Note behaviors child attempts to use to reinstate the activity
(may be different)
–  A reactive response is different than an attempt to initiate a
purposeful expressive movement.
 Wait & allow the child to
initiate
 All by themselves.
 Don’t even think of touching them.
 Without your verbal coaxing.
 Without your applause.
 Without the need for you to do anything.
 If you do anything you take away their
potential experience of POWER.
 Social reinstatement !

  Many students need

» BIG behaviors to reinstate!

» Simply program the VOCA to say:

» Come here …
or, go away!
 Strategies for Teaching
Reinstatement
 Convey an expectation of a response…
 Provide wait time… (shhhhh!)
 Offer your hand proximally to the child…
 Offer an VOCA with an access switch
near the child’s most successful point of
control (that means not too easy or too
hard)
 Control your prompting (be aware of it)
 Prompt Heirarchy
  Most-to-least   Least-to-Most
–  Full physical –  Independent (natural
–  Partial physical environmental cue)
–  Modeling –  Verbal
–  Gesture –  Gesture
–  Verbal –  Model
–  Independent (natural –  Partial physical
environment cue) –  Full physical
 Sample IEP goal
  Student will use their *repertoire of behaviors to reinstate pleasurable
activities 3/5 opportunities given min 30 second wait time and a verbal
prompt.
–  *smile, activate voca, vocalize, eye gaze toward desired object
  Student will use a VOCA to gain attention given teacher prompts to do
so (i.e., teacher anticipation cues and/or teacher indirect verbal prompt)
3/5 opportunities and adequate wait time.
  Student will look at a thematic object used during shared reading time,
3/5 opportunities.
  Student will say key vocabulary words 3 times during group reading
time.
  Student will engage in 3 reciprocal communication exchanges during
morning greeting with the teacher given 30 second wait time and verbal
repetition of encouragement to continue the interaction.
 Level II

  Not Appropriate:
–  “Time – out” is still too complex because
the child doesn’t have dual orientation or
contingency awareness!
 Level III
Nonconventional, Pre-symbolic Communication

  This is a CRITICAL stage!!

  Our students communicate intentionally!! 
  But… communication is not conventional:
–  Push pull, movement, eye gaze
  Child uses these behaviors- and they direct
their behaviors to you and are learning to
wait!
  However, still not socially acceptable to all.
  These behaviors are extremely effective.
 Types of Choices students
can make:
  Within the activity:
–  A choice of 2 or more materials that is provided within
the context of any activity (I.e., color paint)
  Between activities:
–  A choice of 2 or more different activities is provided
(what do you want to do?)
  Refusal:
–  At the beginning of an activity, provide the choice of
whether or not to participate (be ready for a rejection
response, though!)
 Consider the following to elicit
requests:
•  Materials in view but out of reach
•  Materials with which need assistance/help
to use
•  Small amounts
•  Inadequate portions
•  Sabotage
•  Keep it interesting
 Dual Orientation

Learner: speaker, conveyer

means

teacher: Topic
Listener/receiver
 Level III

  Technology/Access:
–  Child appears to understand cause and
effect!
–  Child waits (or is working on waiting) and is
learning to operate switches appropriately,
 Level III

 Receptive-SAME as Level II…keep it

up!
–  Appears to anticipate routines,
–  Responds to name,
–  Understands some directions
–  You can direct child to look, listen to
something
–  Seems aware of symbols (type?)
 Level III

 Literacy
–  Child should handle books as much as
possible
–  Child should be read to
–  Child should have time with his “pencil”
–  Child should choose own books to “read”
–  Focus on interactive shared reading
–  Alphabet & sounds-
 Level III

  What should we do?

–  Let the child use push/pull!
–  Offer our hand (hover) to allow the child to
continue to develop this!
–  Push symbol use: at least one symbol per
interaction! All day!
–  Use symbols receptively (to) the child!! Embed
during play, transitions, during travel !!
–  Okay to start PECS phase I training, other symbol
training, simple device / introduce choice making,
–  Scripting, use of a VOCA turn-taking
 Symbol Systems can be
Receptive or Expressive!
 Some systems TELL the student about
an activity, task or sequence of the day
 Some systems are used for the student
to express themselves during classroom
routines
 Level III

  What should we do?

–  Move toward choice making!
–  Start with a space filler/nothing choice
–  Add a distractor objects in the array
–  Careful about prompting
•  Quickly fade if used
•  Pace the practice sessions fairly
•  Minimize distractions
•  One new thing at a time
•  Proceed thoughtfully
 Level III
be cautious-
  Careful not to overload the child,
  Again, teach one new thing at a time,
  Child may use level II behaviors at any time (i.e.,
when sick, stressed, overload)
  Remember that the auditory system is “the first to go”
…most transient.
 What to do:
 Some students will need training in
multiple ways of communicating until
they exhibit a preferred method
–  Eye gaze systems are a great solution
–  Choose the route that will ultimately get
them beyond an array of two,
–  If orthopedic issues are too complex, may
need to work on scanning
 Partner Assisted Scanning
  Unaided (no   Aided (using symbol
symbols, auditory display with switch
only) to select)
–  List choices by –  Name choices by
naming them pointing with finger,
flashlight, stick, one at a
–  Show objects one at time,
a time –  Point to symbol or object
–  Giving time for a self- across an array
initiated “indicating –  Giving time for self-
initiated “that’s it”
response”
response
 Considerations in Partner
Assisted Scanning
1.  Motivation
2.  Multiple cycles of presentation
3.  Consistency of order
4.  Include a “way out”
5.  Decrease verbal questions/language
6.  Use easiest student mode
7.  Accept multiple communication modes
8.  Attribute communicative meaning to all attempts
9.  Support physical movement with PT/OT input (positioning)
10.  Pair options presented by augmenting input
 More considerations
  Consider HOW Choices are Offered:
–  Visual?
–  Auditory?
–  Tactual?
–  Sign?
–  Small sampling?
  Accept Multiple Communication Modes
  Attribute Meaning to All Communication Attempts
  Be careful about facilitation
 Early Partner Assisted
Scanning-Training
 Joseph
 Level IV
Conventional, Pre-symbolic Communication

  Our students communicate intentionally!! 

  Communication IS conventional!
–  Socially acceptable,
–  Understood by anyone, universal.
  Child has dual orientation / cause-effect
–  Child can act on BOTH a person & a symbol
–  May be multi-modal or
–  Cross modal
–  Difficult to establish these abilities without vision-
–  Difficult to establish if too overwhelmed sensory
system
 Level IV

 Speech:
–  Intonated sound patterns
–  Vocalizations accompany gestures
–  WAITS for a response,
–  Alters sounds or inflection if not successful
 Level IV

  Receptive:
–  Appears to anticipate routines,
–  Responds to name,
–  Understands more directions
–  You can direct child to look, listen to something
–  Seems aware of symbols (type?)
–  You can direct child to look, listen to something
–  YES / NO start using it!
 Level IV

  Technology/ AAC
–  Moving to two-choice or more options
–  Yes and no (watch for difficulty of question!)
–  Partner assisted scanning
–  Eye gaze board
–  Symbols are
•  Valuable!
•  Powerful!
•  Consider easiest symbol to understand!
 Level IV

  Gestures / Universal signs:

–  Waves,
–  Points,
–  Distance pointing
–  May be beginning to nod head for yes/no
–  Other simple gestures emerging (come, bye, hi,
me)
 Level IV
 Literacy:
–  Self-Selected Reading
•  Child in control
•  Practice handling a book (indiv access method)
–  Guided Reading
•  Full of interaction & talking (balance talking)
•  Child regulates reader.
•  Reader can offer thoughts-i.e., “that’s funny!”
•  Connect new with known information
–  Write
•  Name, anything (pick topic by choosing picture)
•  Lots of practice with pencil…takes years!
 Level IV

  What should we do?

–  Teach 1:1 correspondence between symbols and
what they represent
–  PECS
–  Other choice-making systems
–  Technology
–  Embed communication devices within activities to
give the child a feeling of control
 Level IV

  Consider:
–  To expect maximal communication abilities across
all situations
–  Do not pressure student to communicate
symbolically all of the time!
–  Expect lots of errors
–  Be aware of your cueing
–  Technology
–  Be ready for change
 Level V
Concrete Communication

  Our students are using concrete symbols

  Symbols represent specific objects or people!
–  Bear a 1:1 relationship to a specific
referent
–  Clear perceptual relationship to the referent
(easy to understand)
–  Symbols physically are similar to its
referent
–  Access may vary
Level V
 Level V

 Speech:
–  Mimic sounds
–  Echolalia
–  Limited repertoire
 Gestural:
–  Depictive gestures
–  Multi-modal expression
 Single icons/symbol use
 Core Vocabulary
 Level V

 Literacy:
–  Expressively beginning to use symbols to:
•  Talk about the story
•  Regulate a reader
•  Request books
–  Child regularly uses the alphabet and is
learning to write with their “pencil”
 Level V

– Consideration to expand to
sequencing icons or large
single icon usage
 Expressive and Receptive Symbol Use:

Symbol System Examples:

Object schedule board

PECS book Eye Gaze Board

More symbol
system examples:

Color coded
 ipad

Voice Pal

Ipod touch

Mighty Mo

Vanguard
Go Talk
 Level VI
Abstract Symbolic Communication

  Students are using single icons with gestures

or objects available to them!
  Keep students moving and their core
vocabulary should be with them at all times!
 Level VII
Abstract Symbolic Communication

  Our students are using concrete symbols and

beginning to sequence them and combine
with their gestures or objects available to
them!
  Access may vary
  Understandable by strangers
  May be starting to use a more sophisticated
AAC device to house so much vocabulary!
 Where on the Matrix?
  Grimacing due to not feeling well
  Pulling teacher to the door
  Bring an empty cup to a staff person
  Taking your hand and putting it on the
refrigerator door
  Handing an icon to you with a picture of a toy
  Standing by the door
 Let’s jump right in!

The Communication Matrix Online: www.communicationmatrix.org

  Questions?

 Comments?