Episode 313: Tiffany Joseph (Part 2): The Use of Gestalts in Acquiring Language as a Part-Time AAC User

This week, we share part two of Rachel’s interview with Tiffany Joseph! Tiffany is an autistic mother of three neurodivergent teens, as well as an educator, advocate, and a part-time AAC User with inconsistent verbal speech.  She shares about her experience as a gestalt language processor, how she thinks AAC could help students mitigate their gestalts, her perspective on Spelling to Communicate, and more!

Before the interview, Chris and Rachel answer a listener question about “seasoned SLP‘s” in the listener’s school district who said that “high-tech AAC wasn’t appropriate for kids with lots of behaviors.” Chris and Rachel discuss the question, noting that behaviors are often reduced when a student has a device, and they wonder whether those “seasoned” SLPs should reconsider their openness to new ideas.

🔑 Chris’s motto  is “education instead of restriction,” meaning we should teach people how to use new things (like AI, etc) rather than just try and restrict or block them in the schools. In his experience, you can restrict a particular app or website but it’s better to teach students to use the tool in a better way.

🔑 Tiffany said it would’ve been really helpful for her communication growing up if she could’ve had a device that displayed the first half one of her gestalts, followed by different logical alternative endings that she could choose from to help her mitigate her gestalts.

🔑 Tiffany believes that spelling to communicate is a valid form of communication and doesn’t believe it should be  controversial. She feels that, similar to “body doubling,” where the presence of a familiar person can help us regulate and focus, having a familiar partner facilitate communication is really valuable. Tiffany says that having a person there for to help coach the motor plan doesn’t make S2C invalid.

Transcript of the Episode

Please Note: This transcript was generated using speech recognition & AI tools; it may contain some grammatical and/or spelling errors.

00:00:08
Welcome to Talking with Tech. I'm your host, Rachel Madel, joined as always by Chris Bugaj. Hey Chris.

00:00:12
Hey, Rachel. Well, it's been a hot second since we've done a listener question and answer sort of episode, so I've got one right here. Again, thank you, because I think you parcel through all of our email and then you forward something to me like, hey, maybe we should talk about this one on the podcast. And this one jumped out at me. Alright, ready?

00:00:32
Here it goes. As a new member of my school district's at team in 2022, I've encountered discussions on prerequisites for access to high tech dynamic display devices in AAC. While there are no general prerequisites for AAC access, concerns have been raised by seasoned slps about the appropriateness of these devices for students exhibiting challenging behaviors such as biting, licking, throwing the device, and swiping or using their entire hand to touch the screen. How should I navigate these considerations when determining the suitability of high tech AAC devices for students with complex communication needs, especially in cases where challenging behaviors may impact device use? I listen to your podcasts often and have ideas on how this should be approached, but they seem to conflict with what I'm being told by more experienced colleagues.

00:01:28
I'd love to hear your thoughts, Rachel and Chris.

00:01:31
Oh, Chris, I love this question. It's a good one. It's a good one. I feel like a lot of people listening are like, oh yeah, like, what do we do with the students who have all these behaviors and how do we manage that with AAC? What first jumps out to me is just like, students have behaviors cause they can't communicate.

00:01:54
And it's just like, I always circle back to that. Like, imagine if you weren't able to communicate what you need, how you felt, what you were thinking, like, you would get frustrated and you'd probably have all types of behaviors that manifested as a result of that.

00:02:10
Did you hear the quotes in your. I heard the quotes in the way.

00:02:13
You said that you heard the quotes. My air quotes now have an intonation to them. But it's just like, this is so, it's always one that I really hear a lot. Chris is like, oh, we can't give them a device. They'll just break it.

00:02:27
They'll just throw it. And I'm like, okay, but we have to go back to the drawing board and figure out how do we teach, right? I feel like it always goes back to teaching. We need to first give access to the technology and then teach students how to use it.

00:02:47
So I think there's some other things layered in here in this question that maybe bear breaking out. Okay, so that's the obvious. Like, big one is, and anyone listening to the podcast knows and the person who wrote us knows, like, that's what we were going to say. So there's other things that I think are layered in here that I just want to kind of call out and bring to the forefront. Right.

00:03:07
So one of the first ones is the idea that there's a more seasoned or expanded, experienced SLP is telling the younger, less seasoned SLP kind of how to do things. And I don't know that that's necessarily always the best case. So there's something called the Dunning Kruger effect for sure. Right. Where when you first get out of school and you're just learning about stuff, you sort of have this confidence and you believe you know a lot.

00:03:37
And then the longer you start doing it and the more you learn, the more you realized there's so much more to learn. And, like, if you've seen it, if you can, do you know what I'm talking about? Rachel, have you heard of that effect before? Have you seen that? Can you picture the visual in your mind where it's like a roller coaster?

00:03:51
Like it says go up, up, up, and then it drops. Like after two or three years in practice and whatever it is, it's not even just related to AAC. It goes down. And then these seasoned people start to realize what they don't know. But in this case, it seems like the seasoned people have not kept up with the research, have not kept up with, haven't changed.

00:04:16
Maybe their openness into thinking about how to do things in a while. I think the very first thing we want to call out is this move to openness. Have an open mind about your practices and really evaluate. Have they been working? How do I know they're working?

00:04:34
And I know, Rachel, through the conversations you and I have in the past or recently, sometimes when you send me a Marco polo, I'll come back and I'll be like, well, obviously we should do, because I've seen work, whatever that is. And then I got to check myself and go, oh, wait a second, have I seen it work? Do I really know that's true? How do I know that's true? Have I implemented that?

00:04:56
I start really reflecting on whether what I know is really what I know. Maybe gaslighting myself is the. But I feel like it's a healthy way to be, is to always be challenging what you think you know I.

00:05:14
Also want to point out the fact that, you know, seasoned slps, let's put that in air quotes sometimes, not always, but sometimes, you know, are kind of stuck in old patterns of thinking. And it's something that, you know, we need to think about when we are, you know, working alongside of other professionals. You know, I want to be around people who are thirsty for more information, for new technology, for new innovation, for new, you know, ways of thinking. And I think that sometimes, you know, we get in a field and we kind of do what we do and we know what we've done and we see results from what we've done and so we kind of get more complacent. And what's nice, nice about younger, newer clinicians is that they have this fire.

00:06:08
They're like, I'm so excited. I'm launching into my career. I have all this energy because I'm younger and I'm really eager to learn. And that thirst for learning, I feel like fuels seeking out the podcast, seeking out professional development, going to conferences. It's like that's really what informs your practice, regardless if you're a new clinician or a seasoned clinician.

00:06:36
And I think that there's something to be said for looking at someone and I guess being curious as to what kind of clinician do you think they are. Are they the kind of clinician that knows about the latest things or are they just kind of more complacent and just kind of like, okay, I do what I do and this is what I do and this is what I tell people to do because I've been doing it forever.

00:07:01
You know, I really am going to resist the urge to talk about the difference between learning in school because I definitely have thoughts around how school sort of drives the love of learning out the window in some cases. And you get this feeling of, haha, I've done it, I have graduated and therefore I don't need to learn anything more. Or the way our organizations say you have to have a minimal number of ceus or hours or something like now if I just get the minimum that I'm keeping up with the practice. No, that's, those are the wrong ways to look at it. But I'm going to resist the temptation to dive in there because there's another point that I want to make in this email.

00:07:48
So the other thing that jumped out at me is the term challenging behaviors. And at the beginning of the school year, I did a like an hour long presentation for some of the staff that I work with. And it was called surefire ways to decrease behaviors which impede learning. And in that slide deck and in, during that presentation, I talk about a resource that I want to share on the podcast, because I don't know that we've talked about it before, and that is from the organization communication first. So have you heard of communication first?

00:08:29
Okay, you're smiling. You have? Of course.

00:08:31
Yes, I have.

00:08:32
So a while ago, maybe like a year ago or so, they put out a style guide. Well, let me first go back up and say, what is communication first? It's an organization because you've heard of it, but people might be going, yeah, okay. Rachel's heard of a Chris, but we haven't tell us what it is. So it's a, I think it's like a nonprofit organization that is all talking about, you know, the rights of how communication is a human right and some of the people involved in it.

00:09:08
There are going to be some familiar names on this list. You ready? There's familiar. If you've been listening to the podcast, Jordan Zimmerman is a part of it, is the current chair, India Oaks, who's also been on the podcast. Lateef McLeod, who's been on the podcast.

00:09:23
Erin Sheldon, who's been on the podcast, Alyssa Hillary Zisk, who's been on the podcast. And there's a bunch of other names here. But the point is, these are people that, the ones that I know, I trust, and I like to learn with and learn from. Right? Sound fair?

00:09:39
Yes.

00:09:40
So they put out about a year ago, in July 2023, a style guide where they are talking about different ways to reframe language. And one of the things they talk about is the term behaviors. And again, did you hear it in my voice? I'm putting it behaviors in quotes. And what they say, again, I'm going to give them credit, but just so we can talk about it, I'm going to quote them from it.

00:10:05
Exactly. It's a lot of Chris reading on this podcast today. Okay, here we go. When people move or make noises in ways that are unexpected, unfamiliar, or unwanted, they are often labeled as having behaviors. Human beings move in different ways.

00:10:21
Some movement is planned and intentional. Some is unplanned and unintentional. Some is both at once. Some is triggered by sensory reactions to environmental inputs or lack of input, pain, trauma, emotions or habit. And on the particular slide, I have that bolded.

00:10:42
Right? Because I feel like that's on us to create environments that are not like this. Right. That don't cause pain, trauma, emotional dysregulation, don't form bad habits. Right.

00:10:56
So. But there's more to it. Okay. There's more to it. No.

00:10:59
Human is merely a bundle of behaviors. When we characterize human movement this way, we are more likely to view both the movement and the human. Doing that movement as other or inhuman behaviors become something to control or fix. Behaviors often become a prerequisite to address before someone is given access to AAC. The word behaviors erases and dehumanizes the human behind the movement.

00:11:30
Like mic drop. Right? Like mic drop.

00:11:32
Drop that mic. I mean, I feel like there. It's so well articulated, and it's so. It's such an important thing to start wrapping our heads around because I think that, you know, we're starting to listen to autistic adults, people with a lived experience as an AAC user, just, you know, people with disabilities. And it's like, we're starting to understand how, you know, paradigms should be shifting.

00:12:08
And I think that this does a really great job of really opening your eyes to the fact that, you know, the students that we work with, they have lots of movements from their body. And I love how it talked about intentional and also unintentional. I think about that all the time when I'm working with students. I can see it. Like, I feel like if you step back for a second and you just observe and you get curious about why a student's doing whatever it is that they're doing in front of you, it's like, sometimes I can see my students just not able to stop moving their bodies for whatever reason.

00:12:44
And it's just like to imagine how that sensory system must be processing the world and doing its best to just kind of stay regulated and stay put, it's like, you can know what you need to do, but if your body's doing something different because your sensory system needs other things to be in a state of kind of calm and regulated, imagine how hard that is. And so it's like this idea of behavior and looking at these movements as behavioral, I feel like there's this connotation of these students are doing something wrong, and I feel like that's just, like, we don't need to shame our students for things that they can't control.

00:13:29
And that's. I think maybe the advice we would give to the person who wrote us is to maybe share this style guide, share this resource with those seasoned, experienced slps who maybe have not learned this yet. This could be a great resource, because then it's not coming from you, it's coming from somebody else. Right. And the other thing that they say, just be like, okay, Chris, Rachel, they say, okay, don't characterize behaviors that way.

00:13:56
What words should we use? And what they suggest is the person is trying to communicate needs because there's currently no other way to communicate. And I just love that as a question, too. So, all right, I'm hearing, I'm hearing what you say. You're thinking that this high tech AAC, they're not ready for it or there's something they have to do.

00:14:17
When do you think they'll be ready? And if they're doing these actions in a certain way, then, and we think that as communication, how else would do you think we should teach them to communicate? Right. And I think asking those reflective questions in a way that really encourages people to think about their choices they're making when it comes to words they're using and interventions they use is a way we can help this person who wrote that email.

00:14:50
Yeah, totally. I always kind of circle back to just like, if this is the thing that's going to teach them communication, and communication is the key to unlock the door to helping the student manage the behaviors, quotes, then we can't take away the only thing that's getting us out of this situation, right. We have to have that present. It's like a prerequisite. We need it in order to move forward on this path.

00:15:20
And so it's just like, it's so important to practice having conversations like that. And I've definitely, in my own clinical experience, have lots of conversations where someone comes and says, well, they can't touch the screen yet, or they're not touching the screen, or they're licking the screen, or they're, they get really, you know, they love throwing things. Whenever something's in front of them, they just throw it. I'm like, okay, but that's our job as educators, to start teaching students in front of us how to engage. And it's not always easy.

00:15:53
That's the other thing. It's not always easy. It's not always fast, but it's important that we make the effort. And again, we are the ones that can grant access to technology for communication, or alternatively not. And gatekeep that.

00:16:10
It's really important that we are always just honoring our students by giving them access and then doing our job, which is teaching them just as a quick.

00:16:19
Little soundbite that I think can maybe stick in people's heads, I always think education instead of restriction. So when we get asked this a lot in assistive technology land where it's like can you lock a student out of. Can you put this. This. Can you take this thing away?

00:16:39
You know, the answer is, well, yeah, we usually can. You know, usually there's a function where we can. Guided access is a great example. We can turn on guided access. We can do that.

00:16:48
But we don't lead with that. We lead with teaching. Why you'd want to stay in the app in the first place. We lead with. With stories and videos and plays and reading books and watching other people do it.

00:17:03
See how I do it? I'm not closing the app. I'm using it because I need it for my words. Like doing all that stuff first and then going, well, okay, we've tried all that. Then maybe consider restriction.

00:17:14
But that's ten steps down the line. And even then, I'd be like, the phrase is education instead of restriction, not education before restriction. Right? So even then, like, why are we restricting totally?

00:17:28
No, I completely agree. I feel like that also leads into the idea of vocabulary, you know, which we've talked a lot about on this podcast, but, like, give kids all the words. Like, give kids all the words. Don't restrict access to the words because it's like one thing. Like, okay, now they have the technology, but also so many kids have the technology, but people are restricting their access to language.

00:17:52
So it's like, it's so important to remember. And I love that. I love that catchphrase, Chris. I'm going to remember that with that.

00:17:59
Rachel, tell us about the interview today.

00:18:01
Chris, this is part two of the interview that I did with Tiffany Joseph. Tiffany is a part time autistic AEC user, and this interview was just so powerful. So if you haven't listened to part one, definitely go back to last week's episode and listen. It just has been such a really, really eye opening experience talking to Tiffany, and I'm really excited to share part two of the interview that I did with Tiffany Joseph.

00:18:39
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00:19:01
We'd so very much appreciate it. Now let's get back into the episode.

00:19:15
So I would love to talk a little bit about Gestalt language processing. I know that you've kind of spoken to this before. It's definitely kind of an area of our field where we've seen a lot of evolution, a lot of education around it. It's definitely an area when we're thinking about AAC that feels very tricky for individuals to navigate. And so I'm really curious what your take is on gesture language processing, what your experience is, and ultimately, how do we help support our students who might be learning language through that lens and needing AAC and how to kind of fit those two pieces together.

00:19:59
Okay, so I had been. I had been doing this on social media about autism since, like, 2016, and I had started off just describing my experiences, and eventually in 2018 or 2019, something like that, I had a mom who wanted to consult with me about her daughter and everything that I was describing to her. She's like, oh, yeah, that's the start language processing. And I was like, well, she's. Your daughter is probably going to want to do this.

00:20:41
And these are things, and this is how I am. And she's like, oh, yeah, that's Gestalt language process. Everything I said, it was like, Gestalt language processing. So I was like, I looked up, and that is literally how my brain and my body work. It's Gestalt language processing.

00:20:59
Like, I feel the best way to support Gestalt language processors is, I'm always going to say, through text and writing. And for me, being able to write my scripts, like, that was a game changer. Like, you know, those. Those computers they would have back in the day, like the CNC and stuff like that.

00:21:42
Grow back. Yes.

00:21:43
That's how I would. I would. That was my. My AAC back in the day. And there were other computer things like that, but.

00:21:58
Right. Have them write down their scripts or their gestalts, you know, didn't change one word. You know, I don't know anything, to be honest. I don't know about. I don't know about the mitigation.

00:22:14
I just know I'm a processor, and I can explain it from being. I don't know anything about the. Yes. So I know there's a term called mitigation.

00:22:28
Yes.

00:22:30
I don't know. Is that like switching words?

00:22:32
Mitigation is basically this idea that if you go through certain stages of Gestalt language processing, the first is just like, you know, a single unit of meaning, that one script. But then eventually, students will kind of break apart the script and then start mixing and matching. And that mixing and matching is mitigation.

00:22:51
Yes. So the mixing and matching. Like, if you can combine that with. So combine that with. With writing, whether it's handwriting, text typing, AAC refrigerator magnets, you can mitigate through that.

00:23:18
And I think AAC can eventually and should eventually get to the point where for, at least for gestalt processors, like, one whole page is, and maybe this already exists, where one whole page is just like, like part of the script. And all the other words in that page or for that page are like, mitigations. Or, like, things mix and match. Like, kid always, always says, like, I remember, I still remember my scripts from when I was little. Yeah, I remember my script from when I was three.

00:24:09
And it's because it was an adult pleaser. It was a spectacular. It made the adults love me. It was from Pinocchio. I saw it at daycare.

00:24:20
And it was. I learned my lesson. And the lesson I learned was learning my lesson comes first. The adults loved it.

00:24:31
They're like, what a good little girl. Yeah.

00:24:35
And I would say stuff like, stuff like that. Like, they'd be like, oh, she's so precocious. And I'm just, like, just trying to razzle and dazzle them with the few things I can really say spontaneously. Yeah. But if I had something like that, that would be like, I've learned my lesson.

00:24:56
That that's the page, right? Like, click on the button and it says, I've learned my lesson. And then it opens up to a whole bunch of things, you know, a whole bunch of finisher sentences or words, you know, that would be, like, awesome if that would have been, like, magic for my communication. I don't know if this is connected to gestalt language processing or just like, autism. I don't know where things begin and end inside me, but it took me until my early twenties to be able to communicate feelings.

00:25:49
If I had had somebody do, like, a writing exercise or AAC or typing or something, and this is what I do with the kids at my school, like, all right. I feel. And then every day we do, like, a different word and what it means, that would have been helpful as well. I don't know if that's for me.

00:26:18
No, this is great. I love hearing kind of your own personal experience. And when it comes to feelings, I feel like that is oftentimes where a lot of individuals that are autistic have a hard time kind of finding the language. And if we think about it, it's like, it's kind of hard for anyone to learn. Right?

00:26:38
Like, what does frustrated feel like? Well, it's like, I have to have a series of experiences where I feel like that in my body and have certain situations, and then someone kind of shares that language with me. Right. I think that's the natural process of all students and kids learning how to communicate about their feelings. You know, I think when we're thinking about children with disabilities, it's like, oh, like, you must be mad or you must be, you know, in the moment, we are trying to have these teaching opportunities for students, and it's like when a kid's mad and throwing down.

00:27:08
Like, it's not the teaching moment. Right. And so what I hear you saying is, like, I'm incorporating, like, a daily routine where not only are we exposing students to the language of feelings, but also probably doing some kind of explicit teaching around, like, what is this emotion? When do we feel it? What does it look like?

00:27:27
What does it feel like? You know, all of the kind of ways that we help teach what that emotion and that language means. And I think that's really important because, again, like, it's like we don't think about talking about feelings until a student's upset. And then we're like, oh, you must be frustrated. You're angry, you're sad.

00:27:45
Fill in the blank. Right. There's also the whole other spectrum of emotions, like happy, excited, like proud. Right? And it's like, I think we have to kind of do a better job as educators, specifically with students with disabilities, of, like, one presuming that they can understand the language.

00:28:02
Because I feel like that's oftentimes, like, when I start targeting that in my sessions, my parents are like, sometimes like, oh, I don't think he understands. I'm like, right. He might not understand until I teach it to him. Right. So kids need the actual experience.

00:28:14
And oftentimes I feel like, I just got an email this morning, actually, from a client. So the student was upset and got his AAC and was communicating deep, deep, deep. And the mom was like, I didn't know what he meant. And then he went to his AAC, and he said, give. And so she's like, give.

00:28:33
Deep. And he says, yes, he's a multimodality communicator. He has some verbal speech but also uses AAC. And then eventually she realized he was trying to get his. His dinosaurs.

00:28:44
His dinosaurs were left in the bathtub after bath time, and he needed them before he went to sleep, but before he. Before she was able to land on dinosaurs. That's what he was saying. He went to his feelings folder and he said, frustrated. And she's like, are you feeling frustrated?

00:29:01
And he said yes. And it was just this beautiful moment where he just started using AAC maybe six months ago. So he's young too. I think he's four. And so it was just this beautiful moment.

00:29:14
And mom was so excited. She sent us an email late on a Sunday night. And the whole team, he has a lot of speech therapists on his team, but it was just such a beautiful thing. We didn't teach him frustrated necessarily, but he was able to navigate it and find it and express himself in that moment. And she said that that alone just gave him this feeling of, okay, I'm understood.

00:29:38
At least mom's acknowledging. And I feel like when we're thinking about feelings and our kids emotional states, the first step is like expressing how I feel and then at least someone understands my experience. Like, it might not be that I can give you the thing or I can totally fully understand, but at least we can acknowledge and validate a child's experience with what they're feeling. And it's even more important that we're teaching that language to students.

00:30:05
Yes. And as far as, so, just like he could go through and get the word for frustrated and he felt listened to. One of the things about Gestalt. No, I'm sorry, just AAC users in general is being able to communicate more than requests is a huge motivator for using and continued use for. They need to have the language to fill scene with their, whatever modality they, yeah.

00:30:54
And they also need adults around them modeling how to communicate for other purposes. Because it's like, that's, everyone's like, well, these only using it for requesting. I'm like, well, who's modeling other pragmatic functions for the student who's modeling how to comment, how to, you know, self advocate, how to share a story, tell a joke. Right. Like, it's like if we don't model these things for students, then, yeah, of course they'll be in this vicious cycle of stock requesting because it's our job to teach them how to use language for other purposes.

00:31:22
Exactly. And people expect disabled bodies to be able to pick up an AAC device and use it for full, fully functional language with their, their vision that may not be able to track buttons or stay on, stay on a like focus for more than a second or two. They expect those bodies who've never seen AAC and its usage because nobody has modeled it for them to be able to pick it up, like right away.

00:32:05
Yeah, yeah, we, like, I always say that, like, we need to give our students so much grace in the initial stages of AAC because it's like, I think about the time that I first picked up a smartphone, right? It was like I didn't know what I was doing. I was just, like, bopping around, touching buttons. Like, how do I do this? I don't really know.

00:32:22
You know, and. And I have language and literacy. Like, I have the ability to read the labels that were helping guide that process for me. And seeing home and being like, I know what a home is. I can figure out how to get back to that other screen.

00:32:36
It's like, you know, we take for granted that we have all those, you know, skills. And our students, you know, we put these devices in front of them, and they don't have language yet, and they don't oftentimes have literacy yet, or it's just emerging. And then we have these super high levels of expectation around how they're using it and if they're accurate and all these things, and it's like, they don't.

00:32:58
They don't use it for communication. They're just skimming on it. They're. They don't know what communication is. Like.

00:33:07
I've even heard that.

00:33:09
I know. Super frustrating.

00:33:15
So I wanted to talk about this thought language processing a little bit more, please. So I want people to realize when we're talking about Gestalt language processors, like, maybe, at least for me and a few others, I know they are just Gestalt processors, period. Their bodies, like, maybe even the way they think. I like to say the reason we can't say that somebody's not using their AAC device for communication purposes is because, especially we know specifically their Gestalt language processors. They have, like, or I have.

00:34:13
We have a cascade of thoughts, right? So let's say I'm talking about a trip to Georgia, and I'm constantly pressing peanuts, peanuts, peanuts in my device. And people are saying, I'm just playing on it, but I literally, I cannot think of Georgia without thinking of being on the highway and traveling past the boiled peanut huts that they have all in the house. So that person might be, when they think of Georgia, they think of boiled peanuts, but they don't know how to say boiled on their device yet, or they don't know where it is. So they know where peanuts is, and they want to join the conversation about Georgia, but people are sneering at them and saying they don't know how to use this device.

00:35:17
It's. It's. They're not communicating with. It's thought language processors can you never know what is connected, what thought is connected to what thought, or even. And I don't know, maybe.

00:35:37
Maybe the rest of the world is like this, but when I hear one word, it opens up a whole script from that one word. Sometimes I just say it like, I don't mean to, but, like, the word overt opens up a script from Brooklyn nine nine for me. And I say the whole thing in my head, at least. So I think this is obvious, probably for Gestalt language processing. But, you know, if I say the word peanut, you know, I might not be, or on my a and c device, too, I might not be seeming like I'm saying or I'm joining the conversation, but I am.

00:36:31
Yeah. And especially if you don't have kind of the core language around peanut to be like, I'm thinking peanuts because last time I went to Georgia, I saw boiled peanuts. Like, that's a long, complex, you thought, with lots of other language units around.

00:36:45
It, and all of that is behind the motor system that you have to be able to use to show that complex language.

00:36:56
Yeah. And I think a lot of our students can be mislabeled, misunderstood. And I think that that's where, like, yes, we have a student who is an emergent communicator who's at a single word level right now, because oftentimes of motor planning challenges. And it's like we have to just attribute meaning to whatever a student decides to say and presume that it's important and relevant and especially important to that individual who's communicating it. Like, if a student is initiating communication, whatever that looks like, whatever word they're deciding to say or phrase or anything, any type of communication is important to that student.

00:37:39
And, you know, it. It's important for us as educators to really honor and celebrate any time a child decides to communicate with us. And so I think that that example of peanut is, like, a perfect example. And so often I work with many autistic students and some who are not AAC users. It's so interesting when I see them making connections.

00:38:03
It's like I say one thing and then they're making a connection, but they're not always fully able, you know, to express in language yet, like, what that connection is. But I can kind of see them making connections. And it's like, you know, if we know from working with students that, you know, are using verbal speech and mouth words, that that's happening. It's like, imagine that experience for an individual who doesn't have access to all of that language. You know, motorically.

00:38:34
I like to say that my brain. Oh. Oh, no, I'm sorry. So also, when it comes to gestalt language processing, I think it is important to know that there is a side of it where it's, like, automatic. Because, like, say, for instance, I go to open my mouth to say, so this is a perfect example.

00:39:25
One of my friends was dating somebody. I first called him Cary Grant, because it's like Carr and Grant. Like, my mouth, I was. My brain was saying, say Grant Carr, but it said Cary Grant, and then it said Grant Hill. Like, I couldn't get.

00:39:49
There was. There's something close, you know, but I couldn't get the exact wording out. But I opened my mouth knowing I was going to say grant Carr. I knew I was going to say that, but those other names came out of my mouth first. So there are times when it's so automatic that it is not.

00:40:15
It's not. Right? It's not communication. Right. It's not.

00:40:20
It's like, so embedded. No, wait. Okay.

00:41:17
Another form of Gestalt processing, but maybe not Gestalt language processing itself, is that motor loops, I feel, are part of Gestalt processing. At times, our bodies are automatic, which is like an extreme of Gestalt processing, that some scripts are not actually communicative. So someone will open their mouths, and what comes out is a carryover or long lasting effect of typical Gestalt language processing for actual communicative purposes.

00:41:54
Was that understandable?

00:41:55
Yes.

00:41:56
Okay.

00:41:57
And we've had other people on the podcast, Alyssa, Hillary Zisk, and Lily Conine. Actually, we did an episode with them, and they shared that exact experience of, like, it just, like, pops out of my mouth, these scripts that I've had for years and years, and it almost feels, like, involuntary. It's like I can't. Or if you have to not say it, it takes a lot of energy and effort to keep it in.

00:42:25
Yeah, it's like a tick.

00:42:31
Yeah, that's good, too.

00:42:32
But I do feel like that started off when we were little, as trying to say something for communicative purposes, and then sometimes dyspraxia. So that's how dyspraxia and gestalt language processing, to me are together, is that it just takes something and makes you do it over and over and over again. And that's how motor loops form. And I feel like non communicative scripts were in the beginning, communicative scripts, not those specific ones, but the body wanting to do it, and dyspraxia kind of takes over and just, I like to say dyspraxia. And we're going back to the motive thing is like having Tourette's and full body paralysis, but you don't know when you're going to get what.

00:43:55
Wow. Yeah. I mean that's anxiety producing just thinking about. So it makes sense. I want to talk a little bit about the idea of spelling for communication.

00:44:10
I know that there is um, some controversy around that given Ash's stance. Um, but I wanted to hear from you a little bit about your perspective on spelling. We've talked a lot about motor planning and motor challenges and I feel like that kind of plays into the idea of spelling for communication purposes. Um, and so I'd love to hear your thoughts.

00:44:34
Okay. I guess I don't need to tell you that I'm going to start.

00:44:38
That's okay.

00:44:59
I would like to see the world of OT and speech language pathology marry their fields, at least for AAC, not just for autism, but for all disabilities. Like I previously said, language and communication are not able to get out if trapped behind a motor system that works very differently. Occupational or physical therapies are great for motor planning and disabilities that affect the motor system such as autism. But speech needs to be involved for the language acquisition part of it. There is already a field or group of methods that does this.

00:45:33
In a way its called, in general terms, spelling. Its made for people without reliable speech. There are tons of former ABA therapists, teachers, slps and parents that make up the field of practitioners. That is, they meet the students and clients where they are motorically to either type, write with pencil or pen, point to letters on a letterboard, use AAC keyboards, etcetera. The point is to coach the motor eventually and give motor skills to use AAC independently because students have been taught nothing.

00:46:06
Usually spelling uses challenging academics as a way to engage the mind and take control of their bodies. It's not a miracle technique as it takes months and years to gain skills for this. For both the practitioners and students alike, ICoT, spelling and SLP taking notes from each other to finally get this in public schools where it belongs so that these students will get hours of practice each day like general ed kids with their forms of communication. I also see every kid getting a high tech AAC device to use as well as sign languages as part of our society. Imagine if communication wasnt gatekept and every form of communication was seen as its own language.

00:46:47
Just second nature, like how some regions speak multiple languages. People with disabilities would likely have motor access or cognitive access to various forms and they wouldnt be trapped all their lives for no reason but that. Nope.

00:47:05
Yeah, I. Oh, go ahead.

00:47:11
Okay. That was my first part of the answer.

00:47:15
Okay.

00:47:19
So being, it being controversial angers me a lot because we autistic people teach, have to teach over and over about having motor issues. So I feel like it's arrogance of anybody, really, who doesn't even know the motor issues to feel like they know what is good for that person's communication. So it's not like the speech field or the ABA field or the OT field. It's not like they know this stuff already. It's just that they have turned away being taught this over and over and over again for decades.

00:48:32
And it shouldn't be controversial because what is going on? And I've been a practitioner of spelling, no particular brand name, but I've been a practitioner of many forms of spelling for almost three years now. And I am not great at it because it is. It is hard because we're having to work through and meet that person's motor skills where they are so that they communicate, can communicate to us in the soonest way so we can get feedback from them to help them get even better. So because everybody's dyspraxia is so different, for instance, some people can be fully athletic and have, like, whatever the opposite of dyspraxia is.

00:49:39
What is it? Like eupraxia or something?

00:49:41
Yeah.

00:49:43
Awesome.

00:49:43
Motor. Motor skills.

00:49:46
So they can be so athletic and gifted in one way, but still not be able to coordinate their speech. So everybody's dyspraxia affects them so differently and so many different ways that we as practitioners have to be kind of creative with finding ways to coach their motor system so that they can communicate. But once they can, then they can tell us how to be better. So. So it is a.

00:50:28
I don't know why people think it's like a. Like a miracle drug or something. They. They make it seem like snake oil, but it's really. Somebody finally listened to the motor issues inherent in autism and other disorders.

00:50:49
Somebody finally listened to that and said, this is how we can communicate. 120 years ago, 122 years ago, to be exact, there was a mass produced letter board as that was seen as a communication for people who couldn't speak. And I don't know why in 1921, it can be accepted, but in 2024, it's still controversial.

00:51:22
Yeah, yeah, yeah. I mean, I think that it makes a lot of sense from a motor planning perspective to teach and train 26 letters versus potentially hundreds of other motor plans. When we're thinking about an ICom based AAC system. I also think that it's not necessarily an either or. I have a lot of students who are using spelling for communication, but also symbol based communication.

00:51:51
And I think it's so important for us to understand that AAC users typically have multiple systems that they toggle between depending on the moment and the context and whatever feels best in that scenario. I think, I'm curious from your perspective, because I think where a lot of the controversy comes is having a communication partner and it not being quote unquote independent communication. So can you speak to a little bit about your experience as a practitioner with the transition from helping our students and doing things that. Yes, like they aren't necessarily doing something independently yet, but it really is the goal is a pathway towards independence. So can you speak to that a little bit?

00:52:46
Yes, I do. First, want to mention that everybody's goal is not independence. That might be like the practitioner's goal, but we have to go by what somebody wants for themselves. And not everybody wants independent communication. We shouldn't assume that.

00:53:11
So I just want to get that out of the gate. Also, we can't judge somebody communication by if they did it themselves or not because I mean, that's what AAC is in general. You know, it's coming from some, somewhere. Okay, let me start over. Okay.

00:53:49
Okay. So a lot of the abled world, which is a pejorative for the non disabled world, a lot of the abled world focuses on independence and weaponizes independence. And because somebody is not independently communicating, it's not seen as valid. Again, we're expecting disabled bodies to be able to do things that we wouldn't even ask non disabled people to do. So, for instance, in the ADHD world.

00:54:36
And now it's finally crossing over into the autism, like the adult ADHD and autism world. On social media, we have something called body doubling, meaning even if you're not talking to somebody, just being around somebody helps you get things done. And that helps people with ADHD focus. That is the same idea as being a communication partner. But because the people on social media can speak and can easily communicate with their thumbs and stuff, then it's okay for them to have body doubles.

00:55:20
But it's not okay for more disabled bodies who really need that motor coaching, that constant prompting to it's not okay for them. Right. And I said like, it's okay for one of the, one of the things that is said about it's not them because they're not looking at the board when they, when they point, but I sit in third grade classroom and there's this thing, this program they have to do every week, and it's teaching them how to type with the home row. And the first thing it says is don't look down on your keyboard. So, you know, people who actually have to look away because their eyes can't focus, they're told that their communication is not valid because they didn't look at the board.

00:56:38
But we're telling little kids of able bodied hands and arms and eyes and stuff that they don't have to look at the keyboard. They're valid no matter what they do. Yeah, piano. If anybody play piano, they don't want you to look at the, you know, when you're playing music, you're not even supposed to. You're supposed to look at the music or at whatever, never your hands.

00:57:11
So since they're not looking at certain things, their communication is invalid, although it's totally cool for able bodied people.

00:57:23
Yeah, I mean, it's really good points. And I think that what you really spoke to when you kind of first shared was this idea that not everyone wants to be independent. And that, like, really struck with me as something like, oh, because you're right. Like, it is my goal for my students to become independent, autonomous communicators. We know not every student will become an independent communicator, but, you know, every student has the ability to become autonomous.

00:57:51
But I like kind of how you're sharing about the idea of body doubling. And I also can imagine that, you know, for some of our students who find communication to be challenging and also anxiety producing, having a familiar communication partner to help kind of coach the motor planning, which I also love the way you said that coaching the motor planning could be beneficial and is not less than necessarily just because they're doing it differently.

00:58:24
Right. Why should disabled people having hope be such a bad thing when we know disabled people need help? Like another way they need help. And when I say coaching the motor, I mean that it takes so much practice, not just for the student, but for me. Even knowing when, knowing how, knowing how to coach a specific person's motor system takes months.

00:59:13
Months. Where. Where am I going to hold the letterboard? Where are their eyes best? Because they can't tell me.

00:59:21
They might not even know. Where are their, where are their shoulders weak? You know, can they, can they only point down here? So I have to understand all these things. And when I say coaching somebody's motor or prompting, I mean, they are fighting their bodies to get to one letter and I am fighting their bodies as well.

00:59:54
And that is not easy to learn and it does not just happen overnight. And we would not, I would not spend like two years with one student trying to get one sentence out of them. If it was just, if I was just doing it myself, I could have had them pay a whole bunch of stuff a long time ago.

01:00:27
Right, right.

01:00:29
And I think the reason people say it's like they feel just like they do with high tech devices, they're going to pick it up in day one because we're saying they're these locked in geniuses and now we're holding a board and all of a sudden they know the codes to every nuclear thing because they've cracked all of them and now they just need a way to press the buttons or point to the letters. And that's not, that's not at all it, that's just the silly expectations of society. Like we forgot how we learned language. We forgot because it just happened for us. We don't remember being two or three, so we expect disabled bodies to be able to pick it up.

01:01:31
And then that's why I feel like people say it's influence because they don't see all the hard work put into producing these sentences. These sometimes words take entire hours to get out. In the beginning, if I were doing it, they would have said a whole bunch of stuff that very first day.

01:01:55
Right. It's a good point, actually, I haven't thought about it that way, but it's like, yeah, it's a really good point that you make that like the practitioner is sitting alongside of that student painstakingly working on the motor planning and the spelling and things like that.

01:02:13
And we have to learn which prompts work for them. Like I have one student who hates fidgets, which works for most of my students. Yeah. You know, so how long do you think it took me to figure that out? That, you know, that I have to use like some other form of prompting or coaching, wake up their body.

01:02:44
And I can also say that you can feel, you can feel when the body is too tight, depressed or just gives away and gets too loose. Like you have to be able to say, okay, get your arm up. Get your arm up. Get your arm up or loosen it. You have to be able to know all these different things it takes.

01:03:09
I'm not good and I've been doing it two and a half years. I'm not good at it. Yeah, no, I want to be and I'm going to be, but it's hard. It's not something that just happens. People feel like that's just what happens.

01:03:26
They got bored and all of a sudden they're pointing to the letters. Yeah.

01:03:32
Yeah. I really appreciate all your perspective on this. I didn't realize that you were also a practitioner and that feels like even more insight into kind of this world. And I think a lot of the things that you're sharing make a lot of sense. And I also love that, you know, you have the experience of kind of working alongside of students doing this work.

01:03:54
Have you seen like, you know, progress with some of the students that you've been working with for a while? Like, what does that look like?

01:04:01
Well, yes, I have seen progress. Now I don't have any students who have gotten open very much. Open means they are, they're just letting their own thoughts flow. Right. I don't have, I don't have that yet, but I do have some who have.

01:04:26
Their motor skills have really gotten super good. I'm like really impressed with the motor skills. And they will be open soon. Like, we can get one or two words, you know, in an hour, but it also takes stamina. It's very taxing to do it.

01:04:49
When they know what the word is, they have to press, but now they have to think about, they have to process and give an answer and put some thought into an answer. That's the academic thing that we're doing. But that will lead to open thoughts and writing. Just like, guess what? For kids from k through twelve education, which we don't give our students a chance to even get there.

01:05:22
Right. So I know it's going to take years. I'm committed. And also I do want to say that we can test our influence ourselves. I test it all the time.

01:05:34
I have a family member or somebody who knows something that I don't know, ask them and then they just say the answer. Like, I wouldn't know. Right. So I can even test myself that way just to make sure because it is important, because you can influence, you do have to take, you do have to take precautions. You do have to have constant good technique.

01:06:03
You do have to constantly make sure that your skills are getting sharper too. But I do test myself by having somebody asked a question. I wouldn't know. It has to be a short one word thing. But yeah, there are ways of, I mean, those are very easy ways of testing that.

01:06:31
Like we didn't need, we didn't need to have a whole office statement on something that we could have just.

01:06:38
Yeah, I love it. So, you know, you're an amazing advocate in the disability community, Tiffany. And I am really excited to share this interview and I am curious, you know, what, what is it that you're really working towards changing in this space? And what's your next project that you're really inspired by? Like, what are you up to?

01:07:03
Okay, so what I feel that needs to happen is these schools that are not teaching disabled students just because they're disabled or they have a certain severity of disability. I feel like that needs to be overhauled, and disabled people need to be the curriculum setters for kids of their own disability, and not just for what the kids are learning, but for what the teachers are learning as well on how to teach. And I'm willing to sit in March riot protests, whatever, for this to happen sooner than later.

01:08:11
I love that. And I think that if we zoom out outside of just curriculum and just in general, how can we listen to people that have a lived experience? And that should be one of the most important things that we're looking towards when we're doing anything with people who have a disability. Which is why I feel like the work that you do on your social media is so powerful and spending time with me and this podcast was so valuable. And I just, you know, it's definitely something on this podcast that we try to invite AAC users and autistic adults because it's like, that's the population of individuals that we're serving.

01:08:53
And the only way to really serve them best is by listening to their experience. And I have learned so much doing that throughout the, you know, almost six years we've been doing this podcast. And so I just want to say thank you so much for all of the work that you do and all the advocacy, because it really does make a huge impact in the way that I have, even as a clinician, just thought about the students, even in this interview itself, I'm like, oh, my gosh, I'm now going to think through this different lens. And I'm just like, so grateful that you are able to share your experience.

01:09:24
Thank you.

01:09:26
So, for people who want to touch base with you, Tiffany, what's the best way for them to contact you?

01:09:32
So I like taking deep dives, like, so that would be my YouTube NY nigh functioning autism, but on Facebook, Instagram, and as long as TikTok's around at NY functioning autism and my website, nigh functioningautism.com is coming sometime, it's like, it's there, but I don't think anybody else can see it for some reason. So I don't. I can see it on my end, and I do a lot of trainings for schools and school districts and. Yeah.

01:10:26
Thank you so much, Tiffany, for coming on and sharing all of your experience. I am just thrilled to share this episode. I, like, I'm jumping out of my seat, like, when is this going to air for everyone? So I just want to say thank you again for coming on. It's been such a powerful episode, and I just really appreciate your time.

01:10:42
Thank you for having me. So much.

01:10:44
So, for Talking with Tech, I'm Rachel Madel, joined by Tiffany Joseph. Thank you guys so much for listening, and we'll talk to you next week.