iPad for accessibility – and special needs?

Josh de Lioncourt has written a review of iPad use for visually impaired persons. He’s pretty positive, though reading between the lines I’m guessing version iPadOS 4.1 will be much better (4.0 is due out this fall, I expect 4.1 @ Feb). It does seem like Apple turned a corner with the 3GS iPhone; previously they’d taken a big step backwards with the Classic to OS X transition.

An essential feature for visually impaired persons is VoiceOver, Apple’s robust screen reader. These same technologies are also very helpful for people who struggle to read. Voice commands help those who struggle to write, and predictive text entry helps students who have trouble typing.

The same features that make the iPad accessible to a large number of Americans who don’t use computers well also make it interesting to the special needs community. It is relatively simple to use, very easy to maintain, and much more resistant to virus infection than traditional computing devices.

The next generation iPad will almost certainly support video conferencing (that’s far more likely than adding a camera). There are many uses of that kind of technology in providing support to special needs teens and adults.

It’s a new world indeed.

Fortune

My daughter leaves Zen Shorts out each night for her dolls to read.

One of the parables retold is about fortune. This moment's fortune may be the future's misfortune; this moment's misfortune may be tomorrow's gift.

Yesterday we came within an inch of life shattering tragedy. There was an unlucky accident born of special needs adolescence.

Unlucky?

The cost was small compared to what might have been. Lives have changed, judgments have been revised. Yesterday's future is gone, today's future is new.

Lucky?

You never know.

Persuasion, adolescence, and the joys of prison life

Low IQ special needs adolescence does not come as a "thief in the night". It comes as a ton of bricks.

Behavioral management, which was never terribly effective, has become even less effective. We may still have a "paradoxical permission" effect, whereby when we give permission for an annoying behavior it becomes less attractive. I'm not sure we have even that however.

Medications are still available, but of course side-effects may be less tolerated.

Which is why I'm turning, with a measure of desperation, to my favorite sales book: Three Steps to Yes: The Gentle Art of Getting Your Way by Gene Bidell. I hope I can use some of Bidell's techniques to change my son's choices.

Bidell emphasizes understanding your Prospect's recognized and unrecognized needs and aversions, then figuring ways to meet them to get the sale. The Prospect "needs to win", for example, so find a way they can win and you can lose -- while still getting the Sale.

Understanding my son's world is a real challenge. He combines the limited knowledge of an early teen with a limited capability to understand and assimilate new knowledge.

I think, for example, that I erred by describing prison as the outcome of particularly poor choices. In my son's mind, I now realize, prison means no school, association with the police and K9 dogs he loves, comforting concrete instead of disturbing nature, agreeable routines, few challenges, plain meals, lots of television, regular exercise, no frightening choices, no concerns about employment, and congenial like minded peers.

In his mind, prison is not a bad thing, it's a bit heavenly. The worst bit is that in some ways he's quite right. He might actually find a well run low security prison more congenial than the alternatives.

So I need to persuade him that there are better options than prison (even if I'm not entirely sure there are - but that's a different story). Juvenile detention, for example, does include math class. It doesn't provide much police contact, and there are no K9 dogs. Most of all, there are no girls and his companions may not be very friendly.

At the same time I need to come up with a better future alternative for him to work towards - and I need to come up with it very quickly.

Any ideas?

Update: In our community the local police are happy to enter a special needs person into their database with a special "tag" including disability and contact information.

Update 6/26/2010: UK study on low IQ prison population.

A new behavioral intervention: adding calendaring

It's easy to persuade someone who can reason about past and future, and who can connect actions and consequences.

It's much harder to influence someone when reward or consequences must instantly follow action, where the past is forgotten and the future is inconceivable.

So we would like to make the future more real, more tangible. Something that he can interact with. We need to do it in a way that leverages his skills.

How do we do that?

We know that despite a quite low IQ he has a relative talent for devices and computers. They are natural to him, more comfortable and familiar than forest or water or rock. He struggles with many things, but not with software. Plan iMac has been successful. He's done well with his mobile phone, and texting seems to have advanced his writing skills.

So I've added a Google Calendar to his Gmail account - both on our family (free) Google Apps domain. He can view his parent's free/busy time and subscribe to other calendars of interest to him. I've populated his calendar with school events, and "invited" him from our calendars for events of interest. By necessity we have to plan a long way out, so he can see major events coming from many months away. He's awaiting the arrival of a Wii game -- I've put the estimated arrival time on his calendar.

My goal is that he interact with time through the calendar, that he begin to have a sense of future and past. I expect he will add his own events. Calendar items send SMS reminders to his phone (default 30 minute warning).

If he can develop a sense of time, then maybe we can return to teaching about deferred rewards, and then have more ways to change his behavior.


Update 5/26/10: We ran into a calendaring problem. We can't give my son unlimited Google access since his Google Image searches are not necessarily family friendly. We can't, however, using OS X parental controls, block Google Image search without also blocking calendar access. So this plan is on hold for the moment.

Not recommended: special needs spelunking

This actually worked, but I wouldn't try it the same way again.

We took two "spectrum" kids on the regular guided tour of Wind Cave National Park.

One of them was on the verge of bolting for the half the 60 minute tour, then he settled down. The other was tearful, anxious and had his ears covered and eyes largely closed for about 50 minutes, though after 30 minutes he was doing better. By the last 10 minutes he was almost ready to start.

It's very hard to exit one of these tours. You need a guided escort to take the elevator hundreds of feet to the surface. Yes, it was a bit much for our guys. They need a more gradual introduction. We should have started with the small-time gaudy tourist-trap type caves that are easy to enter and exit. Then we could have worked up the to the real thing.

It can be done though. Not saying it should be done ... this way.

A prosthetic conscience for special needs persons

Some special needs teens and adults may wish to do well, but have a great deal of difficulty modeling the impact of their actions. Impulse disorders, limited abilities to abstract, and autism-associated disabilities may all make a prosthetic conscience useful ...

Gordon's Notes: A conscience for robots - and for humans too

... Some humans too would benefit from a prosthetic conscience. It might allow persons with disorders of conscience to function more effectively in the modern world. Our prisons are full of low IQ individuals with a limited capacity to model the impacts of their actions on other persons. A prosthetic conscience might allow them to avoid prison, or to have great success after prison life...

Adventures in special needs – A Nordic ski resort

At one point in my life if I felt I needed a challenge I’d ride my bike a few thousand miles, or explore a foreign land.

Now I can dwarf those experiences with a simple four day outing to a Nordic ski resort.

I’m still recovering from this challenge. It was successful, but it did push the envelope.

We started a few months ago with one neurotypical child and two on the “autism spectrum” (a somewhat meaningless concept, but we don’t yet have a better classification). One child had done some snowboarding with limited success and had refused any skiing of any sort. Another had done some downhill skiing and decided, after a single face plant, that downhill skiing was insane. A third had very nervously descended a bunny hill.

We ended with all three navigating intermediate cross country ski trails in the wilderness (really) of northern Wisconsin.

The unique challenges here included:

• Three children, two parents. This stuff isn’t easy even for neurotypical children and it was very rare to have all three in a reasonably good mood at the same time.
• Weather. These children are used to winter, but an autistic meltdown can take a long time to resolve. Sitting around at 10F for an hour can be a problem, and they don’t necessarily respond to cold in a rational way.
• Clothing. See weather. Spectrum kids and adults can be resistant to logical dressing.
• Gear. Actually, this was easy. Cross country skiing fear is much more comfortable than downhill or even snowboarding gear.
• Unfamiliar environment, atypical stimuli: Northern scrub forest, harsh winds, knowledge that there really are wolves and cougars in the woods (even if they usually stay out of sight) – all troublesome. One child has a very strong need to always know exactly where he is in relation to the home base and to all family members – the first time on a trail was extremely scary. (The second time was easy however – his location memory is exceptional).
• Different schedules: One child takes hours to come online and peaks in the afternoon. Another rockets at dawn and is done by noon.

The full story of how we made the transition for all three over about two months would take a book to tell. It required genuinely Machiavellian manipulation of sibling relationships and a wide variety of motivators.

There are some quick lessons, however, that one might apply to a variety of similar special needs adventures.

1. Food: As a result of the climate, exertion, and anxiety the children needed to eat five times a day. If they were short on food they all melted down. We needed to keep them fueled with solid, high fat, high protein meals.
2. Everyone melted down sometime, including the neurotypical child. Interestingly they rarely melted down all at once, perhaps because there was a strong sense of group solidarity. Each child felt their parents had gone insane and they needed to look out for one another.
3. Choose a friendly resort in decline with a very good pool. The downsides of the resort people having limited knowledge of what worked and what didn’t was outweighed by the warm water swimming pool. The need to serve to the smoking, drinking, and spending snowmobiling market meant our kids oddities went unnoticed.
4. Our mobile phones were useless, but we had modern digital “walkie-talkies”. These things are cheap and absolutely amazing. REI has very good ones.
5. It would have been better to have had a third person along, but it was doable.
6. You need to be fully on your game. Get lots of sleep. Plan carefully and be ready to abandon every plan. Have contingencies for your contingency plans, and be ready to abandon those. Know when to retreat and when to advance.
7. Find a local expert and review all the trails in depth. In our case one parent woke early to scout out trails in advance and plan routes – that worked well. Get the best possible maps. Have a compass.
8. Carry a big pack to hold clothes, jackets, reserve materials, etc.
9. Be ready to stop a passer by and send them for help. We never had to do this, but you have to be psychologically ready to bail.
10. Establish a routine very early. Our was: TV and breakfast while Dad scouted routes. Swim. Eat again. Skiing. Eat again. Game room/rest/computer use. Eat. Ski/Other. Eat. Swim. Video.
11. Bring chocolate on the trail.
12. Lower the room temperature before dressing. Open a window and discretely turn off the heat. This is a big help.
13. Overdress. They need to be warm at the start. Clothes can be removed and placed in the backpack.
14. The kids snow pants were too heavy. We’d have done better with lighter wind pants over the nylon loose stretchy pants our boys favor. Invest in clothing.

There’s much more, but those are the ones I can remember. The most disabled child who we thought least likely to succeed turned out to be a wizard – he skied circles around us wearing only a long sleeve shirt when the wind chill was probably 10F. Everyone succeeded, all our goals were met, and the parents will eventually recover.

Update 2/1/2012: Years later we've done this several times. The biggest issue lately was with our neurotypical daughter, who gets anxious about downhills and loathes falling behind her brothers. Which is to say, we were totally victorious. Until I reread this by accident, I'd forgotten how hard it was to get this initial success.

Behavior motivation: text message controls

One of my charges combines substantial cognitive and psychological disabilities with a profound insensitivity to common motivators.

Yes, this is challenging.

On the one hand, he has substantial limits. In a modern post-industrial society, he is profoundly disabled. In this he has a lot of company – in our emerging world many neurotypical males with an IQ below 120 have unknowingly joining the world of the effectively disabled.

On the other hand, he often performs far below his maximal abilities. Sometimes that’s because his peak performance is very dependent on environmental factors such as medications, time of day, sleep reserves and satiety. Quite often, though, it’s because he doesn’t respond well to any behavioral motivators, including extinction, operant methods/positive reinforcers, negative reinforcers (time out, privilege loss) and peer groups. That’s not to say they don’t work at all – it’s just that there’s a great disconnect between behavioral tool and response. Instead of power steering, you turn the car by dragging a foot.

When he is motivated, his learning and performance increase dramatically – sometimes into the normal range or even beyond. I remember one hockey practice where fast skaters got to stop sooner than slow skaters. He vaulted from the bottom 20% to the top 10% – without seeming to work all that hard. He then returned to his usual easy pace. When he’d misplaced his prized mobile phone the child who can’t remember anything recited a Temple Grandin-style video-recall linear recitation of everything he’d done with the phone – from the morning to the last moment he touched it.

So we’re always looking for new motivational tools to close the motivation gap and bring his behaviors closer to his maximal abilities. Anything he shows a strong interest in is fodder for behavioral motivation.

The most recent motivator comes from a combination of his technology love and the AT&T parental controls on his mobile phone account. He has grown very fond of texting.

One the one hand, we really want to encourage his texting. It is by far his most common form of written expression. He texts a teenage neighbor, who is kind enough to reply. He texts his school mates. He texts me.

On the other hand, anything he likes that much is a lever.

The way we currently use the texting leaver is we pay $15 a month (vastly cheaper than far less effective reading/writing tutoring) for 1,500 messages. This is well below his current use of about 500 texts a month. I then use the AT&T parental controls ($5/month) to set a cap. If he meets various various behavioral goals, such as working on math homework, he never sees the cap. If he’s not motivated, he runs out of text messages.

It’s just one more lever. We have to be careful not to overuse it, but every one we add helps move us forward.

See also:

(Honestly – these are good. On putting this list together I realize I’d forgotten some effective approaches I’ve used in the past.)

• Training exotic animals, husbands and difficult children
• Games for focal abilities: Set and visual perception
• The homework workstation account
• Managing net access
• Special needs and mobile phones- Why we're starting young
• Special needs- Mobile communications and surveillance
• Mobile phone use with special needs children – more lessons learned
• Judo moves on an atypical mind- Plan iMac
• Latest sticker chart innovation- discouraging sibling torments
• Changing behavior in children- Kazdin for most and what we do now
• TAGteach - dog training for special needs learners
• Reading about autism and ADHD - our personal favorites
• Fear, aggression and social intelligence
• Behavior management and special needs children
• Manipulating the unconscious behavior of persons with impaired frontal and prefrontal lobes
• Different minds, Different paths
• 21st century employment for persons with autism and other cognitive disabilities

The sad story of the autism vaccination scam

Rahul Parikh, on the occasion of Lancet withdrawing the fraudulent Wakefield Autism/immunization paper, reflects on its legacy.

It's a sad story. Wakefield, who ought to be in prison, prospers. Parents agonize over immunization. Misguided publicity hounds perpetuate fraud. Children suffer from preventable illnesses. Credulous advocacy groups waste time and money chasing a lie.

There's no justice. It will take another decade to get this fraud behind us.

Residential occupational training for special needs adults - Eastern New Mexico Special Services

Eastern New Mexico university offers a residential training program for adults with special needs. They are part of the western educational region, so it’s local tuition for neighboring states.

Special Services - Occupational Training Program

The Special Services Department provides services to students with disabilities. We maximize educational and career opportunities, assist disabled students with integration into the university community, and accommodate those students with services needed to allow full participation in all programs. Our certificate program is designed for students who, with appropriate training, are able to obtain positions in competitive employment. We currently have a three semester program, with a second year being developed. This second year will focus on independent living skills and employment.

Entrance Requirements:

A vocational evaluation less than 2 years old. (Either call our office to schedule, or obtain one privately).
Complete documentation and full disclosure of medical/developmental disabilities.
18 years of age or older.
Ability to self-medicate with no assistance.
Independently awaken to alarm/attend classes regularly and on time.
Maintain appropriate hygiene/laundry/dorm room.
Demonstrate effective communication skills and appropriate behavior.
Meet minimum entrance requirements for the selected study discipline.
We have a zero tolerance for any drug/alcohol use and students will adhere to the Standards of Behavior as outlined in the campus handbook.

Certificate of Occupational Training Courses:

Vocational classes and practicum’s/Job seeking skills/resumes
Independent Living I, II, III and labs. Advanced IL for second yr.
Recognizing Conflict/Conflict Management
Physical Education (adapted)
CPR/First Aid
Driver’s Education (optional) with lab
The College Experience

The Special Services Occupational Training Program leads the student to a Certificate of Occupational Training (COT). There are several career programs available (see course catalog). Vocational training emphasizes hands-on instruction, including 12-20 hours per week of on-campus classroom, lab, and off-campus practicum experiences. The technical skills taught in each career field prepares the student for competitive employment in that discipline.

Occupational Training Areas:

Auto Mechanics
Certified Child Care Attendant
Floral Design
Food Services
Certified Nursing Assistant/Home Health
Office Skills
Refrigeration and Air Conditioning Maintenance
Sanitation, Building Maintenance, and Grounds Keeping
Welding
Veterinary Assistant

Special Topics:

Animal Healthcare
Stocking and Merchandising
Dorm Life & Independent Living

Students are provided opportunities to build positive social skills and demonstrate appropriate social behaviors by living at Sierra Vista Village. Although supports are in place to assist our students with the social challenges of living on-campus, all students are considered adults and are expected to adhere to university policy and standards of behavior. Our department has staff available between 7:00 a.m. – 10:00 p.m. Monday through Friday to assist students in their transition to dorm life, learning domestic skills, and making good decisions now that they are living independently.

Students and parents must remember: our educational program is geared toward students with disabilities; however, all students are adults, and must be able to live in the dorms and attend all classes and work sites with no assistant. Each student is expected to take responsibility for their educational and personal success or failure, and demonstrate maturity and behaviors appropriate for a college campus.

Although second year students are allowed to live in the apartments on campus; first year students live in the dorms.

Independent Living classes and labs are required courses for the COT program. In addition to labs, students choose a one hour elective from the following as part of the lab requirements:

Art
Sign Language
Theatre
Support from the Special Services Department:

Academic and tutoring support is provided as needed.

Computer Labs are open for students to use
Limited health concerns are seen by our Certified Family Nurse Practitioner.
Campus Security 24/7
Social Events

Resident activities are held, such as movies, dances, B-B-Q’s, and day trips. We also have Special Olympics and the snow skiing club.

Residence Hall

Our students gain independence as they display responsibility. Staff supervision is active until curfew and, as with any college student; our student’s are expected to adhere to dormitory rules and regulations:

Curfew: 10:00 p.m. M-TR - 12:00 a.m. FR-SAT
Sign in/out log
Weekend check out
Weekly room inspections
No opposite sex visitation in rooms
No private transportation for the first semester
Graduates

Our career training allows students to learn marketable vocational skills, as well as practical life and independent living skills. We pride ourselves on the (avg.) 75% employment placement of graduates. Graduates leave our campus with verification of training (COT), certifications, valuable life experiences, and positive personal growth.

Verification of Training

COT from Eastern New Mexico – Roswell, an accredited university.
Checklist showing technical skills mastered in the chosen discipline.

The web site has additional materials …

• Special Services - Occupational Training Commonly Asked Questions – skills taught, employment goals
• Special Services – Staff

Google suggests an article marketing a vocational assessment program for additional background  …

Marla Wittkopf is the vocational evaluator with the Special Services Department at Eastern New Mexico University-Roswell (ENMU-R) in the state's southeastern area. Marla has been with ENMU-R for seven years and is a tenured faculty member at the institution. The Special Services Department is part of the Developmental Studies Division, and ENMU-R is a branch of ENMU-Portales. This past academic year, Marla tested 115 students, most of whom subsequently enrolled in the Special Services Occupational Training Program.

The mission of Special Services is to provide occupational and social skills training for  students with disabilities who come from across the United States. Although the program can accommodate students without disabilities, the great majority of them have various disabilities. Many have learning disabilities, and throughout their lives they've been constantly told about all the things they can't do.  "It's neat to see their reactions when we help them realize all the things they can do," said Marla.

The program offers students vocational evaluations, counseling, and training within a work setting of their choice in the Roswell community. If program graduates decide to remain in the Roswell area, Special Services staff are often instrumental in aiding them in finding  employment in their chosen occupations.

The Special Services program is unique in the country in that Special Services students live in dormitories on campus, just as students without disabilities do. "They get the real college experience that way, and it also challenges them to learn important new skills," said Marla. "Their days are broken up into two parts, classroom work in the afternoons, and practicum job site training in the mornings. Living away from home in a dorm setting is a big, big change for most of them, and they take classes to help them adjust to living on their own. They take such courses as independent living, conflict resolution, and adaptive physical education."

At graduation, students are awarded certificates of completion that list all of the work skills they have mastered--at least 75% of the job's specified skills. Seventy percent of those who begin the program graduate, and about 75% of the graduates are successfully placed in jobs after they complete the program. "And often the three semester program builds their self-confidence to the point that they want to continue their formal education," said Marla. "It serves as a springboard for students who want and are able to earn their Associate's degree."…

… Many of the students enter the program with specific occupational goals in mind, and it's often the case that their goals are unrealistically low or unrealistically high. "It's not unusual for them to come in saying they want to be physicians or lawyers. Pro3000 and the work samples help them see very clearly where their abilities are compared to the occupational requirements…

… "Many of our students come in having been beaten down all their lives, people always telling them all about what they can't do. Of course they're discouraged," Marla said. "I stress to them that everybody has their own, personal ways of doing things, and we all have areas of strengths. There's no one 'right way' of doing things. We help students discover what they can do. We also provide assistive devices and adaptive procedures  (accommodations) where needed. We view those as the equivalents of the reasonable accommodations employers are required to provide disabled workers under the Americans with Disabilities Act….