When Iris Fishman, MA CCC/SLP, Director of the Kornreich Technology Center in Albertson New York, first came to me to ask about giving this presentation I immediately agreed to it. This enthusiasm was due, however to a serious misconception that I had. I was certain that she was merely asking permission for her to highlight my daughter Diane in an upcoming lecture that she was giving at one of her many professional meetings. It was not until the abstract was actually due that I realized that she had meant for me to write it, and for me to make the presentation. By that time I was hard pressed to back out. On the brighter side, the presentation was about two of my passions, computers and my daughter.

Diane using her device

I was quite surprised that Iris thought that I had something to say that was worth everyone's time. I may have been introduced as Dr. Askinazy, but this subject is not my vocation. My formal education, training and experience is as a pediatric dentist. I felt that it might be presumptive of me to lecture to speech, language, occupational and physical therapists. People in the audience might be computer engineers, technicians or programmers with far more expertise than I have, but when I sat down to think about it I realized that I had gained plenty of experience and that I was looking forward to sharing some of it.

In 1985, my oldest child was born. As a gift, my wife presented me with an IBM XT computer. She then also informed me that "she did not believe in baby sitters" and " I might as well have a new hobby because we weren't going out anymore." That was 14 years and 3 children ago.

Many of my friends did not let their children near their computers. I accepted that the keyboard was the least expensive part of the system and as long as I backed up my important data, children could do no serious harm. In 1987 I found a shareware program for my two-year-old son called Keyboard Banger. It allowed very early users, 1-2 year olds, to explore inputs and receive graphic and musical rewards.

When my third child, Diane, was born. We knew very early on that she had many difficulties. At the age my other children were readily using the computer, Diane could barely hold up her head. She could not use a mouse. She couldn't even "bang" on the keyboard. She could, however, point to things. After some research I found that I could equip my computer with an alternative input device, a touchscreen. Instantly the power of assistive technology was apparent to me! The exploding market of pre-school software was now available to my daughter. The computer held her attention longer than any other toy because she was able to learn to manipulate it herself. My wife and I clearly recognized that there was a lot inside of her that we were not yet seeing. She understood, but could not interact with her environment.

At 2 1/2 years old Diane was fortunate to attend special needs school that included at least some computer access. She did well in computer class, but showed limited communication skills. During one weekend my wife and I became quite concerned. Diane seemed to have developed a spasm or twitch in her hand. She was making constant movements with her fingers and pushing it in our faces for us to see. On Monday, before calling the neurologist, my wife called the teacher who recognized this gesture as the sign for bubbles. Apparently, she was being taught signs without our knowledge! Diane did not seem to be learning them in school. The staff did not think it was important to inform us about it. I was furious! First, I felt that Diane had enough frustrations in her life. If she was using signs, shouldn't my wife and I at least learn them first? Second, when did the teachers make the decision that Diane would never talk, and must use sign language? That's how little I understood back then about learning communication. With a little research I was soon to learn what you all already know, that the more ways the child communicates the faster they learn communication and language. I read about icons, storyboards, and augmentative alternative communication devices.

I also learned about school bureaucracy. Months went by and no one was suggesting a device. My wife and I attended an assistive technology fair to look for a new stroller or wheel chair to replace the lightweight umbrella stroller that we had been using. At a booth at that fair we were introduced to augmentative alternative communication. We saw devices that we knew could help Diane communicate. She could point to pictures, just like on my computer. We decided not to wait for testing, evaluation and third party reimbursement. We wanted to help our daughter as soon as possible. I found an advertisement for a BlackHawk digital recorder in Exceptional Parent Magazine and ordered it. It had 16 buttons on four levels with a total memory of 4 minutes. I still knew nothing of Boardmaker or Mayer-Johnson or other symbols. I made all of my own somewhat intuitive symbols with various computer-drawing programs. Our older daughter loved becoming the recorded voice for Diane. Diane began to realize that she could speak, too!

BlackHawk digitized speech

Although making little progress in more than two years of speech therapy while attending school. Diane's increase in communications skills now seemed rapid and dramatic. One example was an icon that I made for the phrase "bring me." The icon showed a mother leading a child by the hand. To our surprise Diane spontaneously used the icon both to suggest bringing her with us and to ask for something, as in "bring me" a drink. This small investment showed me that a device could help Diane greatly. My wife and I worked with Diane. Her Speech therapist worked with her, but she had never used a device with any student before. Diane was making finally making some progress. Unfortunately, the BlackHawk was not being used in her classroom because the school had not recommended it in her IEP. We finally stopped sending it to school.

"bring me" icon

With the progress Diane was making at home and in speech therapy with her device for two years, we knew that it was time for her to progress to a more capable augmentative speech device. At an ASHA meeting in April 1997 I saw exactly what I was looking for, a computer program called Logical Language for Windows by The Innocomp Corporation. It converted any Windows based computer into a dynamic display augmentative alternative communication device. An introductory module was priced at only $89.00. This included 71 vocabulary boards and even included a text to speech synthesizer that did not require any add on cards or other hardware. Again it was inexpensive enough to allow me to just go out and try it, without waiting for testing, evaluation and third party reimbursement.

Unfortunately, as with many software companies, announcement and release date of the product were many months apart. After months of my calls, Jeri Hoffman, the Director of Marketing and Sales at Innocomp finally let me have a beta-testing version of their program. Although Sentient Systems were reluctant to admit it at the time, I also knew that they were feverishly working on a Windows version of their Dynavox software and I also learned that DECtalk had just come out with a software version of their industry standard speech synthesizer. Now I had only to find a suitable Windows capable computer for Diane. Fujitsu made a computer the Point 510 that seemed closest to fitting her needs. This computer, and the way that Diane uses it is what I really came to talk about today.

Fujitsu Point 510

The Fujitsu Point 510 and the newest upgrade, the Point 1600 are touch screen computers. They can do nearly everything that a dedicated communication device can do plus, and it is a very big plus, it gives the user complete access to all the advantages of a Windows based computer system.

After using this computer at home for several months, Diane's school district finally came around to deciding that it might be time to evaluate Diane for AAC use. This is how I came to meet Iris Fishman. Iris was doing these evaluations at the Kornreich Technology Center. I guess she was quite taken aback to be doing an evaluation for a child who was already using her second device. I am certain she was intimidated and annoyed by my persistent butting in, and pushing her toward recommending the device and software that Diane was already using. Therapists did not yet recognize the computer and software as a choice for AAC users. The package that I had put together for Diane was not commercially available yet. I knew that Iris's recommendation would make school use and financial reimbursement more likely. She also added that Diane truly needed formal training with it. She petitioned my school district for 25 hours of device training. As a pediatric dentist, I relish opportunities to observe people who are so good at managing children. I try to learn from them and to bring back some new techniques and approaches to my office. It was eye opening for me to watch Iris wearing an vest with Mayer-Johnson symbols velcroed all over it engaging Diane at her level on the floor. Diane's response was wonderful. While we often had to drag Diane to school in the morning, Diane would literally run with her walker through the maze of hallways that led to the Kornreich Center and Iris Fishman.

By now Diane was aging out of her school. It was necessary to select another. Following the suggestions from our school district we visited several local and not so local schools. My wife and I were in tears. As much as we felt that her old school could have done more with technology, these other schools lagged even further behind. Diane's first school had had two computers in each classroom and had a separate computer teacher and classroom that Diane attended three times per week. Schools that were seemingly known for there "up to date" equipment had no equipment in the classroom and only selected children went to the computer room once each week. And, the schools were still mostly using Apple IIC computers. My other children had up to date Pentium computer in their school's computer class and in their classrooms.

Technology had clearly been Diane's "magic bullet" for getting her out of her shell and on the road to communication and learning. My wife and I were not going to let her take such a step backward. After some debate with our school district they finally agreed to a home schooling approach. My wife and I tried to fill Diane's social needs with other activities such as a special needs "dance" class, Girl Scouting and Junior Congregation services at our temple. Maybe most importantly, the school district continued to fund AAC training. By now Iris was Director of The Kornreich Technology Center. This is when Iris referred us to Ero Mavrikos. Ero too was wonderful with Diane. She was seeing Diane two hours each week. My wife and I were delighted at the progress that Diane made. This past year seemed to be her best yet. Formal testing results indicated that she had grown a full year for the year of home schooling. Diane is now 9 years old. This past summer Diane attended The Henry Viscardi School, near our home in Searingtown, NY for their summer program. This school is physically connected to The Kornreich Technology Center. Ero was able to change Diane's two one hour device therapy sessions to four 1/2 hour sessions and do them in her classroom.

Diane also uses off the shelf children's software like "Just Grandma and Me", "Kid Pix", "Reader Rabbit" and other children's titles. This still leaves room for Boardmaker, Microsoft Word, AOL and some other assorted programs that I use for her.

I went into this endeavor with a strong bias toward computers already knowing that they were a remarkable teaching aid. This is even truer for special needs users. Most people assumed that Diane could not possibly learn or communicate. High tech intervention has proved all of those people wrong.

The computer is also a most patient teacher. Anyone with several children knows that you can only read a particular favorite book just so many times. Not so the computer. It will repeat the same task over and over and over again. It will work at the child's exact level. It does not tease nor ridicule an error (no more than an occasional beep). For Diane, it is always available. She chooses when to turn it on or off. And she chooses it on often. A parent, a teacher or a therapist may be available for some limited amount of time. Diane often chooses to use her computer for many hours each day.

This leads me to one of the most important facts that I have learned from watching Diane's progress. I had been concerned about presenting Diane to all of you. I expressed this to Iris. While it was true that Diane has benefited greatly from AAC, it seemed to me that she did not quite use the software as it originally intended and designed. She only occasionally uses it at home to actually communicate. She will probably never bring it to McDonalds to facilitate ordering a cheeseburger and fries. Perhaps much more importantly, however, she is learning to speak verbally from using the device. Diane spends four hours in speech therapy each week, but she literally spends several hours each day talking to and being talked to by her computer.

At least three companies Prenke-Romich, Innocomp and Zygo, have now also come to see how ideal this Fujitsu tablet computer is for AAC applications. They each offer complete packages of hardware, software and support in the $5000 to $6000 range. Putting the system together myself, I was able to spend about half of that amount. This was inexpensive enough for me to lay out the money and try for reimbursement later. I went the route of private insurance. I wanted to own the computer myself. I did not want the device to be owned by the school district. Insurance reimbursement was certainly a difficult challenge. It may have taken seven months of appeals, letters, prescriptions, documentation and at least weekly phone calls, but Empire Blue Cross and Blue Shield of New York finally reimbursed me for the computer and most of the software. The key to getting a school district to pay for it seems to be to stress the educational importance of the device. Clearly the key to medical insurance reimbursement is to never mention education. The computer is used as speech prostheses, replacing the vocal chords and oral musculature for sound and speech production. Most prosthesis are covered by insurance unless specifically disallowed by the policy (i.e. many policies specifically disallow hearing aids and glasses).

Diane on cover of 1999 catalogue

The Fujitsu's internal speaker is a little to quite for noisy classrooms. The three companies offering the computer packages chose to solve the speaker volume problem by offering their own amplifier back, installed on the device. This adds inches and pounds to the computer. It also may add to a thousand dollars to the price. I solved the problem with a simple mini-amplifier from Radio Shack (part #277-108C) for $11.98. One company offers a finger stylus pointer for $30.00. Diane uses a plastic guitar finger pick from Sam Ash available for 30 cents. As she often loses them, I can buy them by the dozen. If you are computer literate and have the time, you can save some money. If you need a company that can help you with third party reimbursements and/or you need the hand holding of good technical support, the packages may be the way to go.

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There are still many things that Diane cannot do. The computer has become something that Diane can do independently. Diane knows this better than anyone. The self-esteem this has given her is quite apparent. She is most proud of these skills and extremely protective of her device.

Where is Diane going from here? Who can say? I do know that with the flexibility of computers and with the technology continuing to evolve, computers will always play a major role in her development and her success.