Last Christmas, 13-year-old Kayle Coutie grabbed his palmtop, typed in a sentence and hit the voice button to share it with his grandparents: “Santa brings presents, Christmas tree, snow, two mittens,” declared the handheld device.Kayle, who has autism, had never acknowledged Christmas before and his grandparents had struggled to convey the spirit of the holiday to him. “Kayle’s message was the best Christmas gift ever,” recalls his grandmother Lynne Coutie, noting that the mittens were a reference to a story they had read Kayle about a child receiving mittens for Christmas.
Kayle is one of a growing number of non-speaking children with autism who are finding their voice through technology. “In the last 10 years we’ve discovered that kids with autism have a lot to say and can express wishes and thoughts we never knew they had,” says Margaret Ettorre, the speech-language therapist at Bloorview MacMillan Children’s Centre who prescribed Kayle’s palmtop voice output device.
Margaret has worked with Kayle since he started school as a frustrated little boy with huge behaviour problems, Lynne says. “He talked until he was two-and-a-half and then he lost all speech and became extremely aggressive because he couldn’t communicate.”Over the years, Kayle communicated by gesturing and pointing, using picture symbols or writing down what he wanted. But his writing was hard to read, he never went beyond the use of nouns and he tended to perseverate – getting stuck on one topic, such as his love of Disney movies. Over the past three years, his communication and writing aids team has been searching for a voice output device that would give him the structure and tools for richer communication.
The palmtop – a device that looks like a personal digital assistant and weighs just over a pound – “gives him access to a keyboard as well as picture symbols representing whole phrases,” Margaret says.
It’s this combination that has allowed Kayle’s communication to soar. “The keyboard makes a huge difference because he always liked writing things down but we often couldn’t read them,” Lynne says. “The keyboard gives him access to any word he can type in, not just those that are programmed into the device.”
A word-prediction function means that after typing in the first three letters of a word Kayle is presented with the most likely words and clicks on one – reducing the number of key strokes he has to make and speeding his verbal output.
But whole phrases that are programmed into the device – such as “What are we doing tomorrow?” “I want a hamburger” and “How much does it cost?” – give him the structure and speed to be able to communicate more complex messages, Margaret says. “It encourages him to tell us more than just the noun. The thought is there and by having it visually available, he has a means of expressing it.”
Kayle’s palmtop includes pages for words and phrases related to places, people, school, his favourite restaurants and common social expressions.
Lynne says he’s begun initiating conversations in ways he never had before. For example, he asks for specific CDs he wants in a music store, orders his favourite meals at Harvey’s and McDonalds, tells his teacher what he’s looking for in a cupboard and requests a Pepsi from the lunchroom supervisor.
“Normally he would go to school and not drink or eat at all,” Lynne says. “He wouldn’t even think to ask for a drink in that setting. These are things we never would have known. The other night I was making supper and got out green beans and Kayle went to his supper page and told me he wanted corn instead.”
Lynne says her grandson’s palmtop has made a huge difference in how other people respond to him. “In our civilization, the spoken word is the be-all and end-all. When he used to pull out a piece of paper and pen, people would ignore him and look to us for the answer. The palmtop has given him a voice and people who wouldn’t have given him two minutes before pay attention to him now. They’re fascinated to watch him use it.”
Other benefits of the device are that it’s light, easy to carry and has increased Kayle’s independence with reading and spelling, Lynne says. “If he’s typing something phonetically he can hit the voice and tell right away whether he spelled it correctly or not. If he didn’t, he’ll go back and try again. He loves to read books and he’s started to type in words that he doesn’t know instead of calling us to come and tell him what they say.”
Kayle’s grandparents – who are raising him – have been key players in Kayle’s blossoming communication.They set up situations where he has to use the palmtop, wait and prompt him and regularly program new vocabulary to keep up with his life. “It’s important for families to hear that they’re a big part of these success stories,” says Gail Teachman, the occupational therapist on his Bloorview MacMillan team.